Friday, July 1, 2011

Things We Don't Know

An interesting article in Scientific American about prescription drugs and elderly people makes the case that we’re doing it wrong. After noting that most clinical drug trials don’t have very big samples of old people (and goes so far to say “guidance on practice are not science based [sic].”), the author writes:
A recent study of elderly ICU survivors found that 85 percent were discharged with 1 or more potentially inappropriate medicines, with more than 50 percent in that group discharged with medications deemed more harmful than beneficial (Morandi et al, 2011). The authors press for more attention to appropriateness reviews, with the rationale for starting each therapy in the ICU, and discussion of when it can be stopped.

Brian Strom, MD, professor of public health and pharmacology, University of Pennsylvania, describes the issues this way: "The problem is Congress and our research agencies. They fund so little work on the pharmacology of the aged and other demographic subgroups, and their risk of drug interactions. And, there is phenomenally small, and shrinking by 60% (down to $5.1 million/year), amount of money being spent supporting the Centers for Education and Research and Therapeutics, who are charged with doing studies that industry would not fund, and with changing prescribing to be more rational."

The more you read about health care, the more you’re struck by the amount of stuff we don’t know at all about health care—the lack of knowledge is accentuated by the realization that much of the stuff we think we know is actually unknown, possibly right but possibly wrong. (There are problems with large numbers of studies—see this article on biomarkers for one example—and then there’s the excerpted article above.)

My personal hunch—given facts like the above—is that more substantive, thorough studies will show health care to be much in terms of quantity, with much of the surplus detracting from people’s health.

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