Communist Medicine In A Capitalist World – The Evidence Based
Medicine Conundrum
Any
casual reader of history or anyone at all with any general knowledge know that
the discredited philosophy of communism and its paramount creation the soviet
empire were both destroyed because both economically and even with common sense
it beggars belief that decisions can be made in central committees and by fiat
be implemented in all places and in all situations without a single thought for
local conditions or differences. Crops to be sown, fertilizers to be used and
harvesting times were all imposed on farmers from afar by fat-cat bureaucrats
sitting in distant Moscow committees who thought they knew better than the
local farmers born and bred up on their lands for generations. The result was
total collapse of the agriculture sector and widespread famines everywhere in
Russia. Production quotas and processes to be implemented in factories led to
so many shoddy products that anyone who was just anyone at all in Soviet Russia
preferred to use imported products for everything from shavers to ovens. Rule by distant committee was comprehensively
proved to be the stupidest idea to have ever been invented by the human race
and believe me we as a species have made many, many more such mistakes.
So
if I now told you that the same discredited theory of communism is now being
touted as the only way to practice medicine what would you say? I kid you not-
search evidence based medicine on the internet and you would find plenty of
laudatory articles as the way to go for practicing medicine as per modern
protocols. But read past the platitudes and rule by central committee is
exactly what you would find. And just
because the committee distributing it is the internet itself it finds its
greatest advocates on the net who tout it as the only way to go and not as one
more way as it really is. Now enough with all the historical references and let
me start explaining what evidence based medicine really is all about.
Sometime
in the last decade of the last century (the 1990’s anyone?) there arose a new
system of medicine called evidence based medicine. As with everything else when
it was first introduced the intentions were noble and its advocates were
sincere and it was definitely a step forward to the future. Doctors everywhere
welcomed it because it seemed to offer a way forward during those times when
doctors most need help- decision time. Evidence based medicine involved putting
up the results of large scale clinical trials on the net to help doctors
everywhere follow those same guidelines in their treatment for their own
patients. It showed what worked or what didn’t work to others who were hard
pressed to make difficult clinical decisions in real time. As such it definitely
was a step forward. It even helped simplify which drugs to prescribe or which
not to. For instance many of the old time doctors used to rely heavily on
antibiotics where were popular during their heydays often not realizing that
such antibiotics were no longer active due to an effective resistance built up
by bacteria continually exposed to the same drugs for so long. Hence evidence
based medicine pushed the medical fraternity into discarding old, tried and
tested beliefs and adopting newer treatments. And that’s when things started
going wrong.
When
the popularity of evidence based medicine picked up worldwide big pharma was as
usual right there to swing things in their favor. They started sponsoring the
large clinical trials needed to get their evidence – often using low cost
outsourcing firms in under developed countries where patients signed up for
medical trails for a pittance- and used the results of such biased trials to
push heavily in favor of their own drugs which had been used in such trials.
Other drugs, even tried and tested ones didn’t stand a chance because all the
latest evidence (sponsored of course) freely available on the net pointed
towards such and such drug – as the only one with enough evidence available to
show it worked. If a doctor wished to use any other drug which he felt could be
equally effective he stood in grave risk of being taken to court by the patient
for not following “internationally accepted standards of care available on the
net”. Which led to all the doctors falling in line cowed by threatened medical malpractice
suits and patients reading up the results of such biased trials on the internet
and demanding of their doctors the same treatment that dr.google recommends.
If
to take an example you have constipation and I as your doctor want to recommend
to you a single plantain (local banana) every night and you go on the net and
read that florida oranges grown in glass rooms in chilly Alaska when given to
5000 people led to 4000 people rushing to their toilets every morning and you
quote that study to me and demand that I prescribe only Florida oranges to you-
imported straight from Alaska- then I have no choice except to write a
prescription of the same. Because I or anyone else for that matter have no
evidence at all that bananas work, forget the fact that every single individual
we know all around us for thousands of years have used bananas to evacuate
their bowels. There is no large clinical trial for local bananas- no one paid
money to large groups of people to eat a banana and shit in the morning and
hence no evidence for banana which makes it a false treatment under the
evidence based medicine guidelines and if despite this I want you to eat a banana,
god help me, I would end up losing my license for practicing medicine- for not
asking you to eat imported Florida oranges which might beggar you with just one
months treatment cost. And this is the literal truth and I am not exaggerating.
The costliest drugs are the ones which drug companies prefer to send for large
clinical trials by recruiting thousands of patients. Hence when the results
come out its the same costly drugs which become the default treatment option
worldwide and any doctor who differs is branded a witch doctor for not
following the evidence. Individuality has been stamped out and creativity
rooted out in the name of the evidence based medicine fad.
Just
like communists used to prescribe their guidelines from a central committee for
everything, evidence based medicine has a central treatment guideline which
every doctor has to follow to save their own skins or woe to them. Such evidence
gathered in distant populations does not take into account individuals or their
idiosyncrasies. Medicine is not an exact science and most prescriptions are
based on informed guesses but that doesn’t mean that in the name of
standardization a one size fits all variety of medicine becomes the only way to
practice. The evidence based medicine fad has been taken to such ridiculous
levels that surgeons who often make small incremental advances in surgery by
trying out newer and innovative surgical techniques on individual patients
cannot publish their results anymore as case reports and case series- which are
about smaller groups of patients – are increasingly being not published or
downright derided in favor of larger clinical trials. Surgeons are being forced
to fall in line with the same efficiency as robots and an individual surgical
technique (even surgical flair) is being eliminated in favor of
standardization.
The
day is not far off when patients can print off their own prescriptions off the
internet from a published list of symptoms to treat themselves and a doctor (or
a middleman) becomes superfluous to medicine. Is that a step forward? Or will
it lead to more chaos? Based on the history of communism I am very skeptical of
the future of evidence based medicine as it is now. But I can’t speculate on
what the next medical fad will be. Will evidence based medicine escape the
stranglehold of big pharma and sponsored clinical trials and evolve into
something more inclusive and egalitarian taking into account individual
knowledge. Or will it act the monolith and seem impregnable till it suddenly implodes
on its own like communism did? Only time will tell.
