After documenting the rapid rise in number of clinical studies, authors of the Institute of Medicine’s Knowing What Works in Health Care (page 36) conclude,
For physicians—and patients—who are motivated enough to read through and assess all of the relevant individual clinical studies on their own, keeping current is an arduous, if not impossible, task. Given the variable quality of the research and its limited generalizability, these providers and patients are faced not only with reconciling vastly different research findings but also with scrutinizing each study’s methodology in detail to ensure that the study has been well designed, that the analyses have been well performed, and that the results apply to their particular clinical circumstance (Abramson, 2004). This expectation is unrealistic, especially given that today’s medical residents frequently lack the knowledge in biostatistics necessary to interpret the findings of published clinical research (Windish et al., 2007). These findings illustrate the need for a system that can make sense of all of the data that currently exist, as well as the new knowledge that is now being generated.
Naturally, systematic reviews and clinical guidelines help, but the report documents an explosive number of those too, or none at all in some areas. This strikes me as a real challenge to the notion of consumer-directed health care, at least for consumers who want to make evidence-based choices. Those that just want to make it up as they go along need not be concerned about the volume of evidence.
But it’s worse than that. This strikes me as a real challenge for the very experts on which many of us rely, the physicians we consult for advice and care. Is it possible to assess the degree to which one’s physician is keeping up with the literature? There can’t be very many of them that do so thoroughly, given the challenge of the task and the fact that they must spend some of their day actually delivering care. They probably sleep some too, and eat, and have lives, as they should!
I’m not sure what to do about all this, since the volume of clinical studies is likely to keep rising as we fund more of them. We need those studies. But we also need the information to be accessible and usable. I know PCORI is all over this concept, but the jury is out as to whether it can do anything substantial about it.
No doubt there are information technology solutions. That’s also probably another domain into which we could sink a lot of money for little return. Just as throwing an iPad at a high school student doesn’t cause him to learn calculus, putting everything into a searchable database won’t make doctors and patients sudden masters of the evidence.
There’s a real need for answers. The wealth of our nation and our well being depend on them. I don’t have any right now.
AF
