In this Study of the Week, we learn about the DCP trial, which compared two ways to treat high blood pressure. Experts preferred one drug; practicing doctors another.
We need more trials like this but a major under-appreciated barrier here is IRB reform.
Currently it is very costly (time and money) for scientists/doctors to investigate different treatments. Federal regulations allow physicians to prescribe one pill vs another if both are acceptable treatments, but to then collect data on outcomes requires extensive IRB consultation and approval, which means large amounts of upfront paperwork, 30-page consent forms, 30-page consent form revisions, audits, etc.
This process unequivocally slows down knowledge and hurts patients.
It is not clear if the author is complimenting or criticizing the manuscript. We never can know about the possible preference between two agents without this kind of trial and publication. Good for progress.
Nowhere has this been more true than in addiction medicine. These for profit rehabs have set up shop with a revolving door for suboxone, relapse, more suboxone, using suboxone off label for non opioid drugs (including alcohol), and suggesting using it for life. Prior to me leaving the addiction business for good due to the loss of focus on behavior change via non profit methods (12 steps!), I watched these for profit clinics’ revolving doors making money. Then I observed a slow around the drain demise to many who should have been given some good reality therapy and attend some meetings. I used to tell my patients “If I do my job correctly, you will fire me in 6 weeks, come back for free aftercare anytime, and your meetings will be relatively inexpensive even if you do choose to put a buck in the basket.” Bean counters didn’t like that, and once there was a big money incentive for non expert prescribers to get their waiver, I left the system.
Excellent essay -- this is an exciting untapped potential of our electronic health records. Perhaps one day the EHR will help us augment our understanding with imbedded trials, educate physicians with just-in-time learn, and improve our practice with decision support.. and if this could be done without drowning the doctors in clicks, would be incredible.
Wouldn’t that be nice if this approach was used widely. Better yet if our electronic health records were designed to facilitate this as well. Are you able to provide the reference for the study?
Beautiful
We need more trials like this but a major under-appreciated barrier here is IRB reform.
Currently it is very costly (time and money) for scientists/doctors to investigate different treatments. Federal regulations allow physicians to prescribe one pill vs another if both are acceptable treatments, but to then collect data on outcomes requires extensive IRB consultation and approval, which means large amounts of upfront paperwork, 30-page consent forms, 30-page consent form revisions, audits, etc.
This process unequivocally slows down knowledge and hurts patients.
The External Medicine podcast actually did an episode focused on IRB overreach here: https://externalmedicinepodcast.com/carl-schneider/
It is not clear if the author is complimenting or criticizing the manuscript. We never can know about the possible preference between two agents without this kind of trial and publication. Good for progress.
Nowhere has this been more true than in addiction medicine. These for profit rehabs have set up shop with a revolving door for suboxone, relapse, more suboxone, using suboxone off label for non opioid drugs (including alcohol), and suggesting using it for life. Prior to me leaving the addiction business for good due to the loss of focus on behavior change via non profit methods (12 steps!), I watched these for profit clinics’ revolving doors making money. Then I observed a slow around the drain demise to many who should have been given some good reality therapy and attend some meetings. I used to tell my patients “If I do my job correctly, you will fire me in 6 weeks, come back for free aftercare anytime, and your meetings will be relatively inexpensive even if you do choose to put a buck in the basket.” Bean counters didn’t like that, and once there was a big money incentive for non expert prescribers to get their waiver, I left the system.
Excellent essay -- this is an exciting untapped potential of our electronic health records. Perhaps one day the EHR will help us augment our understanding with imbedded trials, educate physicians with just-in-time learn, and improve our practice with decision support.. and if this could be done without drowning the doctors in clicks, would be incredible.
Wouldn’t that be nice if this approach was used widely. Better yet if our electronic health records were designed to facilitate this as well. Are you able to provide the reference for the study?
Never mind, I see the embedded link. Missed it on first read.