An older article, but interesting in light of the replicability crisis that has come out since. FTA:
"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."
Physician here (intensive care, about 10 years of practice).
> It is simply no longer possible to believe much of the clinical research that is published
Absolutely agree. I've tried arguing this with colleagues—that we should be more careful about the clinical conclusions we draw from single studies—but I'm just met with resistance. We just added a new drug to the standard treatment of heart failure, based on a shady Novartis-funded study that decided, in a post-hoc analysis, to exclude something like 50% of the patients after-the-fact (and oh look! now we can show a mortality benefit!). It spits in the face of everything I've learned about the scientific method and clinical research. This is the PARADIGM-HF study and the drug is ENTRESTO in case anyone wants to look into it more. Caveat: it might be a beneficial drug for many patients.
> It is simply no longer possible...to rely on the judgment of trusted physicians or authoritative medical guidelines
I'm going to disagree with the author on this one. It is possible to trust and rely on your physician, and in many cases you have no choice. Guidelines are just that: guidelines. Not a replacement for careful thought. And I actually like the direction that many guidelines are adopting: one that brings more continual minor updates rather than infrequent major changes. This is a complicated discussion, and depends on what illness you have that leads to your interaction with our health care system, but my advice is to seek out doctors that seem to communicate well with you.
From briefly reading the paper and the post-hoc analysis, it seems that they were very clear about their post-hoc analysis and its limitations. In this situation, whoever are reading into it more than they should (could be novartis and their marketing, could also be the physician colleagues of yours) are the ones that should be criticized, not the authors themselves.
Edit: here are some quotes from the author of the post-hoc analysis
"Referring to the fact that these observations came from a post hoc analysis, Pfeffer said: 'I normally draw a line here, and I wouldn't cross this line if we had things to do for these patients.'
But he added: 'This is a growing part of the heart-failure syndrome. And if we have something that can help these 40% to 50% of people with symptomatic heart failure and an impaired prognosis—if we can improve their prognosis and take care of the safety measures—then I will go below this line by stating that our observations in the Americas—that spironolactone was associated with reduced CV deaths and hospitalizations for CHF—should be taken into account.'"
Your doctor Googling for 30 seconds (not quite on the correct topic) is no substitute for careful research, either. I trust my doctor, more or less, on many matters; but never more on prescriptions, or surgery (a whole other scandal.)
I'm an anesthesiologist. I'm always interested to hear the story of colleagues on hackernews. Would like to ask you a few questions about your projects. Reach me on albin.stigo@gmail.com
children as young as two years old are now being diagnosed with bipolar disorder and treated with a cocktail of powerful drugs, many of which were not approved by the Food and Drug Administration (FDA)
Why are we giving psychiatric drugs to people whose brains aren't fully developed, especially when there is still so much we don't understand about how the brain works?
Why consult a health professional if you're not going to trust what they have to say?
When a doctor tells a parent that their two year old is suffering from bipolar disorder and the way to treat that is to take a cocktail of meds then it's not the parents fault when they follow that advice.
Why treat doctors as infallible? Do you bring your car to the mechanic and blindly trust what they have to say?
Doctors are no better or worse than any other profession out there. 80% of doctors are pretty bad, and the other 20% make the rest look decent. Just like any profession that has ever existed.
You should be double-checking absolutely every single thing a doctor is telling you - especially important things like giving a two year old psychiatric meds that are not approved by the FDA.
I do agree with your point that it's not the parents "fault" - but I also would be pretty upset with my parents if they blindly followed whatever advice some guy with a piece of paper told them.
Trusting a professional's recommendation is not treating them as infallible, it's called "using the advice you paid for". No I don't blindly trust my mechanic, you shouldn't blindly trust anyone but generally when you seek out a professional's opinion on something it's because you value their expertise.
> You should be double-checking absolutely every single thing a doctor is telling you
Right, because the average person who knows next to nothing on mental health is going to make a better judgement call on which medication to prescribe their child than their doctor.
Guess what, if that were the case we wouldn't have a story here.
Right, because the average person who knows next to nothing on mental health is going to make a better judgement call on which medication to prescribe their child than their doctor.
Often, yes, the person who cares about the child more than about themselves will make a better decision than a doctor who has 300 more random kids to check that week.
Now, it depends on how that double-checking is done. The simplest way is to get a second (and third, and fourth) opinion, and then judging based on them all.
You should always be your own advocate, and you should always consider the treatment plan suggested by your doctor and ask questions. Note, please understand I _not_ telling you to be a dick. Doctors have a tough time of it and are expected to give "solutions" that make the patient happy. However, I say prescribed treatments should have an expected range of observable effect(s). Also treatments almost always have additional side effects. Ask about both of these.
Others have already said, but doctors can and do get things wrong.
I broke a collar bone. In the course of recovery I've seen three different physical therapists and while their suggestions overlapped some, there was a wide range of recommended exercises and stretches. One of them was great and super effective, one was meh, and one was down right useless.
This is one of the things that really keep me up at night. None of these drugs have been tested on children, and most of them haven't been subject to long term clinical trials even with adults.
ADHD is one of the scariest overperscribing stories. Researchers projected 3% of children have ADHD yet ADHD meds have been pushed on 15% of all children. Is it worth helping one kid to mistreat five?
Source:https://www.nytimes.com/2016/08/28/books/review/adhd-nation-...
> Why are we giving prescription drugs to people whose brains aren't fully developed yet
Presumably, you left the word “psychiatric” out, or do you really think we shouldn't be, e.g., giving antibiotics to infants with life-threatening infections?
On the one hand, we have some very good pharmaceuticals. They work very well for their purpose. For example, Naloxone [1] is very good for reviving people who overdose on opiates Some of the modern formulations reflect profiteering [1], but this drug and its cousin (Naltrexone) are very useful.
Two more useful generic drugs are the thyroid medications Synthroid and Cytomel.
On the other hand, most commonly drugs can at best be considered 'palliative' rather than 'curative'. This article talks about the drug industry's efforts to convince people that they'll need to take maintenance drugs for the rest of their lives.
It would be helpful for Medicine to undergo a "back to basics" scrap & re-write of the med schools' curriculum. This will probably take 25 years...
Reminds me of how "advisory", pay-to-play rackets like Gartner work. It's dishonest and smarmy and all the more more repulsive when the medical field engages in such practices.
"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."