New therapies aren’t necessarily better

The Pediatric Insider

© 2013 Roy Benaroch, MD

The thing about science: it’s not a body of knowledge, or a list of facts. It’s a method. It’s looking at natural things, explaining them, and testing ideas to see if they’re right. More experiments (and better experiments) on more ideas leads to improved understanding and better ways to predict and influence what happens.

But science doesn’t go in a straight line. Not every study is valid, and not every idea is right. Sometimes it takes years (or centuries!) to figure things out. The path is winding and it is difficult to see what’s around the next corner. Still, for matters related to medicine, I think science is the best way to lead us to better health.

Case in point: good science shows us that the way we’re doing things isn’t always the best way. A recent review from the Mayo Clinic looked at ten years of scientific articles, and found that current practices were about as likely to be wrong as correct. Of 363 studies of interventions that were considered “standard of care,” about 40% affirmed that the care good, and about 40% showed that current practice should be changed (the remaining 20% didn’t reach a firm conclusion either way.)

Some examples of studies that contradicted current advice: controlling exposures to mites with impermeable bed covers was found to be of no benefit to asthma sufferers; and pre-implantation genetic studies during in-vitro fertilization actually reduced the rates of pregnancy and live births.

So how should doctors and patients look critically at medical decisions? We can’t just cower in the corner and not make up our minds, waiting for the best possible studies.

Look at the totality of the evidence. The best medical practices are backed up my multiple studies done from multiple points of view. For instance, current vaccine schedules are backed up by hundreds of studies of basic science, immunology, clinical outcomes, and studies of adverse events; these studies have been done in dozens of countries around the globe by thousands of researchers, backed by government, industry, and academic support. The evidence here is a huge mountain that is unlikely to be wrong. Does that mean there isn’t more to learn? Of course not. But vaccine schedules aren’t just a current fad or bandwagon to jump on—there is solid, ever-increasing evidence here that should make people confident.

Be wary of new things. New treatments are hip and cool and heavily marketed, and have that “new car smell” cache. But they’re also more likely to lack multiple studies and solid foundation of experience.

Be humble. Doctors and patients like to be right. Once we’ve decided on a course of action, it is difficult for us to admit we’re wrong and change course. Doing something because we’ve always done it is not good science. Keeping one’s mind open is.

But remember: too much of an open mind means that your brain may fall out. An open mind is good; but there can be too much of a good thing. Look at the world of alternative medicine—have you ever seen any alt-med proponent criticize anything, or proclaim any skepticism of any treatment? To make good decisions we have to be rational, and, yes, judgmental. Things that have no basis in any rational understanding of science, and lack any clinical evidence of any benefit whatsoever (homeopathy), need to be discarded. While other things that do have some rationale and evidence for effectiveness ought to be further investigated and brought into the realm of every-day, real medicine. Doctors and alt-med proponents need to be willing to say, yes, science shows that what we’re doing is wrong.

Do doctors and scientists have all the answers? Of course not. But it’s exhilarating to keep looking.

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