Thursday, November 12, 2015

Medical reversals

We all hate them. These are when you received a medical treatment and find out months, years, or even decades later we find out from new research it wasn't helpful or could have even been harmful. We justify it to ourselves that it is because the medical world was using the best information available to them at the time and they had no way of knowing.

I have found this out for myself numerous times with my medical history. Treatments that I received are no longer accepted practice.

Now there are a couple of doctors out there who wrote a book on how we need to change these 'flip-flops' in clinical practice. They are actually called 'medical reversals' (not the most aggravating thing you can find out about your medical treatments). Here is a quote from the article:

"...hormone replacement therapy as being sort of the seminal reversal for doctors of his generation.

The thing that really was seminal for me was the routine use of stenting for stable coronary angina. It's a very costly and invasive procedure, and it continued to be done in a very widespread fashion. The evidence for it was always unclear and then in 2007 with the publication of the COURAGE trial, a lot of the evidence was contradicted."

We all remember HRT was found that it was later shown to actually increase the patient's risk for breast cancer.

"In every case of our book, we found an example of something that was perfectly logical, it was incredibly plausible, it made perfect biological sense, but it was broadly accepted without those definitive confirmatory studies to really prove it actually does what you think it does. And in the years that followed, people over time became a little bit more skeptical of it and eventually some brave investigators said hey, you know what? Let's sort this out once and for all. Let's put this to the test.

Their point is that we need a huge overhaul of our medical system to prevent these 'reversals'.  I couldn't agree more. The old way of doing things, based on traditional ideas and ways of doing things, needs some change.

"...we do advocate for a complete overhaul. A couple of chapters talk about how doctors are trained and how academics should work. A couple of chapters talk about how drug and device regulation should work. A couple of chapters talk about what our professional responsibilities are."

They advocate for a lot of change which will take a good deal of time. I think this sounds like a great first step in identifying how we are now able to say, and should say more often 'more research is needed' and 'are we really doing this the right way?' I know I get frustrated when I hear about a medical breakthrough that might help me and then hear that more research is needed. But now I understand better why this is said.

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