When Evidence Says No, but Doctors Say Yes

A fascinating case study and exploration of the WHY behind the delay in evidence to implementation in health care.  Although the article does not address maternal health care, the philosophy is clear – does this sound familiar?

David Epstein/ProPublica writes:

“Most of my colleagues,” Christoforetti says, “will say: ‘Look, save yourself the headache, just do the surgery. None of us are going to be upset with you for doing the surgery. Your bank account’s not going to be upset with you for doing the surgery. Just do the surgery.’”

The first case study in the article looked at two patients with very different outcomes. Neither one needed a stent.  The patient who got one did not survive.  The article explains:

Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?

When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?

For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.

The entire article contains several case studies and a thorough look at the research.  It is a great read!  What are your thoughts relating to maternal health care?

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