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September
2004
What We Know
and When We Know It
You are in the delivery
room and the nurse hooks you up to an electronic fetal monitor
to check the baby’s heart rate as
a means of detecting abnormalities that could lead to cerebral
palsy. This is something that has been done routinely for the past
30 years. What mother would risk saying no to such a critically
important test for her child’s lifelong health?
Probably none. But what
if the mother knew there is no evidence that the test has ever
prevented a case of cerebral palsy but that
it could lead to unnecessary surgery — a C-section — that
can cause harm to her either now or in future pregnancies?
This example from a
recent column in the Boston Globe — part
of the election-season assault against trial lawyers — exemplifies
the difficulty that doctors and, most especially, patients have
in deciding the best medical course of action.
Some people learn about the potential harm of electronic fetal
monitoring from obscure medical journals or newspaper columnists,
but few learn about it on the front pages because daily journalism
rarely delves into the muck of long-term lengthy statistical reviews
of evidence. Only a select few reporters can keep up with the latest
research, either because it is hard to find or requires a paid
subscription.
For the most part, “news” about
scientific findings means only that it is new and previously
unreported. It does not
mean that all research conducted to this point is rendered meaningless.
Rarely does a single
study revolutionize the understanding or treatment of a disease.
Rather, additional studies add nuance to
a larger body of knowledge on any given topic. Capturing that larger
body of knowledge in a meaningful, useful form presents a challenge
to those who must act on it — doctors, nurses, insurers,
hospitals and patients. Systematic reviews of the published and
unpublished literature and clinical practice guidelines are the
tools that summarize the current state of the science and provide
direction.
But “incremental” and “provisional” are
not the stuff of news. Findings that add marginal insights to existing
knowledge can’t compete with the war in Iraq and the latest “American
Idol” for the lead story of the day. So editors have few
incentives to demand the objective description of current knowledge
offered by a systematic review or clinical guidelines, even if
such information is easy to find and relatively simple to understand.
Which it is not.
As long as people are getting their health information from the
media, and systematic reviews are not the key reference when reporting
on new findings, individuals do not yet have access to the best
and most accurate information for the health decisions they are
increasingly required to make on their own.
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