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Monday, March 2, 2009

We're probably a lot further from personalized medicine than we think...

I keep writing posts about how I think we're closer to personalized medicine than we realize, but I think I might have to change my tune... just by a little bit. This article (Why Doctors Hate Science - Sharon Begley/Newsweek) was linked to from Slashdot today, and caught my eye.

I highly suggest giving the article a quick read, but if you don't, the general summary is that many doctors aren't able to embrace science to find the correct/best diagnosis and treatment option, let alone necessarily provide appropriate care at some level. On the surface, it's a scathing taunt at doctors, although really, I think there are "professionals" in all fields that just don't apply logic. To quote my girlfriend "I hate stupid people." Well, apparently they exist everywhere, even in the medical profession.

Still after reading the article, I have to say that change is coming, and it's going to come quickly. Those doctors who can't cope with it are going to be blown away by the younger ones who are able to deal with it - and who will be able to get the diagnosis right the first time, as well as the treatment. (As personal medicine begins to LOWER the number of errors doctors make in treatment, insurance companies will have to start lowering their premiums compared to the "old school" doctors - or raise the premiums on the ones not using genetic information - and we can all see where that will take the medical profession in the U.S.) In Canada, I guess the federal government will just mandate that the correct tests must be done before doctors are paid for a treatment. Voila.

Anyhow, with doctors actively resisting the application of logic and science to their treatment regiments, I have to wonder how long they'll effectively be able to keep personalized medicine at bay.



Blogger Will said...

As an MD/PhD student I think I can speak a little bit to both sides of this issue. Doctors aren't idiots, but almost anyone is capable of falling asleep at the wheel. People lapse into routine and don't very easily get pushed outside of that routine, just as in any other profession or discipline. It's just human. Furthermore there is just too much data out there for doctors to constantly invest in revising their treatment algorithms. They lapse into the conference on the links kind of approach Begley mentions in her article.

And to be fair patients actually like that sort of treatment. Just look at the number who turn to homeopathic and other aggrandized placebo therapies. People really do want to be treated by a person, not by a vast data mining industry. That's why French majors make good, successful doctors, despite the fact that they can barely stomach a clinical epidemiology course. Making a patient feel cared for, and taken care of, takes a lot more than a double blind trial.

That said: as long as the US twiddles its thumbs the Canadian and UK systems will have time to vastly surpass us. You will have access to vast databases of clinical data as electronic medical records become more advanced and start to be linked to genomic information. Our failure to put together a national system to analyze different care algorithms and trim costs will hold us down, but it doesn't have to stop Canada. Perhaps we will see the New England elite flying to Toronto for basic care. Maybe then you can drag us, kicking and screaming, into the next era of medical technology. I would appreciate it if you would.

March 2, 2009 5:20:00 PM PST  
OpenID Mr. Gunn said...

Will, if the treatment success rate was far higher, I think some people would forgive a little impersonalness. It's only the failed attempts that give the alt-med shysters ammunition.

March 2, 2009 5:45:00 PM PST  
Blogger Stephen Henderson said...

There is a problem with doctors attitude sometimes-- but the major probelsm are actually a) patient demand: everyone wants the pill even if it is not indicated), b) legal defensiveness: nobody wants to be sued for not doing a test or giving a drug.

Together these lead to inappropriate and expensive interventions for all.

March 3, 2009 1:56:00 AM PST  
Blogger Steve Murphy MD said...

A doctor you are not. Nor is Begley. Imagine, she gets to bash how doctors hate science, yet not a single mention of the Flexner report or Evidence based medicine, Cochrane reviews, etc....

All you of people want to gang up on doctors, but there is a simple fact that remains algorithmic care gives you average outcomes......

That's all it can do....because our algorithms are built with the precision of a caveman....We don't apply genomics very well to the care we give....

It's not a young or old is a science based care thing.

I rightfully agree that doctors are slow on the uptake......but aren't those patients who didn't get Vioxx better off for it?

Her article is a diatribe and full of hate. To promote it is silly and does nothing to further the discussion.

That being said, she is right. Doctors don't get science.....And Science doesn't get doctors.....

Until we have doctors criticizing doctors, we will have doctors ignoring scientists and politicians.....

Glad you are posting, but not glad Begley uses effectiveness research as a cure all for the mess we have in healthcare......

How many of those Paps were given by NPs????


March 9, 2009 6:53:00 AM PDT  
Blogger Anthony Fejes said...

Hi Steve,

I've never claimed to be a doctor - just another blogger with some unique insight into what's coming down the pipeline at people who've got their heads buried in the sand.

Nor, for that matter, am I bashing doctors. I think there's room for more efficiency, and that personalized medicine will force change onto those who will resist it the most: the MDs who's independence and habits are threatened by the rapid changes it will bring.

The argument that patients who didn't get Vioxx are better off is really a poor one, and is a typical of the bad statistics that I've seen MDs use. Should we hold off on insulin for treatment of diabetics because we don't know the long term effects yet? Should we not cast bones that are broken because there might one day be a better way of splinting them?

No, we have to use the tools that are available to use at any given point in time. We should also demand better FDA trials and high quality research to prevent Vioxx-like fiascoes in the first place. (When pharmaceutical companies pay for the research and have their own financial future ride on the outcome, it's hard to guarantee complete and unbiased results - yet we do.) There is a place for caution, but lets not confuse that with outright resistance to change.

I'll try to write more about this in my next post.

March 9, 2009 1:44:00 PM PDT  

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