Medical Ethicist Dr. Steven D. Pearson says definitely not.
Pearson’s opinions help shape policies that become written into law. His mission: To reduce variation in physician behavior. He believes medical care will be better, safer, and more cost-efficient when physicians base clinical judgments on “solid empirical science instead of clinical observation and experience.”
Dr. Pearson’s word choice is key to understanding where he’s coming from—and how your doctor may be required to treat you at your next appointment. Notice, Pearson uses the term “instead of” as if suggesting solid empirical science and personal experience are mutually exclusive and cannot be reconciled. His assumption seems to be that the average physician is incapable of safely assimilating new experiences.
Conformity is Safety
According to Dr. Pearson, all doctors should treat people with the same diagnosis—say high cholesterol, or cancer—the same way, and their treatment plans should be based entirely on published protocols and guidelines. He suggests doctors rely not on their own experience, but on “solid empirical science.” He claims that individuals are not capable of generating, evaluating, or implementing “solid empirical science” and that only consensus panels and groups of experts can create “solid empirical science.” Furthermore, he characterizes behavior of those doctors who prefer to interpret data themselves rather than accept the interpretation of consensus panels, as “deviant.”
Finally, Dr. Pearson acknowledges that consensus panels are frequently comprised of doctors on pharmaceutical company payrolls and this conflict of interest might present problems. Nevertheless, he characterizes currently available guidelines as “solid.”
Consensus is Truth
Dr. Pearson supported provisions in the new healthcare reform bill that will fund “physician variation” studies to single out doctors who are deviating from expert group opinions more than others.
If you are the kind of person who wants to see an independently minded physician who treats you as an individual rather than a disease state to be fitted into a predetermined algorithm, you might not like the direction medicine will be headed if people like Dr. Pearson have their way. On the other hand, maybe you would rather your doctor concern himself more with what disease category or categories to place you in, and endeavor to adhere closely to guidelines and algorithms as possible.
If you’ve read this site or any of my books, you know what side I’m on. However, maybe the Robot-doctor is what this country really needs. I want to know what you think. Send me your comments and tell me whether, the next time you or your child gets sick, you’d rather make an appointment with a Robot-Doctor, or the old-fashioned kind—the one encouraged to think for herself. Please post your comments!
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I cannot believe that big-pharm hires these “medical ethicists” to try to rationalize their campaign to get doctors to prescribe more and more drugs! I know she didn’t say that, but in my opinion, that’s probably what’s going on.
My relationship with my doctor is based on trust. And I trust that he’ll tell me what he believes is the best course of action, whether or not some algorithm tells him to do something different. I trust that he’s aware of the algorithm and has considered it before advising me.
What’s next? Before you know it, they’ll be bribing doctors to prescribe more of the drugs they tell them to, or cut their pay whenever their “deviant.” This all makes me so angry!
I don’t know who this guy thinks he is, but maybe he could look up the root for the word “ethicist”, which is from the greek, ethikos. I forget what it means, but I know for sure that it definitely don’t mean selling your educaition to the highest bidder! THINK FOR YOURSELVES EVERYBODY!!! DO YOUR OWN RESEARCH!!!
P.S. MY GRANDPA’S A DOCTOR AND IF HE WAS STILL ALIVE HE WOULD HATE THIS GUY!
We can thank the NIH and their new training grants for this attitude. Under the mantra of “bench to bedside”, the NIH funds med schools now through grants, not for interns/residents but for research: an NIH-funded Clinical and Translational Science Institute should be popping up near you if one hasn’t already. These beasts are massive, requiring inter-institutional cooperation, in addition to bringing together “public-private partnerships” and … voila… patents and patients. At an opening of one of these centers, I heard that now everybody in my state would be a potential candidate for a clinical trial.
Over my undergraduate career, reading different works by people like Weston price, your book deep nutrition, and other works, I have fallen in love with learning about nutrition, traditional eating and its ability to heal people of many conditions.
I was accepted to medical school and granted a year deferral. During this time, and the times I spent previously shadowing doctors, working in practices, etc, the less I have been excited about going to medical school. I am just completely turned off by the lack of knowledge of proper nutrition, and the way doctors just seem to treat symptoms and push pills.
I am questioning whether going to medical school would be he right thing. I realize you teach alternative approaches and traditional nutrition in your practice, but do you think if you could go back in time would you do anything different career wise knowing what you know now, and possibly being able to save the trouble of going through 4 years of med school, residency, accumulating lots of debt, etc? Would I be better off just doing something like becoming a certified clinical nutritionist, or should I stay the course and slug out med school and residency so I can work in some kind of alternative practice afterwards. Who knows, maybe they will start having more alternative and holistic residencies in the future.
Thanks.
John
Also, some of the doctors I worked with at a family practice clinic actually tried to steer me away from medical school, saying they have seen things growing worse for doctors over the years, and that things will only continue to get worse (they talked about insurance, work hours, ability to prescribe what they want, pay, etc). Have you seen this over your career ?
Hmmm..
I think if I had to do it over again, I would be better off if I’d skipped college completely and become a real estate agent in Aspen, CO.
Seriously, though, I’ll tell you what I think, I’m not sure it’s wise for me to even try to tell you what I think you should do, so I’ll try not to!
I enjoyed medical school because I felt like we were all part of “team science” and there was a big enough bunch of us that I could find several like minded friends who weren’t in it all for the money or the prestige (we all went into primary care, naturally) but for the connection to deeper truths about the world and wanted to really be able to help people. All of them have become extraordinary doctors.
I’m sure you would meet people like that in medical school, too, but now since you (and maybe even several of them) would have this background of deeper knowledge I think you could do more with your careers.
The alternative practices do not have access to insurance payments. If that changes and they do get access, I think it is likely the reimbursement will be like what the massage therapists tell me: Not often worthwhile.
Alternative therapies have fewer standardized ways of making diagnoses, which impairs the communication process between practitioners, which can stall the progress of moving the science forward, and their therapies cannot be standardized as readily: how do you tell a flower to make exactly 10ng/ml of it’s active ingredient? I know what side effects drugs can cause. I have no way of knowing what side effects many supplements can cause. As a scientist, this makes medicine more appealing for me personally, warts and all.
Any science can be corrupted by greed. Any job can become a daily grind. But the more people doing the same thing are on the same page, the more fun it will be and the more good we can do. So come on in and join the party!
And your second posting, about insurance, regulation, and so on is another common complaint I hear from fellow doctors and totally agree with. But what isn’t getting worse? Even real estate agents in Aspen are having to cut back. If it gets really bad, I’ll go work for a company that takes care of all that regulation, like Kaiser, or the VA.
I’d love it if you let us know what you decide to do!
Will do. I still have a bit of time to mull it over!
I definitely wasn’t referring to anything hocus pocus or to wacky when I said alternative. I just meant an alternative career. I have been thinking something along the lines of clinical nutrition, then I could still approach treating disease and dysfunction.