If it doesn't work, stop it

Editor—Why do doctors use treatments that do not work?¹ A simple question with many answers.

1. Doctors are paid to do this.

2. Doctors are taught to “practise medicine” not to “help the patient.” When these do not overlap doctors are guided by adherence to professionally accepted theories as much as by evidence of benefit.

3. Diffusion and uptake of knowledge have limits. Doctors are overloaded with irrelevant information but have little access to information on things that they have been doing for years but do not work.

4. There is a tension between short term relief and long term attempts to “help the patient.” Some things provide instant relief but little long term benefit (or even harm).

5. Effort must be justified. If people take a lot of effort to achieve something they tend to justify their efforts by attaching value to what they have achieved. Doctors spend years learning to offer some treatments that don't work, making it harder to accept that they may have no value.

6. The myth of the pathophysiological model is strong. Students are taught medicine as if people first learnt how the body works, then learnt how it went wrong, and finally deduced how to fix it. This makes doctors resistant to evidence from clinical trials contradicting a cherished pathophysiological model. In reality, medical knowledge is often discovered in reverse. We first identify an illness, accidentally finding that something works to cure it. We then infer how the treatment works and elucidate the underlying disease mechanism.