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medpundit |
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Sunday, June 22, 2003Yet, despite all the distractions on my return, I can't put aside a nagging disquiet about some of the lectures I heard at the conference. It was a family practice review course, designed to give an overview of the latest developments in medicine and clinical treatment, yet some of the speakers went overboard in their enthusiasm for the latest treatment trends. The cardiologists and endocrinologists were the guiltiest. Time and time again they resorted to truncated graphs to exaggerate the therapeutic benefit of a drug. Their ultimate messages? Statins for everyone! ACE inhibitors for everyone! Metformin for everyone! Not surprisingly, these were the speakers that listed drug company sponsorship under their full disclosure agreements. No doubt, they’re sincere in their belief that drugs are the answer to everything, but I had to wonder to what degree they had been blinded by their enthusiasm for a particular theory of a disease and its subsequent treatment. Blinded to the point of believing that a difference in outcome of 1 to 2 percent is actually significant. Which made me think about times past when other enthusiasms ruled the day. Take, for example, the treatment of tuberculosis. In 1934, tuberculosis was a common disease about which much was know. It had been around for centuries, so its natural history was familiar to doctors. It was also known to be caused by a bacteria. Nonetheless, treatment was rooted in ideas that fit the theory more than the science. Here’s what the 1934 edition of Cecil’s Textbook of Medicine (a highly respected textbook, by the way) says on the subject: Of the countless remedies for tuberculosis, complete rest for body and mind is the only one which has proved eminently successful....Even sitting up in a chair or reclining in a chaise-lounge must be regarded as exercise. Since it is undesirable for the patient with fever to walk even as far as the toilet, a bed-pan or commode should be used. The number visitors must be strictly limited, for conversation is tiring. No invalid should be submitted to the strain of talking with a deaf person. Sounds crazy, but until the discovery of antibiotics, this was the standard of care for tuberculosis patients around the world. And the doctors who practiced it would have said it was based on the best available evidence. The treatment neatly fit their theories of the disease process. Exercise increased the flow of blood and oxygen to the lungs, which in turn fed the tuberculosis germs. Complete bedrest deprived the bacteria of their source of nutrition, and thus provided the cure. So, they gave the credit of the natural regression of the disease to the bedrest on which everyone was placed. Not too much different than the doctors today who believe everyone over a certain age should be on statins regardless of their cholesterol levels. They see in the evidence that which they want to see. posted by Sydney on 6/22/2003 08:58:00 PM 0 comments 0 Comments: |
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