Overcoming medical dogma

When a doctor says "take two and call me in the morning," how do we know this is the best course of action? Some of this is, of course, from the doctor's own judgment. He or she has probably seen this problem before and knows what to do. For rarer cases, she might consult the scientific literature, or a more experienced colleague.

Although many treatments have withstood the test of time because they really work, some continue to linger despite evidence that they aren't effective. David H. Newman writes of "Believing in Treatments That Don't Work," where he "explores how medical ideology often gets in the way of evidence-based medicine."

Writes Newman:

In the early throes of a heart attack, caused by an abruptly clotted artery, the stunned heart often beats quickly and forcefully. For decades doctors have administered “beta-blockers” as a remedy, to reduce consumption of limited oxygen supplies by calming and slowing the straining heart. Giving these drugs in the early stages of a heart attack represents elegant medical ideology.

But it doesn’t work...Remarkably, the medical community has continued to strongly recommend immediate beta-blocker treatment. Why? Because according to the theory of the straining heart, the treatment makes sense. It should work, even though it doesn’t. Ideology trumps evidence.

Newman gives several other pertinent examples, such as the use of cough syrup (no better than a placebo, for both children and adults), back surgeries, and the use of antibiotics to treat ear infections.

Although Newman didn't mention any mental health conditions in his list--an unfortunate occurrence, although as a fellow writer I do realize you can't mention everything--I think they would apply. We continue to treat eating disorders the same as we have for years, despite recent advancements in science and treatment protocols that indicate much more effective forms of treatment, especially for adolescents. Yet it remains very rare for sufferers and their families to be presented with the latest treatment options- indeed, any options at all!

Why? Why, when the information is disseminated in the literature and increasingly at conferences? When studies have been done. And done again.

I believe there are several layers of answer to this question. One layer stems from the fact that treatment providers are human, as are doctors, and core beliefs are typically not changed all that easily in spite of evidence to the contrary.

Another part of the reason has to do with a general lack of effective treatments, especially for adults. That "treatment as usual" feels like doing something, whether or not it actually is. Developing new methods to treat eating disorders, and then doing the rigorous scientific tests, can take years. And in all of the cases that Newman named, I'm betting that medical dogma prevails because no one knows quite what else to do.

Then we have dieting, weight loss, and obesity prevention, which is quite possible more blindingly stupid about failing to give up dogma than the ED world. The fact remains that we don't know how to get people to reliably lose weight and keep it off long-term. Still we tell people to lose weight, that you just need to burn more calories than you eat, that you're not trying hard enough, you're eating too much fat, too many carbs, shit- you're just eating too much, you're eating period.

For people who see weight as a behavior to be "fixed," I would imagine those same feelings of helplessness creep right on in. How harmful can a trip to Weight Watchers be? Right?

We all have our own prejudices, even scientists. But by actually using science, we can start to jettison the things that just aren't working so we can make room for the things that might finally make a difference.

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Kim said...

I have a very skeptical view of doctors for the reasons you discussed. Granted, most people with most conditons probably do fit into a designated treatment model, but mental illness is a different beast. My current dr., as nice as she is, does not "get" anorexia AT ALL. I've given up on even faulting doctors for this (which is just sad). It's just that if I cared too much, I would work myself up into an infuriated frenzy. There is so much misunderstanding about EDs, and very little attempt to adjust treatments. I don't know when things will change, but I hope they will.

Anonymous said...

I don't have an eating disorder, but I do have a mental illness. I have to say I have tried about 20 different psychotropic medications, and they either make me sick with side effects or just don't work. I am at my witts end don't know what to do. I started thinking about trying more natural remedied, but I am not sure if they work either. We need better treatments for mental illnesses!!! My view of doctors is getting very skeptical as well....

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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