Pandora of Medicine: Guiding Evidence-Informed Practice

I recently opined that pharmacists must be a major part of winning the “War on Error.” To optimize their role as drug therapy experts, pharmacists must also help develop and ultimately embrace a “Pandora of Medicine.”

It is well understood that health care providers should rely on clinical evidence to make treatment decisions, but it is less clear why they don’t. Scientific journals date back to the 1600s, when their publishers disseminated them physically. This practice was relatively unchanged until the 1960s, when the US National Library of Medicine (NLM) developed the Medical Literature Retrieval and Analysis System, which we now know as MEDLINE.

Though the system has advanced over the last 50 years, searching the medical literature is still considered tedious and time consuming because there are tens of thousands of scientific journals to access. Health care providers are trained to make data-driven decisions, but unfortunately, they don’t have the resources or the time to do so.

Even the most proactive health care providers couldn’t possibly read and digest all of the 22 million available studies. Not to mention there are more than 300,000 prescription and OTC medications available to treat the more than 10,000 existing diseases, and more than 10% of the population takes at least 5 medications.

It’s just not possible for health care providers to keep up with the ever-changing medical literature. So, most medical knowledge still comes from school, even though cognitive limitations prevent providers from remembering it all.

A “Pandora of Medicine” would combine all of this ever-changing medical evidence with individual patient records, environmental data (from a GPS that tracks where patients spend their time), social data (from social media usage), activity data (from a Fitbit or smartwatch), and genetic data (from a one-time test) to help make treatment recommendations.

Kaiser Permanente seems to be a leader in building such a tool, as it already has 10 million real-time medical records that include 30 million e-visits last year, with data scientists modeling key diseases.

Even when a “Pandora of Medicine” becomes reality, the hard part will be getting clinicians to embrace it.

A sizeable cohort of health care providers still sees themselves as being positioned somewhere between humans and God. Even as technology becomes available, they are understandably reluctant to embrace it because it represents the idea that a computer could practice better medicine than a health care professional.

Some also claim that data-driven decisions are at the expense of individual patient needs. Many providers will see the “Pandora of Medicine” as not being in the best interest of the patient.

Instead of using technology to facilitate “evidence-based medicine,” health care providers should use it to guide “evidence-informed medicine.” Treatment decisions should not be based on data, but rather informed by it along with other determinants such as the patient’s expectations and tolerance for risk.

The average annual temperature in Georgia where I live is 61 degrees Fahrenheit, but I wouldn’t dress for 61 degrees every day. It would be incredibly difficult in January and unbearable some days in July. In the absence of other information, the average annual temperate is a good way to make an educated guess, but it would be irrational for me to ignore more specific information about the weather conditions on a certain day.

Similarly, the “Pandora of Medicine” should be embraced as an essential guide for the skilled health care professional. By facilitating evidence-informed medicine, I believe we can lead the way to higher quality, lower cost care.