Podcast Summary
Challenging the Accuracy of the Average Body Temperature: Professor Macoviak discovered that the long-held belief of an average body temperature of 98.6 degrees Fahrenheit may not be accurate, as the original research was based on an atypical thermometer and less rigorous methods.
The long-held belief that the average human body temperature is 98.6 degrees Fahrenheit (37 degrees centigrade) may not be entirely accurate. This belief, established by physician Carl Wunderlich in the mid-1800s, has been challenged by professor of medicine and medical historian Philip Macoviak. Macoviak, who specializes in clinical thermometry, discovered that Wunderlich's original thermometer was not typical and registered almost two degrees higher than current thermometers. Additionally, Macoviak found that Wunderlich's research methods were not as rigorous as modern standards, leading him to question the accuracy of the 98.6 degree average. Through his own study using modern thermometers, Macoviak found that human body temperatures vary more than previously thought, with an average closer to 97.9 degrees Fahrenheit (36.6 degrees centigrade).
Challenging the Norm: Body Temperature and Medicine's History: Only 8% of body temperature readings are 98.6 degrees, the actual normal temperature is 98.2 degrees, and medical history includes numerous mistakes like lobotomies, mercury compounds, and the Tuskegee case.
Our understanding of normal body temperature and the practices in medicine throughout history have not always been accurate. In the case of body temperature, only 8% of readings were found to be 98.6 degrees, challenging the notion of this temperature as the norm. Macoviak discovered the actual normal temperature to be 98.2 degrees. Temperature can vary greatly from person to person and throughout the day, and an elevated temperature doesn't always indicate illness. The history of medicine includes numerous mistakes, such as the use of lobotomies, overuse of mercury compounds, and the Tuskegee case, to name a few. As a medical historian, it's clear that future generations will question our current medical practices and the importance of maintaining a healthy skepticism towards them. In this three-part series of Freakonomics Radio, they will discuss medicine's greatest hits, failures, and the current state and future of medicine.
A brief history of ineffective and harmful medical practices: Recognizing the importance of questioning and challenging medical practices leads to advancements in healthcare.
Throughout the history of medicine, particularly in the Western world, there have been numerous practices and treatments that were once considered legitimate but have since been proven to be ineffective or even harmful. These practices ranged from drilling holes in skulls to using toxic substances like mercury. However, instead of viewing this history with shame, it's important to recognize that the pursuit of health and wellness is complex and that progress often comes through trial and error. The ability to question and challenge existing practices has led to significant advancements in medicine over the past few decades. As doctors and healthcare professionals, it's crucial to remain open-minded and committed to continuous learning and improvement.
Exploring the mysteries of the human body: Significant progress has been made in understanding the human body, but much remains unknown from the gross anatomy to the genetic level. Notable medical advancements continue to transform disease treatment.
While we have made significant strides in understanding the human body from a medical perspective, there is still a vast amount that remains unknown. Historian Jeremy Green uses the concept of "known knowns" and "unknown unknowns" to illustrate this point. From the gross anatomy of the body to the microscopic level of cells and proteins, and even further down to the genetic level, our ability to explore and understand the human body continues to expand. Notable medical advancements, such as the discovery of insulin and the development of statins, have transformed the way we treat and manage various diseases. However, as historian Evelyn Hammons notes, every historian of science and medicine would have a different set of "greatest hits." Despite the progress, there is still a long way to go in fully understanding the complexities of the human body and its functions.
From anecdotes to evidence-based practices: The integration of scientific methods into healthcare led to more effective and rational treatments, thanks to advancements in public health, new therapeutics, and controlled experiments.
The advancements in healthcare and increased life expectancy over the past century and a half are the result of a combination of factors, including public health improvements, new therapeutics and medicines, and the use of controlled experiments. While breakthrough medicines have played a significant role, improvements in housing, sanitation, diet, and tackling urban problems were instrumental in reducing mortality from infectious diseases before the advent of antibiotics. The use of controlled clinical trials marked a turning point in medicine, shifting it from relying on anecdotes and charismatic leaders to evidence-based practices. However, even with the emphasis on evidence, it's important to note that practices can sometimes be reversed, as new research and understanding emerges. Overall, the integration of scientific methods into healthcare has been a game-changer, leading to more effective and rational treatments.
From eminence-based to evidence-based medicine: The Cochrane Collaboration, a global network, produces systematic reviews summarizing the best available research evidence, ensuring medical decisions are informed by reliable evidence accessible to all medical fields.
The evolution of medicine from an eminence-based practice to an evidence-based one has been a significant shift. This transformation, driven by the increase in randomized controlled trials and advancements in computer technology, has led to the production of systematic reviews summarizing the best available research evidence. The Cochrane Collaboration, a global network that produces these reviews, has been a pioneer in this field, being the first to regularly update them, implement post-publication peer review, and have a strong conflict of interest policy. Unlike the past where doctors relied on their experience, opinions, or industry funding for information, the Cochrane Collaboration provides reliable evidence accessible to all medical fields. Sir Ian Chalmers, a co-founder, observed vast differences in medical practices in the past and recognized the need for a standardized evidence base. Today, the Cochrane Collaboration continues to play a crucial role in ensuring that medical decisions are informed by the best available evidence.
Discovering the need for evidence-based medicine through tragic consequences: Dr. Iain Chalmers' experience at a refugee camp led to the establishment of the Cochrane Collaboration, emphasizing the importance of evidence-based medicine and randomized trials in providing the best care for patients.
The importance of evidence-based medicine was brought to light when Dr. Iain Chalmers discovered the fatal consequences of outdated medical knowledge during his work at a refugee camp in Gaza. He found that children with measles were dying from bacterial infections due to the lack of preventative antibiotics, despite medical school teachings against it. Frustrated and saddened, Chalmers embarked on a mission to systematically review and compile medical research to provide the best evidence for medical questions. The Cochrane Collaboration was born, and despite initial resistance from the medical community, it became the new standard for evidence-based medicine in the late 1980s and early 2000s. The use of randomized trials, which provide clear cause-and-effect evidence, became more common and mandatory. The story of Dr. Chalmers highlights the importance of continually challenging outdated medical knowledge and relying on solid evidence to improve patient care.
Medical reversals: Contradicting long-held medical practices with new evidence: Rigorous scientific evidence is crucial in medicine to challenge and update long-held beliefs and practices, as shown by medical reversals.
The practice of medicine involves making diagnoses and prescribing treatments based on the best available evidence at the time. However, the feedback loop in medicine is often sloppy, making it difficult to determine if a treatment was effective or not. This was highlighted in the late 1980s with the Cardiac Arrhythmia Suppression Trial (CAST), which showed that a commonly prescribed antiarrhythmic drug did not improve survival as previously believed but actually worsened it. Such contradictions to long-held medical practices are called medical reversals, and they underscore the importance of rigorous scientific evidence in guiding medical treatment. For instance, the recommendation for post-menopausal women to take estrogen supplements based on observational data was contradicted by a well-designed randomized controlled trial in 2002, which found that they increased the risk of heart attacks and strokes rather than decreasing them. Vinay Prasad, an expert on medical reversals, became interested in this phenomenon while still a student, observing that contradicted practices still persisted in hospitals despite newer, better evidence. In summary, the importance of rigorous scientific evidence in medicine cannot be overstated, as even widely held beliefs can be contradicted by well-designed studies.
Issue of Indication Drift in Medical Procedures: Despite studies showing ineffectiveness, doctors continue to perform unnecessary procedures like stenting for stable angina due to financial incentives, leading to loss of faith in medical system if patients are not informed.
Many medical procedures and treatments, including stenting for stable angina, have undergone "indication drift," where they are used for conditions for which they may not be effective. Studies have shown that stenting for stable angina does not improve survival or decrease heart attacks, yet the rate of inappropriate stenting remains high. This issue raises questions about doctors' incentives and financial considerations. Other treatments, such as certain knee surgeries and cement injections for broken vertebral bones, have also been found to be placebo effects. While new studies often conclude that newer is better, studies testing existing treatments often find contradictions or reversals. These reversals could lead to a loss of faith in the medical system if patients are not informed of the latest research. It is crucial for medical professionals to stay informed of the latest research and communicate effectively with their patients about the effectiveness and necessity of various treatments.
Prioritizing evidence-based medicine and ethical practices to minimize medical reversals: Medical field should prioritize evidence-based medicine, effective regulation, and ethical practices to minimize harmful medical reversals. Regulation should ensure only safe and effective treatments are approved, especially for rare conditions. Physicians should communicate uncertainty clearly to patients.
The medical field must prioritize evidence-based medicine and education, effective regulation, and ethical practices to minimize the occurrence of harmful medical reversals. The current system, where basic science is taught before evidence-based medicine, needs to be flipped. Regulation should be adjusted to ensure that only safe and effective treatments are approved, especially for conditions with many options and low incidence. Lastly, physicians must communicate uncertainty clearly to patients when offering uncertain treatments. The consequences of medical reversals include causing harm, lag time harm, and loss of trust in the medical system. These issues have been highlighted in recent years with shifting recommendations for mammography and prostate cancer screening. It's crucial to address these challenges to maintain trust and confidence in the medical profession.
Barriers to an evidence-based healthcare industry: High costs and entrenched interests hinder the healthcare industry's progress towards becoming more evidence-based, with the pharmaceutical industry's excessive pricing and exclusion of certain populations in clinical trials being major contributors
The healthcare industry, specifically in the United States, faces significant barriers in becoming more evidence-based due to entrenched interests and high costs. The pharmaceutical industry, for instance, has been criticized for pricing drugs excessively, with the average cancer drug costing over $100,000 per year. Additionally, clinical trials have historically excluded certain populations, such as women and vulnerable groups, leading to questions about the representativeness of the data. These issues contribute to the healthcare sector's resistance to change and hinder the progress towards a more scientific and evidence-based approach.
