Evidence Based Medicine: Whose Evidence?

The Story Behind Senator Kennedy’s Surgery

A recent article in The New York Times analysed the medical world with reference to the case of one of the most famous patients, Senator Kennedy’s brain tumour.

Evidence based medicine is now the cornerstone of medical practice but unfortunately it has been hijacked by politicians in their attempt to control cost and to control doctors.

I have always maintained that we need to strike a balance between sound evidence and the need to make progress. Progress in medicine cannot be achieved if we are ideologically stuck with outdated evidence and worse, evidence that suited politicians. In recent times this has led to gross discrepancies across countries in the treatment of Alzheimer, lung and breast cancer, where some treatments have been accepted by other developed countries including USA and France, but not in U.K.

Sometimes acceptance seems to depend on where the evidence originates from. For some time when Europe was merrily using Clozapine for schizophrenia, the US was still humm’ing and hah’ing to the point that there were grey imports of the said drug.

Those entering the medical profession must realize sooner or later that we can only make progress if we keep an open mind and refrain from being dogmatically stuck with old ways.

Now it is interesting when a politician falls ill with something serious. It is unclear what exactly Senator Kennedy’s brain tumour was but from all the information in the public domain it is safe to say it was a glioma and most likely glioblastoma.

As the third longest serving Senator in America’s history and chairman of the Senate’s health committee, he can certainly pull strings. He was not going to listen to just one doctor from Massachusetts General Hospital and accept that operation was out of the question. That conclusion was based on their interpretation of the evidence. He was able to get a number of eminent doctors across the whole country, some flying into Boston and others on the phone, for what amounted to a top level medical conference.

The result? The New York Times reported,

“Two weeks later, Mr. Kennedy, 76, flew to Durham, N.C. There, at Duke University on June 2, neurosurgeons operated for three and a half hours and declared the procedure ‘successful,’ though they did not specify their criteria.

“Whether the surgery was justified or not, that Mr. Kennedy had it at Duke embarrassed the Massachusetts General Hospital, a Harvard teaching institution. The change in venue strongly suggests that the meeting somehow led to the more aggressive surgical approach.

“Senator Kennedy has had a track record of being thorough and diligent in researching medical options when relatives or friends have fallen ill.” These included two of his own children and for both he helped them choose a more aggressive route. Both seemed to have done well, according to the New York Times.

Is this new approach going to be an adopted practice, I have my doubts. For the influential, EBM has a different slant and perhaps a different meaning: evidence from a number of top doctors and the patient gets to pick what he sees as the best treatment option.

It pays to be a Senator, I suppose.