Bad Medicine … and the evolving truth

Since being interviewed by Freakonomics in early 2011 regarding Hygeia Foundation’s innovative healthcare access work, I have been a fan.

So today I was thrilled to listen to Freakonomics’ Bad Medicine, Part 1: The Story of 98.6

We tend to think of medicine as a science, but for most of human history it has been scientific-ish at best. In the first episode of a three-part series, we look at the grotesque mistakes produced by centuries of trial-and-error, and ask whether the new era of evidence-based medicine is the solution.

… and to contemplate this story’s connection to Dr. John Ioannidis work out of Stanford relative to the significant issues even to this day of clinical research …

“… when up to half of the most acclaimed clinical research can’t be trusted according to Dr. John Ioannidis, who has challenged his peers’ misleading and simply wrong clinical research. In fact, he claims that 80 percent of non-randomized studies and 25 percent of randomized studies are wrong.”

… and commentary from the Institute of Medicine …

“Add this to the Institute of Medicine’s claim that only about half of medicine is based on valid science.”

And to once again conclude we must do significantly better in protecting all those we serve as the truth in healthcare remains a moving target.  As shared previously we must for starters …

  • First, 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.

It is not too late, but long overdue.

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