A good lesson for everyone in healthcare, especially patients and physicians, is to remember, what we believe is right is only finite, fluid, changing. One study does not make or break a body of evidence or change practice. That is important for both laypeople and professionals to understand.
Everything changes. Being open-minded in accepting new information and findings is the key, and that includes communicating those findings.
For laypeople and patients, don’t be fooled when you read or hear about “a study” says that “X” prevents cancer or reduces the risk of cancer by “Y” percent. The key is not the amount of risk reduction or the variables involved. It’s the fact that it was “a study”. Just one. Of many.
Listen carefully. Think about it, but don’t change your whole routine, diet, or lifestyle based on one study. Because next week there will be a study that says the opposite, or something completely different.
One study is not sufficient to change recommendations or practices. Professionals know this through training. It’s also somewhat irresponsible reporting by the media, because they don’t understand the meaning of the results, and pass that misinformation onto the public.
The public is not necessarily under-informed, in fact, they are usually over-informed, with so much information coming at us every day, we have to filter it out somehow. To make sense of all of it, we create shortcuts and remember only the things that seem relevant to us.
For example, if weight control has been on our minds and we see the results of a study that showed kale eaters are 30% less likely to be overweight, suddenly it is interpreted that everyone should eat kale to lose weight. We often pick this up without knowing that the study was done under certain conditions to a certain group of people who might not resemble us at all.
For doctors and health care providers, evidence is important. It drives further research, our body of knowledge, and our practice forward. But if other sources of information, for example, the results of non-quantitative research, anecdotal evidence, or simple common sense, we blind ourselves to things that could actually help our patients.
Practice change takes years, even decades, even in our electronic world. First there have to be research studies, building the body of evidence that leads to an agreement on change in practice. Then there is the training and dissemination of new information to providers.
Meanwhile, if your patients are continually coming to you with similar complaints about a certain class of drugs, but you insist, based on population studies of risk, that they stay on that medication that ruins their quality of life, without recording the anecdotal evidence and driving further research with it, are you really doing them any favors?
Pay attention to what’s really important. Take an example of the use of aromatase inhibitors in breast cancer:
- If the patient in front of you reports that she can’t exercise because of severe fatigue and joint pain and has gained weight since starting on the medication you prescribed based on risk numbers, do you know how much she, the individual with her characteristics, is likely to benefit? What if her type of cancer is equally or less likely to recur if she is an active, otherwise healthy person with a normal BMI?
- If she normally would be out exercising and moving for several hours a day if she didn’t have such bad joint pain, but instead she is gaining weight and is less active, as well as becoming depressed. Is the joint pain, lower level of activity, and mental health decline worth the amount of benefit given by the drug? Would she be better off if she were active and healthy in her normal activities without the joint pain, accepting the evidence-based risk of recurrence?
Eventually, we are all going to die of something, and the older we get and the more we try to do everything possible to prolong our lives, we are going to pay in many ways that we can’t even foresee. Sooner or later our quality of life will be affected by our attempts to prolong life. Let’s concentrate instead on making our time here as enjoyable as possible. Everybody slow down, and remember what health and medicine mean in terms of everyday living, functioning, and well-being.