Skip to main content

Google and Why Modern Medicine is in a Rut



I'm at the annual SGIM meeting and the following topics came up in conversations w/various folks, so I thought I should write about it.

First, I was struck by a recent news article about Google and how the expectation is that each one of their new products should be 10 times better than the competition.  In an interview, Larry Page talked about how setting the bar that high forces everyone to think "outside the box" and come up with new, transformational ideas, rather than tinkering around the edges to make something marginally better.

Second, I was struck by a recent scholarly article by Mittra entitled, "Why Modern Medicine is in a rut" (PMID 19855121) (Props to Dave Aron who suggested the article to me).  In it Mittra argues that the first 30 years after WW2 was characterized by transformational change:  Dialysis, Ventilators, CABG, etc.  However, the last 30 years have been characterized by incremental change despite a huge increase in research funding.  He cites 2 reasons:  overdependence on high tech research (i.e. Human Genome project) and overdependence on big RCTs (if you need 5000 pts per arm, by definition the effect is modest--truly transformational requires only small studies because the effects are so profound.)

I'd argue that we need more Google-like thinking in research.  We shouldn't be investing $200million on a single study to figure out whether triple anti-platelet blockade is better than double blockade.  Rather, we should be spending that money to 200 $1M grants to think about revolutionary approaches to atherosclerosis.  I don't know what those revolutionary approaches would be, but I am fairly certain that few funded grants are proposing interventions that are 10 times better than current standard of care.

Finally, I was talking to Seth Landefeld, a mentor and disruptive thinker, who talked about how the projects he's most proud of are the ones that were not grant funded.  I think this points to the fact that most researchers are drawn to transformative, high-risk projects.  The problem is that the vast majority of what is funded is incremental research.  So, the safe path is often to do that study on triple blockade rather than transformative research.

Luckily, most of us find some time to do both incremental and (hopefully) transformative research.  But if we were able to align funding to reward potentially transformative research, I think we'd get more innovative research, and we'd be able to get Modern Medicine out of Its Rut.

by: Sei

Comments

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Language Matters: Podcast with Brian Block and Anna DeForest

One of our first GeriPal posts was titled "Rant on Terminology," by Patrice Villars, NP.  In the spirit of looking back over our first 10 years, here is the opening paragraph to that post:

News Headlines read: Sen. Edward Kennedy loses battle with cancer. Really, he lost? I thought he died from a malignant brain tumor, an “aggressive” brain tumor. The median survival is less than a year for people for his particular tumor. Kennedy was diagnosed in May of 2008. He lived over 15 months after diagnosis. What a loser. He must not have fought hard enough. Huh? I thought he spent most of his life battling for social and health care reform in America. In this week's GeriPal podcast we take a deeper dive into this issue of language and medicine.  We are joined by guests Anna DeForest, MD, MFA, a resident in Neurology at Yale, and Brian Block, MD, a pulmonary critical care fellow at UCSF.  

Anna recently published a paper in the NEJM describing her reaction to hearing terms like, &…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …