Why I'm Writing For Sensible Medicine

Because medicine is increasingly irrational

There's no doubt about it. When people are scared, when they're stressed, when they're tired, they're not at their best. The same thing that's true for an intern at the end of a 30-hour shift is true for an anxious person in year three of the pandemic. But ultimately, the best medical and public health decisions are the ones based on the best available evidence, and the most deliberate thinking. That’s what I hope to do in these pages.

I joined my colleagues in writing Sensible Medicine for a few reasons.

First, I believe we need to hear a range of opinions to make sense of current events and medical practice. No one person has the monopoly on truth. And often many people are right, to some degree. Sensible medicine is a place that will feature a range of views. Even some that I may disagree with!

Second, Medicine has always captured many dimensions of life. It ranges from the molecular to the poetic. Doctors have to interpret clinical trials and have hard conversations. It's the breadth of the profession that makes it constantly challenging and eternally validating. I'm thrilled that Sensible Medicine will be a place that features stories from the trenches of medical practice, as well as takedowns of research articles.

Third, I'm a student and scholar of evidence-based medicine. That means something to me. It means that when we have really good evidence, we follow it. And we don't prioritize anecdotes and opinion above the best available evidence.

It also means that when you don't have great evidence, you're honest about that. You don't lie or oversell the truth. It's okay to tell people this is my best guess, but it's not okay to embellish or falsify. During the pandemic, we ran into a lot of situations where people outright lied about the evidence instead of acknowledging its deep limitations.

Evidence-based medicine means that, as much as humanly possible, you conduct studies to reduce uncertainty. You don't live mired and ignorance for the rest of your life. Again, during the pandemic I saw many people create excuses for why we are not generating evidence. Those excuses were almost always vapid. Recently, we published a study debunking many of the misconceptions about randomized control trials.

But if we're perfectly honest. All of these deficiencies existed before Covid-19, and all will persist thereafter. We have often adopted costly, toxic, invasive medical practices on the basis of limited evidence. Brave investigators have called for randomized control trials. Rarely they have been performed. And when they have, as often as they validate practice, they contradict it. Trials testing unproven established medical care frequently result in medical reversals. Adam and I detailed this in our book: Ending Medical Reversal.

Someday COVID-19 will be over. And the New York Times will return to its hard-hitting coverage on the pros and cons of eating blueberries or drinking coffee. Sensible Medicine will be a place to discuss the latest medical news, health policy bills on the docket, or Supreme Court rulings that affect the practice of medicine.

We will still need to re-learn the principles of evidence-based medicine for years to come. I hope Sensible Medicine is one place where I can remind you of that. If you appreciate our project, share this post.

Vinay Prasad is a hematologist-oncologist and Associate Professor of Epidemiology and Biostatistics, and also writes the substack Vinay Prasad’s Observations and Thoughts