About Data Based Medicine

Adverse drug events are now the fourth leading cause of death in hospitals

It’s a reasonable bet they are an even greater cause of death in non-hospital settings where there is no one to monitor things going wrong and no one to intervene to save a life. In mental health for instance drug-induced problems are the leading cause of death — and these deaths happen in community rather than hospital settings.

There is also another drug crisis — we are failing to discover new drugs.

These two crises may be linked in that detecting adverse events on drugs is still the best way to discover a new use for a drug, and new drugs. But there are fewer and fewer incentives for anyone to recognize adverse events. Companies are blocking efforts to detect problems and in so doing are sawing off the branch on which they are sitting. Doctors are neutering themselves by failing to recognize and treat what should be the most recognizable threat to life and moreover the most eminently treatable cause of death in the world today.

A century ago Freud drew our attention to the many ways in which speech could be biased. Half a century ago clinical trials drew our attention to the biases that both doctors and patients bring to therapy. Just as Freud’s insights once made it difficult for anyone to accept things that were said at face value, so clinical trials and evidence-based medicine have created a culture that makes it increasingly difficult for doctors or patients to spot what is right in front of our own eyes. Ultimately Freud ended up being used to explain away or deny claims of abuse that we now know were happening, and in much the same way companies and doctors are now using trial data, or the lack of it, as a drunk uses a lamppost — for support rather than illumination. Just as a point came at which claims of abuse could no longer be denied, we may be nearing a point where treatment-induced problems will have to be recognized.

This blog aims at raising the profile of this interlocked set of problems and the need for Data Based Medicine.

See my first blog post for a full discussion of what I hope this blog can help achieve.

David Healy
January 2012