2015Weeknotes

How Instincts and Evidence Drive Medicine and Guide our Project

How Instincts and Evidence Drive Medicine and Guide our Project

Listening to Dr. Gil Gonzales at Massachusetts General Hospital, I couldn’t stop thinking about how the best practitioners of medicine treat it as both science and art. In almost every sentence, he swerved between how evidence is so important for medicine, but how each patient is different; how so many things in life follow logarithmic trends, but key individual discrepancies are where you can make the most effective interventions. As he showed us a case study from a stroke patient, he described what was seen in all stroke patients, and what was specific to this person’s case. The eventual treatment he described was a wonderful blend of the two: an idea driven by instinct and based in fact. Something which his artistic side saw as unique for the particular patient, but also could be supported by ideas found in the latest academic papers.

He’s not unique; ask many passionate doctors and they will tell you it’s not just the books that help them practice, but their own experience with the heterogeneous patient population they encounter. Because every patient is different, often the same prescribed treatment doesn’t work, and doctors need to do more than just follow a protocol. In our experience of clinical trials though, we see the artistic side has been pretty much erased from the system. The clinical trial system is based purely on numbers, evidence, and facts. One or two success stories, no matter how great, are never enough to get a drug through the clinical trials process. On the other hand, high enrollment numbers, protocol instructions that have to be followed to the letter, and unlimited documentation is what defines clinical trials today. It’s inconceivable that we would ever ask doctors to practice medicine using only aggregate data without focusing on the patient, but the clinical trials process does exactly that. This might be an extreme metaphor, but it’s as if modern paintings were to be judged by computer software based on numerical analysis of color rendering and online popularity polls.

It’s no wonder that Dr. Gil Gonzales said that the patient has no power in the process. Every patient in the clinical trials system is turned into data, deidentified, and then aggregated into analysis using statistical methods. Maybe bringing some of the instinctual practices so prevalent in medicine into the clinical trials system can help solve this problem.

Luckily, our team is more like the practice of medicine than the current system of clinical trials. We hope to blend our skills in design and engineering, much like doctors blend art and science. We anticipate, then, that we can use our instincts to guide us to solutions that are based in evidence and fact.

By:
Sauleh Siddiqui