Oct 25, 2010
By: Alvaro Fernandez
Malpractice Methodology (New York Times OpEd by Peter Orszag)
Right now, health care is more evidence-free than you might think. And even where evidence-based clinical guidelines exist, research suggests that doctors follow them only about half of the time. One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice. As a result, any clinical guidelines that exist often have limited impact. How might we encourage doctors to adopt new evidence more quickly?
If this is the case with health care overall, despite much progress over the last 30-40 years, imagine how worse it may be when we talk about brain health, when neuroscience and cognitive neuroscience are relatively more recent disciplines.
This is a key insight to keep in mind as we debate the value and limitations of innovative brain health solutions, especially those that are non-invasive and have no negative side effects: what matters most to actual human beings living today is how those tools and solutions seem to perform, based on best evidence, compared to alternatives available today — not compared to Platonic ideals about research and practice which may exist in our minds but not in the real, empirical world. Of course we then need to guide research so that we have better evidence in the future, but progress must occur in parallel and reinforce each other: progress in practice and in research.
The OpEd author then proceeds to defend malpractice reform as the primary way to do so. This may well be so with healthcare as a whole, but when we are talking about brain care I believe his next 2 proposals are more directly relevant:
Better technology would help, too. Your doctor’s computer should be able to not only pull up your health records (after you have approved such access) but also quickly suggest best-practice methods of treatment. The doctor should then be able to click through to read the supporting research. Subsidies in the stimulus act help doctors pay for this kind of technology.
A final step toward improving standard medical practice will be to better align financial incentives for delivering higher-quality care. Hospitals now lose Medicare dollars, for example, if they succeed in reducing readmissions. Medical professionals should be given incentives for better care rather than more care.
A couple of recent interviews in our expert series elaborate on these points, showcasing how innovation is already taking place:
- “…putting good evidence to work in practice requires more than publishing good research. I’d say that scientific evidence is directly relevant to perhaps 15% of clinical decisions…we require technologies that translate emergent knowledge into practice.” – Dr. John Docherty, Adjunct Professor of Psychiatry at Weill Medical College, and former Branch Chief at NIMH. Full Interview Notes.
- “We should be thinking about the brain through its whole lifetime…We need to break the silos, to aggregate knowledge, to help advance our knowledge of the brain 50 years in 5 years.” — Patrick Donohue, founder of the Sarah Jane Brain Project. Full Interview Notes.
Enabling and accelerating such innovation is of course why we are launching the SharpBrains Council for Brain Fitness Innovation.