What We Don’t Know.

Posted on | August 27, 2019 | Comments Off on What We Don’t Know.

Mike Magee

Some years back, I asked Craig Ventor, co-discoverer of the human genome, what percentage of the knowledge he believed we currently possessed to take optimal care of human beings. His rapid response? “Less than 1 percent.”

Austin Frakt, public health professor at Boston University and Harvard’s T.H. Chan School of Public Health, recently highlighted lack of evidence in equally dramatic terms. He cited a British Medical Journal analysis that confirmed that evidence of benefit does not exist for over 50% of current medical treatments.

Frakt says the problem extends into the health policy arena as well, a theme I drum repeatedly in CODE BLUE: Inside the Medical Industrial Complex. His words: “Much of what we do lacks evidence; and even when evidence mounts that a policy is ineffective, our political system often caters to invested stakeholders who benefit from it.”

The absence of evidence is nothing new in America’s history, a fact that has been made abundantly clear in my preparation for a Fall offering at the President’s College at the University of Hartford titled, “The President’s Hidden Health Record – From FDR to Trump – and How It Shaped America.”

Beginning with George Washington, whose death was hastened by a toxic mixture of induced bleeding and enforced purgatives, our Presidents (and the citizens who elected them) have been poorly served by the medical establishment of their days.

Adding to the confusion, Presidents and their White House doctors have routinely conspired to hide serious and at times life threatening medical conditions in an effort to be elected and stay in office. They have taken mind-altering drugs with abandon. They have altered or destroyed medical records. They have continued to hold tightly onto the reins of power while mentally or physically unfit.

Even with full disclosure, as Frakt outlines, “It is not uncommon for newer evidence to contradict what had been standard practice. A study by an Oregon Health & Science University School of Medicine physician, Vinay Prasad, and colleagues examined 363 articles in the New England Journal of Medicine from 2001 to 2010 that addressed an existing medical practice. Forty percent of the articles found the existing practice to be ineffective or harmful.”

States like North Carolina are wading into performance payment systems, promising insurers that, in the future, they will “pay for health not health care.” But to deliver on that promise will require quite an investment in medical humility, including: research transparency, full disclosures, real-time evaluation and application of evidence, and knowledge transfer to health professionals, patients, families and communities.

In that pursuit, knowing what we don’t know will prove to be at least as important as knowing what we do know.