PubMed is Drive Through Only Now
We live in the Information Age, but our medical decisions, the most consequential of all of our decisions, aren’t evidence- informed. Instead, we continue to make them based on habit, gut, ritual, instinct, and anecdotal evidence. We’re building InpharmD, with the backing of Y Combinator (the world’s top accelerator, with notable alumni Truepill, Stripe, Dropbox, and AirB&B), to enable evidence — informed medicine.
For centuries, we routinely recommended fever reducers like ibuprofen when the body’s temperature went above 101 °F. In 2005, 82 intensive care unit (ICU) patients were randomly assigned to receive a dose if their temperature rose beyond 101°F (“standard treatment”) or if their temperature reached 104°F. As the trial progressed, seven people (8%) getting the standard treatment died, while there was only one death (1%) in the group of patients allowed to have a higher fever. The trial was stopped early because the team felt it would be unethical to allow any more patients to get the standard treatment — but the trend didn’t.
That same year, Dr. John Ionnidis found 16% of our medical practices are proven ineffective and later contraindicated. A follow up by the British Medical Journal Clinical Evidence of 3,000 medical practices found 15% were harmful, not effective, or a tradeoff between the two; and another 40% were considered to be at best ineffective — yet they continue on.
Five years later, Vinod Khosla lamented, “We cannot expect our doctor to be able to remember everything from medical school twenty years ago, memorize the whole Physicians Desk Reference (PDR), and to know everything from the latest research.”
Now nearly a decade ago, Khosla went on to predict: “I doubt very much if within 10–15 years I won’t be able to ask Siri’s great great grandchild (Version 9.0?) for an opinion far more accurate than the one I get today from the average physician.”
Surely our practices are evidence- based today, right?
Our new normal
In 2020, we saw hydroxychloroquine become protocol at most hospitals, random parts of the sink like vitamin C thrown at COVID patients, and vaccinated people being advised to keep the mask and distance — all contrary to the best evidence.
“We had no choice, we were in a pandemic!” I hear some of you yelling. A pandemic is not an overdose, though we may feel the same sense of panic. We have plenty of time to review the evidence, and the result isn’t necessarily death if we do nothing.
No, our non- evidence based practices in 2020 cannot be blamed on COVID. References like the PDR have been converted to large online data warehouses, forcing the provider to physically search their virtual aisles. They have massive scale and a few credible authors, so they maintain limited credible information, generally covering mainstream questions. For the rest, we have PubMed; every study we need is right there, but so are 20 million others. The problem of our time is that there’s so much information, we choke on it.
Who can blame the physician? They now see five patients an hour. It’s imperative that we make shopping for treatments as easy as shopping for blenders. Allow me to request what I want and present just that information, clearly.
Much has been made of the use of evidence to make binary decisions. There has been pushback, because there’s nuance involved in the practice of medicine. But the use of evidence in clinical practice is not for making decisions, but more broadly, for informing decisions. It can describe our patients, direct our interactions with them, and help us understand the safety and cost- effectiveness of treatment options. Evidence does not invalidate clinical expertise, but works as an adjunct to complement it.
Our goal isn’t to replace the physician, but make her more formidable. Besides, who wants to be treated by an “average” physician?
By: Ashish Advani
