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

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Elderhood: Podcast with Louise Aronson

In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th.

We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody).

This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey as a geriatrician facing burnout, aging and death of family of Louise's members, insightful stories of patients, and more.

We focus therefore on the 3 main things we think our listeners and readers will be interested in.

First - why the word "Elder" and "Elderhood" when JAGS/AGS and others recently decided that the preferred terminology was "older adult"?

Second - Robert Butler coined the term ageism in 1969 - where do we see ageism in contemporary writing/thinking?  We focus on Louise's…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …