First, do no harm – as applied to unproven medical technologies

In an opinion piece in the Wisconsin State Journal, physician Phil Colmenares writes:

“U.S. physicians irresponsibly adopt all sorts of new, unproven gadgets or procedures, and inappropriately recommend or perform unnecessary heart surgeries, heart catheterizations, robotic surgeries, back surgeries, MRIs, CTs, and PET scans.

In addition, physicians are often unfamiliar with the science of clinical effectiveness. Most of their justifications for the use of unproven therapies are based on evidence (often industry-supported) that use soft or surrogate outcomes that may or may not be related to clinical outcomes. A rigorous definition of clinical effectiveness requires use of hard, patient-oriented clinical outcomes.

Comparative effectiveness research is a step in the right direction, but it falls far short of a serious federal effort to provide the necessary scientific infrastructure to support the hard work of determining the clinical effectiveness of many unproven medical therapies in use today.

For now, state action is our best hope. In 2006, the Washington state legislature set up a Health Technology Assessment program “to ensure that medical treatments and services paid for with state health care dollars are safe and proven to work.” There is no reason why Wisconsin cannot do the same.

There will always be a degree of uncertainty in medical practice, but it should not be used as an opportunity to maximize profit. It should be used as a challenge to use a scientific, unbiased approach in the service of patient care.

Unfortunately, the financial rewards associated with a complacent, unscientific attitude toward unproven medical technologies have distracted U.S. physicians from their fundamental ethical and professional duties.

One of those duties is primum non nocere. (First, do no harm.)”

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