Uncategorized

Ethical Blinders?

Is this a case of ethical blinders?

Today's New York Times has an important story about the ineffectiveness of removal of lymph nodes for certain women with breast cancer. That is a significant result of clinical research. But read this:

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published.

And they felt no need to spread the word quickly to other hospitals and to breast cancer patient advocacy groups and help women across the world avoid the surgery and its after-effects? (As noted in the article, "It can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.")

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

 

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

7
Leave a Reply

7 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
6 Comment authors
bev M.D.Paul LevyLarry HustenBrittCraig "Quack" Vickstrom, M.D. Recent comment authors
newest oldest most voted
bev M.D.
Guest
bev M.D.

I agree with Craig’s points. Although you may rightfully bemoan the lag in adoption of best practices in medicine (and I would vigorously agree with you), medicine is also replete with situations where everyone jumped on the bandwagon for a new treatment which was later found to be ineffective or downright harmful. Bone marrow transplants for metastatic breast cancer, super-radical mastectomies for breast cancer, stenting every artery with any blockage for stable patients with heart disease, the list goes on and on. Our lab, when confronted with a request for the newest and greatest test, used to go by a… Read more »

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

Paul,
Not necessarily a question of “not paying attention” or “unaware.” Maybe they are just waiting for more proof before they change their practice. Precedent has standing in medicine. Standard of care/practice has standing in medicine. What is “strong” evidence? What may be strong evidence in an experimental, university hospital may not be strong enough evidence out in the hinterlands. Large, experimental academic medical centers have more leeway to experiment with new treatments and protocols than small, rural health clinics. Like everything else, “right” is contextual.

Paul Levy
Guest

Thanks, Larry and Craig. So, it is just good enough for some people and not others? How would you explain that to a woman is now reading this who had the surgery at a hospital that either was not aware or chose not to pay attention. OTOH, if the conclusion is not strong enough scientifically, why have some centers adopted the practice? Or, are you just saying that this is one of those cases where the judgment lies with the surgeon and oncologist? If so, do we have an assurance than the patients are being presented with a full explanation,… Read more »

Larry Husten
Guest

This would be a great point but as the editor of Oncology Times just told me, the trial results were presented to the cancer world last spring at ASCO and duly reported in, among other places, Oncology Times. So the investigators did make a good faith effort to report and disseminate the results. There’s always the problem of the lag in practice but this does not strike me as an example of unethical behavior.

Britt
Guest
Britt

Paul, I couldn’t agree with you more.
Sadly, in today’s competitive market for patients at medical centers (esp teaching medical centers), it gives an institution an advantage to enhance its reputation as a leader or why it is “always” a leader in utilizing the most recent data, if even for a short time. Collegiality and data-sharing among research sites is becoming a relic of the past in the name of proprietary information and patents.
It’s a shame and, in this case for many women, shameful.

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

Probably not a case of ethical blinders, nor a case of laziness. Today’s latest, greatest medical breakthrough is often tomorrow’s disaster that “everyone” can see perfectly from hindsight. That is why careful, conservative, and conscientious physicians will change their practice only slowly. Change will only happen after a preponderance of the evidence from many different, independent centers all arriving at similar conclusions after a good interval of time and many different patient populations. Fads exist even in medicine. I have sworn never to be taken in by them. Non-physicians are the first to be taken in by fads, and the… Read more »

Jared Miller
Guest

http://www.youtube.com/watch?v=mH3k-nEP55s Our humorous take on OBAMACARE