By Victor M. Montori, MD, MSc
Harlan Krumholz is a healthcare hero. He has actively campaigned against the corruption of healthcare and has received attacks aimed at him personally and professionally. He has formed a cadre of rigorous researchers in cardiovascular outcomes research who meet regularly. He is now the editor of the leading journal in this space. He is an independent thinker, a productive researchers, and a supportive and loyal mentor to his peers and students. The opportunity to express my admiration comes from the publication of Harlan’s op-ed in the Washington Post that directly relates to the topic of this blog.
For minimally disruptive medicine to take place, clinicians and patients need credible research evidence about what works, how much interventions are able to accomplish in terms of patient-important goals and outcomes, and what are the harms and costs to pay to get those benefits. Both positive and negative trials (the latter referring to those who find conclusions of no difference between a new intervention and no intervention, placebo, or the standard of care) are essential to this mission. However, negative trials are less likely to be published which furthers the notion that most of medicine’s treatments on average are effective.
Harlan’s Op-Ed makes a strong case for supporting, publishing, and celebrating negative trials. And this is important for minimally disruptive medicine and to answer the question that patients ask: “is there something that we can stop doing?” For many of my patients with diabetes taking pills this means that they can stop checking their blood sugars using finger sticks. We know this from well conducted research showing marginal, if any, benefit.
Clinicians and patients in the US are enthusiastic tinkerers and are in the lookout for exciting new opportunities to improve their health. As a result they are often attracted to new potentially effective therapies. Publication of only positive trials contributes to sell those therapies; hiding of negative trials distorts the record, misleads clinicians and patients, and corrupts healthcare.
Thanks Harlan for raising this issue, and for all you do for patients.