As mentioned here previously, the stimulus package passed in February includes funds to encourage evidence-based medicine. Some uninformed critics will claim that this is some big government conspiracy to exert socialized control over private medicine. But, truly, encouraging a firmer empirical basis in all aspects of medicine–through more studies, government guidelines, and just improved common practice–is a very desirable outcome.
A post by David Newman at The New York Time’s Well blog lays out a variety of examples of why this is so (with links to original studies!). Also, Hugh Pickens has a nice summary of this post at Slashdot. Newman lists a variety of clinical interventions that are commonly used, despite ample evidence indicating they’re ineffective, or even harmful: early administration of beta-blockers, general use cough remedies, various applications of antibiotics, and certain surgeries. Check out his post for more.
Beyond the fact that doctors must strive to give the best, most effective, and most efficient treatments for their patients, and even beyond the fact that some of these needless interventions have more far-reaching consequences (i.e. the spread of antibiotic resistant bacteria), this status quo is just very wasteful (to the tune of billions of dollars). Newman’s main point, though, is about ideology trumping empirical evidence:
The administration’s plan for reform includes identifying health care measures that work, and those that don’t. To place evidence above ideology, researchers and analysts must be trained in critical analysis, have no conflicts of interest and be a diverse group.
Perhaps most importantly, we as doctors and patients must be open to evidence. Pills and surgery are potent symbols of healing power, but our faith in these symbols has often blinded us to truths. Somewhere along the line, theory trumped reality. Administering a medicine or performing a surgery became more important than its effect.
Scientists–and professionals in related fields, such as medicine–are often driven by the desire to understand and explain nature. Still, a good scientist knows that evidence always trumps theory, regardless of how elegant your hypothesis is. Of course, those most guilty of letting ideology trump evidence are the pseudoscientists. The creationists who won’t accept evolution because despite all of the evidence it fundamentally disagrees with their worldview. The peddlers of new age treatments that have never been demonstrated to have any real medical value but fit with some personal idea of how the body is supposed to work. The anti-vaccinationists who latch on to one thoroughly discredited study and a variety of anecdotal evidence at the expense of all other studies on the topic–and at the expense of the health of their children and the children they come into contact with.
The list goes on, partly because such thinking is human nature. We’re drawn to patterns and to neat ideas. That’s why we must continually go out of our way to avoid unempirical thinking, particularly in such an important field as human medicine.
Hat tip to Ben Goldacre.
