Why Common Sense In Medicine Often Fails

In 1967 (the year in which I was born) a study about heart attacks was published in the prestigious New England Journal of Medicine. It was one of a number of similar studies in the 1960s showing something important and dramatic: lidocaine—the same drug we use to numb up the skin for minor procedures—could be used to prevent deadly heart rhythms after a heart attack. The idea itself goes back to the early part of the 20th century, but this study and the ones like it showed definitively that lidocaine (usually given by IV) suppressed often-fatal heart rhythms like ventricular fibrillation (VF) and ventricular tachycardia (VT). Lidocaine became the standard of care to prevent VT/VF after a heart attack.

The study of medicine is tricky. Human beings aren’t simple machines but a complex biological system full of interdependent parts and chemical reactions. The most logical-seeming ideas about human health often break down under the scrutiny of well-done science.

Part of doing science is coming up with the right question. Another important part is asking a question the right way: come up with a hypothesis, test it, and keep or trash it depending on the results. The wrong way is to come up with a hypothesis and keep doing experiments until you get the answer you wanted. This is a surprisingly common mistake.

In most of the studies about lidocaine, the question asked was, “does lidocaine stop these often-fatal heart rhythms.” No one thought to ask, “does lidocaine save lives,” which is a little different and a lot more important.

In 1999, a group of doctor-scientists decided to do just that. They built on the work of about ten years of work of other curious and concerned doctors and designed a powerful experiment. They studied heart attack patients and also looked back at years of data from other studies. The conclusions were both expected and unexpected: lidocaine certainly reduced VT/VT in patients after a heart attack. But patients who received lidocaine tended to die more often than similar patients who didn’t get lidocaine. An editorial in the in the same issue of the American Heart Journal recommended we stop using lidocaine this way.

I bring this up to show one of the pitfalls of practing medicine: an idea can be completely logical and can even by correct, at least in part, but until you ask the right question and test it the right way, you risk hurting your patients.

I also bring this up as a warning: the safety and efficacy of vaccines like the MMR has been tested the right way over and over. Measles vaccines not only save lives, they are also very, very safe. But the current head of HHS, Robert F. Kennedy, Jr. has just appointed a well-known crank to “study” the question again. David Geier is well-known to those of us with an interest in vaccination and vaccine safety, and by “well-known”, I mean well-known to be a dangerous fraud who has previously been disciplined for practicing medicine without a license. When you read about what he and his physician-father David Geier did to children, you will be horrified. This is a man who defintely does not ask a scientific question and follow the evidence to wherever it may lead. He has dangerous, pre-formed conclusions and will torture the data until he makes it say what he wants.

We are in the midst of a growing measles outbreak and a growing problem with bird flu. Kennedy has stated that he wants to de-emphasize our focus on infectious disease at just the wrong moment. And putting a dangerous and disgraced non-expert in charge of asking the wrong questions in the wrong way will ultimately kill children.

Now more than ever we have to remember that medicine is complex. We need objective experts who know how to ask the right questions and test their hypotheses the right way.

Stay well.

-pal