Tuesday, February 08, 2011

The importance of evidence based medicine

From my inexperienced vantage point, the greatest internal battle going on in the medical profession is the contest between medical dogma and evidence based medicine. Believe it or not, there are quite a few interventions that physicians utilize on a regular basis that have never been proven to actually benefit patients.

If some treatments aren't proven, why are physicians still doing them? Well, lets hypothetically say that obstetricians have been doing "x, y, and z" for premature babies for the last two decades, but there is actually no evidence to support z. Are you going to let your premature child be the first in an experimental group that forgoes treatment z? And what kind of malpractice insurance would a physician have to have in order to conduct that sort of experiment?

A New York Times article about a new breast cancer study touches on this challenge. Its pretty easy to convince someone to try something new that is not proven, but getting them to pass on established treatment options in the name of science is another matter. And yet, the physicians who carried out this study on breast cancer did just that. A quote from the article:

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

As it turns out, the study proved that axillary dissection in some women provide no benefit. This is a win-win-win. The surgeons can be confident they are providing the best care, the patients are not getting unnecessary treatment with lots of complications, and the health care system is not losing thousands of dollars on a procedure that isn't helpful. A very courageous study, and we need more like it. I don't presume to know all of the barriers that prevent more research studies like this from being executed, but we should all be working to break them down.

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