Apr 3, 2016
Two major problems exist which compromise the care we receive. The majority of medicine currently practiced has not been scientifically validated and further physicians practice medicine without understanding the biology of the diseases which we are treating. According to Dartmouth Atlas of healthcare and other sources 50 to 85% of medical practice is not supported by solid scientific evidence Physicians are trained to practice medicine based on prior experience, blind to the fact there may be no hard science to support their recommendations. Well meaning caregivers perpetuate the practice of medicine which they were taught. Instead of following established protocols and best practices, physicians practice on an ad hoc basis.
Physicians were trained to practice non evidence based medicine based on anecdotes and conventional wisdom. Even when practicing based on some published research, the validity of the studies often has not been established. John Ioannides, a highly respected statistician and Professor at Stanford, has reported a decade ago that most peer reviewed published scientific studies cannot be validated or reproduced due to poor statistical analysis or scientific bias. Harm is inherent in a system where care is not based on science.
Due to no fault of the clinicians, they continue to practice medicine without realizing we do not understand the fundamental biology of disease. 20 to 30 percent of cancers diagnosed by looking at the tumor under the microscope by pathologists, our current gold standard, are not biologically significant ( they will not cause harm to the patient). Women treated for breast cancer and also patients with lung cancers identified by screening are subjected to deforming surgery and toxic chemotherapy/ radiation therapy without any ability to determine if the tumor represents a risk to their health. Many times patients needlessly suffer terrible complications and even death. Without transparency to patients explaining the lack of fundamental knowledge, harm continues to occur.
The time has come address these issues to improve our health care delivery system:
- Patients should enhance their health literacy then query and research the recommendations they receive .
- Patients and caregivers should solicit second opinions which can be very useful.
- Payers need to stop reimbursing for care that is not shown to be beneficial through reliable and reproducible studies.
- Caregivers need to critically evaluate the scientific foundation on which current practice rests.
Education, research and funding of current practices and diseases is crucial. Identifying and adopting best practices should occur as soon as possible. We need to redouble our efforts to understand the illnesses we are treating and we need a call to action.
Copyright Nicolas Argy 2016
Nicolas Argy, M.D., J.D. Health/Business Consultant/Educator, Patient Safety, Quality, Risk Management, Public Health