The practice of medicine is rooted in secure statistical support, derived from carefully constructed studies, to provide the knowledge base on which clinical decisions rest. In such a well formed culture, weak disease associations or observations in small groups of patients not reaching statistical significance, whilst discomfiting, are often sidelined pending further evidence. Worse, they may be cynically discredited as irrelevant observations of arcane groups not altogether relevant to mainstream medical practice. For many doctors, Valproate Embryopathy represents a case in point. However a recent study in the New England Journal of Medicine ushers an end to the era when the evidence for an association between Valproate exposure in pregnancy and fetal malformations might be intellectually consigned to "not proven" and politely ignored.
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