Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises

By Richard A. Deyo; Donald L. Patrick | Go to book overview

17

For Doctors
Evidence-Based Medicine

Supposing is good, but finding out is better. —Mark Twain1

It seems unlikely that the results of the Women's Health Initiative trial of estrogen
and progestin replacement will transform the interventionist mind-set of
American medicine. "Don't just stand there, do something!" will continue to be the
battle cry of most doctors and patients. On the other hand, it's going to be a little
bit harder from now on to say of interventions aimed at improving health that
they're so obviously beneficial that only a compulsive fussbudget could demand
proof. —David Brown, Washington Post journalist2

WE'VE DISCUSSED many common medical practices that proved to have no basis: long-term hormone replacement therapy after menopause, episiotomy for childbirth, pulmonary artery catheters for high-risk surgery patients, encainide for abnormal heart rhythms after a heart attack, expensive new drugs for high blood pressure instead of old-fashioned diuretics, bone marrow transplants for late-stage breast cancer, radical mastectomies for breast cancer, and many others. If these treatments were useless or wasteful (and sometimes harmful), why did doctors use them? How did their use get started in the first place? How can we avoid similar mistakes in the future?

We'll argue in these final chapters that we can improve the process of technology adoption if all parties are willing to make some changes. There's no single solution to this problem, and there's no single stakeholder whose choices will be decisive. Instead, any improvements are likely to come through a combination of changes in doctors', patients', the media's, and manufacturers' behavior; better research; new regulatory approaches; and

-229-

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