The inprecision of evidence based medicine

Another unmmissable video of Eric Topol MD discussing why, despite our fears, we should celebrate the coming healthcare revolution and how we can address the ethical challenges along the way.

The entire talk should be watched (you want to hear about the “heart attack ringtone” right?) but if there’s one take away for me it’s got to be Eric’s explanation of the false sense of confidence so many have in the solutions offered by our current population based big pharma solutions:

we have a rarified opportunity because what we’ve had in medicine is all population based everything we do in medicine is based on the population all the evidence that we have so when we do a clinical trial that shows that Lipitor, the number 1 prescription drug in history in terms of sales, has a heart attack incidence in the treatment group of only 2% whereas the placebo group was 3%. That is a 33% reduction of heart attacks and it becomes the number 1 prescription drug in the world until it became generic, that’s the best evidence there is in these tens of thousands of patients in trials we’re talking about one in one hundred patients deriving benefit, not about their LDL cholesterol/bad cholesterol going down in the laboratory but rather are they getting protected from heart attacks. Let’s say it’s 2 or 3 per hundred even 4, what about the other 96 that are taking a drug for the rest of their lives without any real evidence that is based on an individual not on a population. That same principle in medicine today which is the best we have “evidence based” often times it’s “emanence based” these guidelines that draw on no evidence but a bunch of people sit around a room and come up with the guidelines but the problem is it’s so imprecise we have mass screening all women should have a mammogram every year after age 40 when most women have zero risk of developing breast cancer for the rest of their lives and that’s the same for all these procedures we’re doing and in many ways this fosters the waste we have in healthcare and when you think about $300 billion in prescription drugs and we know that at least $100 billion are unnecessary and unmatched for the patient and not having the effect we would like now we can switch that population based medicine for personalised medicine because we have new tools that we didn’t have before

It’s only when you have Dr Topol’s 20/20 vision of the inprecision of evidence based medicine that you realise how outdated the sickcare business has become and get an appreciation of why it struggles to see beyond pills and procedures to the informational opportunities mHealth provides us with.

A few years ago a Journalist with a national newspaper asked me about the “evidence base for 3G Doctor” after a General Practitioner with an academic body had suggested to them that the service offered “convenience but nothing more” on the basis that we had decided not to prescribe medicines to patients because we wanted to provide a service that was focused on the informational needs of Patients and Carers.

If you also struggle to appreciate the irrefutable value of a documented consultation with an informed registered Doctor just because they aren’t offering you a prescription medicine start by considering how we fail to communicate and listen to patients. If you want to get an idea of what this means consider that WE KNOW 40% of all calls that patients make to the UK’s leading mental health charities 9-5/Mon-Fri advice line and the ISPCC’s Childline service go completely unanswered.

Good Doctors know how to prescribe, better ones when to prescribe, and the best know when not to prescribe and are prepared to document this for their patients…

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