Health treatments, testing and research: time to rethink?
Headline: An aspirin a day may not keep the doctor away. Headline: Cholesterol meds raise diabetes risk in women: study. These and other health-related updates have worked their way through the media just this month. The news isn’t very reassuring to consumers.
It’s possible that almost 50% of established medical care standards are wrong. That disquieting stat is included in a commentary published in JAMA, Journal of the American Medical Association (Jan. 4), “Reversals of established medical practices: Evidence to abandon ship”.
John Ioannidis, MD, director of the Stanford Prevention Research Center and senior author of the commentary believes that many current practices are entrenched in the system even though current evidence does not necessarily support their continued use. The benefits just aren’t there. He thinks it’s time for a reality check.
And it is not just treatment he’s questioning. Certain testing procedures appear to be counterproductive as well. His work with biomarkers (something indicating a particular disease) is mentioned in the January edition of Wired Magazine. His conclusion is that these indicators can be misleading. Writer, Jonah Lehrer, offers some interesting statistics of his own in “Trials and Errors: Dead-end experiments, useless drugs, unnecessary surgery”.
The concern centers on causation, correlation and fact. They are not the same. All of the data collected during an examination can be confusing.
Whether it’s a biomarker, MRI, or other popular diagnostic tool, heavy reliance is placed on what these procedures reveal. An association can be forced between what is seen in test results and the illness to be treated. Lehrer points out, “Our habits of visual conclusion-jumping take over.” He cites some intriguing examples where conventional thinking has led to an inaccurate assessment of the problem.
Research is another area where some rethinking has to take place according to Lehrer. “One study” he writes, “analyzed 432 different claims of genetic links for various health risks that vary between men and women. Only one of these claims proved to be consistently replicable. Another meta review, meanwhile, looked at the 49 most-cited clinical research studies published between 1990 and 2003. Most of these were the culmination of years of careful work. Nevertheless, more than 40 percent of them were later shown to be either totally wrong or significantly incorrect. The details always change, but the story remains the same: We think we understand how something works, how all those shards of fact fit together. But we don’t.”
Dr. Ioannidis thinks the current advertising and messaging that would “try to maintain the status quo” can be countered through education. “Trust is likely to be strengthened when patients are more knowledgeable, when they question their physicians about the evidence pertaining to their condition and when physicians give them the full, unbiased picture about this evidence.”
When it comes to health, a wise and thoughtful approach seems the way to go. We are our own best advocates. As Oscar Wilde once wrote, “A man who does not think for himself does not think at all.”