Map of life expectancy at birth from Global Education Project.

Tuesday, May 11, 2010

Science and medicine

Harriet Hall, at Science Based Medicine, discusses Druin Burch's Taking the Medicine: A Short History of Medicine’s Beautiful Idea, and Our Difficulty Swallowing It. Discussion and debate ensues about what percentage of accepted medical interventions today have an adequate base in scientific evidence. Here's my take:

I would say that the greater challenge right now is not so much to increase the evidence base for medicine and find new and better treatments, although that should certainly continue; but rather to implement what is already known. This is particularly a problem in the United States where we have no equivalent of the UK’s NICE and it is, in fact, politically toxic even to suggest such a thing.

I’m looking right now at Bridget Kuhn’s article from the April 28 JAMA about inappropriate prescribing of antipsychotic drugs. In spite of a black box warning, doctors keep giving these to elderly people with dementia. She notes that in an analysis of VA data, 60% of people who got a scrip for an AP in 2007 had no record of a diagnostic indication. These drugs have potentially terrible side effects and shorten people’s lives. She quotes Douglas Leslie of Penn State College of Medicine as saying that docs are prescribing these drugs off label because they have heard “anecdotal stories of benefit.” They are also widely prescribed to children, by the way, who ostensibly have "bipolar disorder," although there is no evidence whatsoever to support that and they cause diabetes and dyslipidemia and all sorts of horrible stuff that you do not want to happen to children.

Of course it’s because of illegal marketing by the drug companies, and they’re getting away with it.

More science is great, but let's use the science we already have.


roger said...

when an alarming number of our citizens believe that the earth is 4000 years old and that the president was born in kenya we shouldn't be surprised that some doctors are only loosely tethered to reality. i wonder how many accept anecdotal evidence of immunization causing autism.

Cervantes said...

I believe it is only a very small minority of physicians who go for crank stuff like that. I think the problem with docs is not so much that they get seduced by unscientific ideas, as they just don't have the time to keep up with all the science -- which pours out every week through a firehose. So they fall back on habit and intuition, and what those attractive young people the drug company sent around tell them.