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Evidence and practice at odds

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

David Epstein for ProPublica:

For all the truly wondrous developments of modern medicine … 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.

He gives a great example of a doctor who prescribes epic quantities of a completely discredited drug:

When asked why he continues to prescribe atenolol so frequently in light of the randomized, controlled trials that showed its ineffectiveness, Huynh said, ‘I read a lot of medical magazines, but I didn’t see that.’ Huynh added that his ‘patients are doing fine with it’ and asked that any relevant journal articles be faxed to him.

Best practices can elude the best of us. It’s hard to keep up. Doctors are only human, after all.

There are many quotable passages from this important article. I will share it again, highlighting more.

P.S. Fun detail: as I was reading this, I kept thinking, “This is really good writing. This author is sharp.” And then I realized it’s by the same sharp author of the fantastic book I’m in the middle of: The Sports Gene.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher