Truth in healthcare: A moving target

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[Originally published by Hospital Impact – 2011]

I recently wrote about the importance of finding truth in our efforts to create real, ongoing systemic healthcare change. Since writing that blog post, I continue to process truth and found that truth can change over time.

In December 2010, Jonah Lehrer wrote the article “The Truth Wears Off: Is there something wrong with the scientific method?”

Mr. Lerher wrote, “The test of replicability is the foundation of modern research.” Yet, consistently, well-established clinical research findings are looking more and more uncertain when tested for replicability. For example, “efficacy of antidepressants has gone down as much as threefold in recent decades,” he noted. But healthcare truths have not always correlated with replicability outcomes; changing times call for changing attitudes.

And when an established truth does change, the new truth is not disseminated efficiently. The new truth is not easily accessed by caregivers and patients and, thus, is not used within the healthcare system to improve patient safety, optimize healing opportunities, or leverage limited resources.

This must change.

In addition, current literature can be misleading. According to biologists Michael Jennions at the Australian National University and Richard Palmer at the University of Alberta, publication bias (or the tendency of scientists and scientific journals to “prefer positive data over null results”) continues to skew data and inhibit optimal truth sharing. Publication bias can exaggerate generalities and a collective illusion nurtured by strong a-priori beliefs.

So how does this manifest in the current healthcare system?

Dr. John Ioannidis, epidemiologist at Stanford University stated, “What happens is we waste a lot of money treating millions of patients and doing lots of follow-up studies on other themes based on results that are misleading.” Taking this a step further, patients are in harm’s way, and we continue to lose opportunities to effectively use already limited resources to improve the healthcare system–all because we are not optimally finding truth in healing, nor sharing updated truths effectively.

David Eddy in his article “Evidence-Based Medicine: A Unified Approach,” published in Health Affairs in 2005, further highlighted the problem of sharing updated truths. He stated that even when randomized-controlled trials (RCTs) are conducted, it can take years for the healthcare system to incorporate the new truths into everyday medical practice–again, all the while wasting resources and potentially harming patients (those we are entrusted to care for).

So what can be done? For starters:

  • First, we all must be open to new truths. We must replace ego and closed-minded thinking with open hearts and minds, while still maintaining scrupulous scientific rigor as we seek out new truths.
  • Second, we must acknowledge our biases. Bias does not go away. Be mindful of bias, acknowledge bias, and correct for bias. Put a light on the bias; don’t succumb to it.
  • Third, we must set an expectation that null data is as important as positive results and that a more complete picture of the truth is required. As Thomas Edison reportedly said, “I am not discouraged because every wrong attempt discarded is another step forward.” And in healthcare, every reported wrong research attempt may save lives and, most certainly, will save resources.
  • Fourth, we need more investment and focus in the T4 phase of translational research. T4 essentially bases research on the idea, “What is the best method to reach clinicians and patients alike with a nationwide policy concerning treatment X so that they, first, will understand the new treatment and second, start to use it?”
  • Fifth, we must better position clinicians to leverage this new wisdom with their individual patients. We must create a healing environment where the clinician is compensated appropriately for the time shared with each individual patient. We must create a healing environment where the patient is no longer simply a “fever chart, a cancerous growth, but a sick human being,” as per the Hippocratic Oath, where authentic connection, relationship, and trust lead to the patient telling the whole story, a better understanding of the patient’s truth, and clarity as to the appropriateness of a specific healing intervention for a specific patient.

The Institute of Medicine has identified six aims for improvement in care: Safe, Effective, Patient Centered, Timely, Efficient, and Equitable. To achieve these aims, it is imperative that we continuously find and refine the truth and efficiently get the truth to the front lines of the healthcare system.

Anything less is not good enough.

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