Show 1409: From Hippocrates to Hypocrisy: The Hidden Risks of Healthcare

This Saturday morning, November 23, 2024, an expert from Australia helps us examine the hidden risks of healthcare. Healthcare providers have the best of intentions, but they simply cannot truly uphold the (apocryphal) part of the Hippocratic oath that urges “First, do no harm.” How can patients and their families become more familiar with the pitfalls of modern medicine and avoid them as much as possible?

You could listen through your local public radio station or get the live stream at 7 am EDT (11/23/2024) on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the live broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the audio stream on this post starting on November 25, 2024.

From Hippocrates to Hypocrisy:

Historically, medical students were expected to take the Hippocratic oath upon graduation. Although the original Greek does not actually contain the warning to do no harm, the oath is widely believed to carry that intent. Yet it may be difficult for doctors to avoid harming some patients. We’ll examine where patients should be especially vigilant and how the evidence from careful studies can help. Other portions of the Hippocratic oath are also routinely violated in the context of current medical practice.

One problem is that we don’t always have evidence for the medicines or other interventions physicians are using. For a long time, rheumatologists prescribed hydroxychloroquine for their patients with lupus, expecting that it would be helpful. They had no real evidence that it would help until finally scientists conducted a randomized clinical trial. This showed that hydroxychloroquine is, in fact, better than placebo for treating lupus. That original lack of evidence, though, is one of the most serious hidden risks of healthcare.

Knee arthroscopy is another example. Surgeons assumed that looking into the knee joint and removing any bits of collagen debris they found there would reduce knee pain and improve function. But when a study was eventually done to confirm that assumption, it turned out not to be true.

When drugs are tested prior to approval, many people may be excluded from the clinical trials because their conditions might make the findings harder to interpret (or potentially make the benefits harder to see). Once a drug is available, do doctors also avoid prescribing it for those who were not included in clinical trials? Usually not. Also, if it was approved for a fairly narrow indication, healthcare providers may start using it far more widely.

The Cochrane Collaboration:

Dr. Rachelle Buchbinder is Coordinating Editor of the Cochrane Musculoskeletal, Back and Neck division, along with many other responsibilities. Many people have not heard about the Cochrane Collaboration, so we asked her to describe it. Volunteers trained in objective methods of assessing clinical trials examine all the clinical trials that have examined a specific intervention. Quite often, what they find is that the existing studies have a lot of flaws. But occasionally, their high-quality systematic review shows that, yes, the research shows that this approach works for this problem. Or possibly, no, we should not use such an intervention for that problem. For example, a Cochrane review demonstrated that despite popular opinion, medical cannabis is NOT effective against chronic pain.

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