Knowledge chain sanitation, a difficult undertaking

By Cristina Roure 

In one of my posts  from "Pantone" series, August 17, I was talking of the need for crystal clear knowledge sources so we can make appropriate decisions, but the point is that our sources are contaminated by a number of biases that permeate the decisions we make as citizens, as patients, as health professionals or managers, and this leads to over diagnosis and overtreatment. Faced with these biases, Gerd Gigerenzer and Muir Gray, in the book "Better Doctors, Better Patients, Better Decisions" propose some sanitization measures, to which I have allowed myself to add some homemade ones:

1. How to make research more relevant to patients

a) Regulatory agencies, such as the FDA or the EMA, should require studies demonstrating the superiority of the new drugs compared to the best treatments available, not placebo.
b) Independent sponsors should promote research on simple, beneficial and patient relevant treatments and practices that do not involve the use of drugs or technology, practices that for this reason lack sponsorship (exercise, healthy diets or checklists to improve clinical safety).
c) I would add that the so called Patient Reported Outcomes should be included in clinical trials, which unlike conventionally employed variables, report on the effectiveness of treatment perceived by the patient.


2. How to reduce the lack of transparency in the publication and dissemination of clinical research

a) The editors of journals should require authors to avoid the use of misleading statistics measures that are distorting the benefits and risks perceived by the reader.
b) Clinical trials and protocols should be recorded before being undertaken and should require comprehensive publication of all the results, whether positive or negative, including all variables, during the monitoring period established a priori.

3. How to reduce the effects of statistical incompetence of professionals and citizens

a) In the training of health professionals, managers and journalists, we should work more on the appropriate interpretation of risks and benefits based on statistics.
b) Every healthcare organization should have a chief knowledge officer, whose duties would be to ensure the independence, quality and transparency of information used by professionals and patients in decision making.
c) Health authorities should ensure the quality, transparency and independence of the information provided to citizens so that they can take informed decisions about their health, as they do for example in the UK with the NHS Choices website or the section Behind the headlines.

4. How to reduce conflicts of interest 

a) The organizations responsible for the continuing education of health professionals and recertification should establish mechanisms to discourage pseudo-educational activities (so called by Marcia Angell, former editor of the New England Journal of Medicine, in his book "The truth about the drug companies "Random House 2004) sponsored by the pharmaceutical industry, which more or less explicitly, are hiding marketing messages.
b) Payment systems should encourage the quality of care and practices that add value, not the volume of work performed.
c) Citizens in general and patients in particular  should be encouraged to become more involved in decisions that affect their health through shared decision making.

We may think that this is a utopian approach. Okay, the solution is not easy nor is available to individuals. But surely the sanitation and treatment of drinking water wasn’t easy either in the nineteenth century and today we can’t conceive that it can be otherwise.