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Re: [Gnumed-devel] Clinicians: indications, again

From: Jim Busser
Subject: Re: [Gnumed-devel] Clinicians: indications, again
Date: Thu, 17 Jun 2010 14:12:11 -0700

On 2010-06-17, at 12:39 PM, Karsten Hilbert wrote:

> I do appreciate your concern on precision but also maintain
> that this is "pragmatically correct" in the sense of typical
> clinical use, no ?

This argument is not an edge case... I would put it (from the North American 
perspective) as upside down from what I am accustomed to:

your indication = what you are trying to prevent
my indication = what pre-existing condition justifies to use/do this

So while the ASA clinical outcome effects (purpose, end points) include

        reduce the rate of myocardial infarction
        reduce the rate of (recurrent) transient ischemic brain attacks

we do not prescribe ASA for every individual... we may require

        history of myocardial infarction, TIA or stroke
        high cardiovascular risk score

... and it is the last-named above that I (and many colleagues) think of as the 
"indication" ... the justification or "approval factor" for why to give it. 
This is in distinction to  what is achieved as the desired outcome.

The corollary is the contra-indication. The contra-indication is the 
pre-existing condition or risk group that makes you want to avoid giving 
something. A history of egg allergy is a contra-indication. If a person already 
has natural immunity (from previous infection) to Hepatitis A, they do not have 
an indication (a justifiable reason) to give Hepatitis A vaccine. 

-- Jim

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