Medicine: A work in progress

Our job is to sift through all of the research that is carried out (and there is a lot) and utilise the research that makes sense.

As I sat down to write this article, my initial aim was to try and pinpoint the biggest advances in medicine over the past year. In doing so, I rather suspect I made a rod for my own back. It turns out that pin-pointing specific advances that aren’t incredibly specialised and frankly mundane for the uninitiated is quite difficult. Headlines from certain sections of the media pronouncing grand new breakthroughs every other day would have you believe that vast strides are frequently made overnight. Talk of “miracle cures” and such is all too common and, while regular grand discoveries may not in reality be as frequent as they were perhaps a century ago, this is not to say that dramatic advances are not being made. Rather the process behind these advances is simply more gradual and far more intricate.

This led me to reflect upon one of the most interesting aspects of medicine and hopefully by the end of this article I will have conveyed the numerous ways in which medicine and the way in which we practise it remain a work in progress.

Throughout the last century people felt justifiably reassured by the steady advance of medical know-how. The twentieth century saw some incredible breakthroughs in the organisation of medical care, the understanding of disease and the implementation of effective treatments. (Antibiotics, public health, surgery, pharmaceuticals… the list is almost endless.) A lot of this will have been based on a new approach – evidence-based, which I will come to later.

Even now, however, even after all these advances, it is important to acknowledge that we don’t know everything and must constantly strive to improve and develop existing treatments as well as being on the lookout for new ones. Part of this will involve adapting to changes in demand which may vary to one decade to another. Thankfully, as you read this, that is exactly what many people are working on in order to stay up to date and push the boundaries in order to make treatments more effective. Not only is medical research important, it is – for better or for worse – big business. As such, a phenomenal amount of money is invested in research every year. In the UK alone, the Industrial Strategy Challenge Fund has set aside £146m of government money over the next four years for life sciences. Add to that the countless charities working on medical research along with the pharmaceutical companies and one can see how much activity there is in this field.

It is inevitable therefore that we see headlines almost daily about rumoured miracle treatments for this and that and warnings about things to avoid that at first glance seem perfectly innocuous (eg burnt toast – cancer).

Our job is to sift through all of the research that is carried out (and there is a lot) and utilise the research that makes sense. Often this is done via panels that do that work for us and produce guidelines, though it must be said there is frequent disagreement amongst professionals about even these. Needless to say, there is considerable variation in the quality of research and some of it must be taken with a pinch of salt.

If we consider the development of a new drug, for example, one of the most important aspects is naturally whether or not it is effective. In order to answer this question, studies must be carried out to trial it on ideally as many people as possible in order to iron out any statistical inconsistencies. The longer the trial goes on the better, for the same reason. Add to that the complicated task of removing as much bias as possible from those carrying out the study and one will find that, of the thousands of studies carried out each year, very few have enough statistical power to draw totally reliable conclusions.

Unfortunately, even the most unfounded conclusions end up as headlines. Here’s an example. “Tattoos could give you cancer, new research suggests”. This was based on a study in which 4 out of 6 donors had ink particles in their lymph nodes after post mortem. There was no information about whether the donors had cancer or not. And yet, for many, that headline is enough. For this reason, we all have a responsibility to be wary about what we take from the news no matter where it is published. It is so easy to fall foul to misinformation, even health ministers are not immune.

It is important to add that some studies, although they do not come up with firm conclusions, add to the body of research out there. If people didn’t at least try to generate evidence, progress would be much slower. For example, last summer a UK study hit the headlines following its claim that the age-old notion of finishing a course of antibiotics may be outdated. It suggested that doing this actually contributed to antibiotic resistance. Quite rightly the study did not sway official advice – to finish the course of antibiotics even if you begin to feel better before they run out – because the way the study was carried out left too much scope for bias from the organisers. It did however raise the question and will no doubt encourage further, more powerful, studies in the future that will give us a better idea of what we should be doing.

So this is what I mean by an evidence-based approach, as mentioned earlier. This approach has become the cornerstone of modern medicine and for good reason. So, while it may not have given us a list of show-stopping breakthroughs of late, it has given us a valuable and active research community that is perpetually in motion and coming up with improvements and suggestions, however large or small, all of the time.

To finish, I must stress that development of medicine is not just about medications and treatments. It is vital that we are able to utilise these treatments in the best and most effective way possible. Technological advances are becoming more prominent (artificial pancreases for type 1 diabetics and drones delivering medical supplies for example) but, with the current levels of demand and the well documented pecuniary squeeze in mind, for me the biggest advance in 2017 has been the provision of locally available care. As hospitals come under more strain, a big drive to treat more people in the community is afoot through minor injury units, intermediate care and rapid assessment units. Having services like this makes a huge difference and I feel I must highlight how much of a positive these additions have been. The more people are aware of the services available, the easier it is for the health services to spread the load. After all, if the strain on our health services becomes too difficult to sustain even at the most basic level, it may be even more difficult to make the clinical breakthroughs of the future a reality. 

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