Imagine managing a significant but not debilitating health challenge and needing professional help.
Take a moment and visualize not knowing where to turn or what to do next…
Over time you learn that you can go online to a website and see which medical school a physician has attended, whether or not the physician is licensed in your state, and their specialty.
Your friends have told you about another website where you can assess the quality of physicians and see the number of blue ribbons they have received.
You follow your friends’ recommendations. You identify a physician who is clearly an expert in her field. She is licensed and certified in your state. She has graduated from one of the best medical schools in the country. She has received a number of blue ribbons for clinical guideline adherence.
You make your selection and are comforted by these data. You are in good hands.
You visit this new physician and within 12 minutes you have your diagnosis and are off to pick up your prescription (as per the clinical guidelines).
While at the pharmacy you access your new iPad. You Google your new diagnosis and in so doing begin to follow a variety of interesting links.
You go to the NPR website and find an interview with Shannon Brownlee (author of “Overtreated”) where you read, “But an enormous amount of medicine is not based in science. In fact, the Institute of Medicine estimates that maybe half of what physicians do has valid evidence to back it up. And David Eddy, MD, an expert in medical evidence, says he thinks it’s about 15 percent”.
Intrigued you continue your search and see that according to a study published in the Archives of Internal Medicine and referenced by Douglas Perednia, MD, in a recent blog post “only 14% of the 4,218 individual recommendations (from 41 clinical guidelines) released by the Infectious Diseases Society of America between 1994 and 2010 were based upon properly randomized controlled trials.”
After becoming a little discouraged you decide to relax and read the Atlantic when you come across the article “Lies, Damned Lies, and Medical Science”. From this article you see that Dr. John Ioannidis and his team have determined that between a third and a half of the most acclaimed research in medicine were proven untrustworthy.
Lastly you turn to the New Yorker and you find “The Truth Wears Off” article and begin to read about the “decline effect” and its application to clinical research outcomes and you begin to further understand the challenges of empiricism.
Processing all of this information you refer back to the blue ribbons awarded to your new physician for clinical guideline adherence and you hope that the guidelines she (and now you) are following were derived from the research that IS considered trustworthy, from THE properly randomized controlled trials and where the decline effect has not been shown to be in play.
You begin to wonder how even the best of the best clinical guidelines which are resultant from the trustworthy research and properly randomized controlled trials can be effective for each and every patient. You ask “Are all diabetic patients the same? Are all patients with high blood pressure the same? Am I the same as every other patient with my same diagnosis?”
You think about one of your friends who has the same diagnosis as you and yet who is unfortunately quite overweight, eats a diet high in saturated fats along with lots of carbs, is going through a messy divorce, is dealing with significant financial issues, and is at least ten years older than you.
You consider your own situation. One of your grandparents and two of your cousins have received the same diagnosis as you and your friend. You have two children in college and are taking care of your elderly mother while working fulltime. Your allergies are working overtime and your gut is just not quite right.
You wonder if a 7 minute office visit with your new physician truly positioned you both to account for all of these variables. And was all of these data point’s best leveraged in planning your specific course of treatment.
You further contemplate whether the clinical guidelines recommended by your physician are really appropriate for both and your friend or even for either of you? Or worse could they be harmful?
You begin to imagine an improved model of healthcare that would better meet your needs, the needs of your family, and the needs of your community.
What does this new model it look like?