Evidence-Based Medicine Versus Innovation

In this interview, a doctor who does research on biofilms named Randall Wolcott makes the same point I made about Testing Treatments — that evidence-based medicine, as now practiced, suppresses innovation:

I take it you [meaning the interviewer] are familiar with evidence-based medicine? It’s the increasingly accepted approach for making clinical decisions about how to treat a patient. Basically, doctors are trained to make a decision based on the most current evidence derived from research. But what such thinking boils down to [in practice -- theory is different] is that I am supposed to do the same thing that has always been done – to treat my patient in the conventional manner – just because it’s become the most popular approach. However, when it comes to chronic wound biofilms, we are in the midst of a crisis – what has been done and is accepted as the standard treatment doesn’t work and doesn’t meet the needs of the patient.

Thus, evidence-based medicine totally regulates against innovation. Essentially doctors suffer if they step away from mainstream thinking. Sure, there are charlatans out there who are trying to sell us treatments that don’t work, but there are many good therapies that are not used because they are unconventional. It is only by considering new treatment options that we can progress.

Right on. He goes on to say that he is unwilling to do a double-blind clinical trial in which some patients do not receive his new therapy because “we know we’ve got the methods to save most of their limbs” from amputation.

Almost all scientific and intellectual history (and much serious journalism) is about how things begin. How ideas began and spread, how inventions are invented. If you write about Steve Jobs, for example, that’s your real subject. How things fail to begin — how good ideas are killed off — is at least as important, but much harder to write about. This is why Tyler Cowen’s The Great Stagnation is such an important book. It says nothing about the killing-off processes, but at least it describes the stagnation they have caused. Stagnation should scare us. As Jane Jacobs often said, if it lasts long enough, it causes collapse.

Thanks to Heidi.

6 Responses to “Evidence-Based Medicine Versus Innovation”

  1. Jim Purdy Says:

    The Wolcott interview you cited has profound implications for diabetics. This statement was particularly meaningful to me:

    “… a small cut or sore can become infected, and flare into a limb- or life-threatening condition in as little as three days. These wounds are so difficult to heal that most of medicine considers them a lost cause and treats them with amputation.”

    In early 2010, I was hospitalized while numerous physicians and surgeons said that my right foot had a massive diabetic ulcer and that my leg needed to be amputated immediately or I would die. That didn’t sound to me like a great idea, and I left the hospital after 6 days, even though the doctors said I would be back within a few days in much worse shape, if I didn’t die first.

    It took many months, but my leg healed just fine. Over millions of years, our bodies have evolved awesome defenses against illness, but doctors give up too quickly and perform many unnecessary life-changing leg amputations.

  2. Thomas Says:

    I’m sure I’m just missing something here. Didn’t you just the other day request that doctors always provide you data with evidence that their treatment works?

  3. Seth Roberts Says:

    Didn’t you just the other day request that doctors always provide you data with evidence that their treatment works?

    Not quite. I said it was always a good idea to ask for data. If the doctor has no data, fine, now you know. If the doctor has anecdotal data, fine, now you know. The problem with evidence-based medicine is not the emphasis on evidence, it is the emphasis on being an evidence snob. Asking for evidence, to be perfectly clear, is not the same as being an evidence snob.

  4. Grundle Says:

    Risk versus reward — what doctor is going to risk a hefty malpractice suit and losing their medical license to step out of the norm?

    There ARE places where this can happen. There are research hospitals trying to pioneer new treatments every day, but because of heavy government regulation there is a lengthy process they go through before their new treatments are allowed to be used.

  5. Mark Says:

    Seth-

    Avid reader of your blog (and your book). Just saw this article about a treating physician potentially conflicted due to business relationships with pharma: http://www.minnpost.com/healthblog/2011/12/09/33717/how_u_student_with_ms_came_to_doubt_her_neurologists_motives?utm_source=MinnPost-RSS&utm_medium=feed&utm_campaign=Feed%3A+minnpost-region+%28MinnPost+-+MinnPost.com%3A+Region%29#108-33717.

  6. Elaine Says:

    Evidence-based medicine is an improvement if you compare it not to innovation, but to doing the same thing that has always been done even when that practice does not actually work that well. That is usually what evidence-based medicine is compared to, and that is where the push for evidence-based medicine is coming from. It’s not the practitioners pioneering new treatments who are viewed as a problem here, so much as the medical “wisdom” that is unstintingly followed, even when it turns out that it’s not so wise after all.