I recently read an article by Dr George Lundberg on Medscape (George D. Lundberg. Guideline vs Physician: Which Do You Trust? – Medscape – Jul 13, 2018). I found it to be a breath of fresh air and common sense commentary on the state of our healthcare system. He goes on a bit of a rant about the “evidence based healthcare” climate that we live in.
Let me first state that I am very pro-research. I need to know how something works before I embrace it as truth. While I am a fan of case studies as guides for future research, anecdotal evidence doesn’t cut it with me. I like placebo controlled, double blinded studies. I want to know the benefits and the side effects of things. I also want to know that the people doing the study are not benefitting financially to produce the desired outcomes. Figures don’t lie, but liars do figure. I want credibility and honesty in the outcomes.
Call me a skeptic, but I’ve seen too many tragedies occur in “health care” over the years,
causing me to question the ethics behind the prescribed treatment. Dr Lundberg stated it well, “While truth may be ineluctable and eternal, humankind’s search for truth is never ending. The basis for clinical practice guidelines must always be the best evidence. The individuals assembling the results of the best studies published in the best journals, and distilling those data into applicable prose, should be the best experts. The sponsoring organizations should erect firewalls around those individuals and the committees, and between those individuals and the organization itself, and between both of those entities and the monetary impact of the resulting guidelines. Disclosure of conflicts of interest may not be enough to keep the results clean. Those experts with conflicts may need to recuse themselves or be barred from influencing guidelines. Always, follow the money.”
A recent study published by the Cochrane Library (Industry sponsorship and research outcome, Lundh, et. al. 16 February 2017) confirms Dr Lundberg’s suspicions. In summary, they state, “Results from clinical studies on drugs and medical devices affect how doctors practice medicine and thereby the treatments offered to patients. However, clinical research is increasingly sponsored by companies that make these products, either because the companies directly perform the studies, or fully or partially fund them. Previous research has found that pharmaceutical industry sponsored studies tend to favour the sponsors’ drugs more than studies with any other sources of sponsorship. This suggests that industry sponsored studies are biased in favour of the sponsor’s products.”
That’s no surprise. I think we’ve all suspected as much. So, where does the doctoring come in? When we are bound and restricted from using good old fashion common sense in favour of higher authority guidelines and “evidence based healthcare” as “best practices,” can we avoid cookbook medicine? Can doctors return to doctoring?
Once again, Dr Lundberg states, “I’ll take a competent, caring, professionally ethical, and personally moral physician over 10,000 guidelines every time. We need key decisions to be shared by patients and physicians, informed by the best evidence, and taking cost (no matter who pays the bill) into consideration. The timekeeping bean-counters be damned. Poor decisions forced by a rushed process often turn out to be penny wise and pound foolish.”
We should never allow the “bean-counters” to over-rule common sense. When medical error becomes the third leading cause of death (Medical Error Is Third Leading Cause of Death in US, Marcia Frellick, Medscape, May 03, 2016), things need to change. Move over Big Pharma and let doctors be doctors.