Saturday, September 5, 2009

Is medicine going backwards?

One of the talks I am giving to the OBs, Pediatricians and Midwifes in Mongolia is reviewing neonatal resusciation and the reasons for using room air v. 100% oxygen.  This is a relatively hot topic in the neonatal community as there an ever growing body of evidence that 100% oxygen in the first minutes of life isn't a good thing.  There have also been several studies recently that have demonstrated that babies resuscitated with room air do just as well if not better.  The problem is that several of these studies were not approved to be done in the US because they couldn't get IRB approval due to the strong belief that oxygen was needed, that they would be "doing harm."  Further, at least one of the early trials had the Oxygen arm in developed countries while the room air arm in the developing nations.  Again a way to bypass IRBs, but also potentially treating those in developing nations with less respect.  An interesting issue to deal with when giving the talk in a developing nation.  I'm trying to be sensitive to these concerns without ignoring them.  It is a fine line.
Further, in tangentially talking about this the other night over dinner, we wound up discussing how medicine might be about to start going backwards, or at least stop forward progress, given the need to have everything so tightly monitored and watched over.  So many of the great advances in medicine occured through happinstance and use of questionable techniques.  If Alexander Fleming complied with current standards of cleanliness and research protocols, we might not have penicillin.  If Jonas Salk wasn't willing to consider injecting people with cow pox, small pox might not be erradicated, and the concept of vaccines might never have been born.  These are major steps forward that occurred in ways that would be considered unethical now.  There are more recent examples too, a study completed in England in the 90s was considered unethical in the US because it was potentially witholding life saving therapy even though that therapy had never been proven effective, nor rigorously studied. I'm currently trying to get a research protocol through my institutions IRB and the amount of red tape for something simple is mind boggling.  
Is it possible for medicine to continue to move forward in this era?
How do we continue to move our therapies forward and respect all people equally? because just taking the studies out of the US is not the answer...

1 comment:

Jodi said...

What a thought provoking post. Do you think a lot of lack of experimental therapies and the massive amounts of red tape have to do with the litigious nature of things? I think that greatly impacts so much of the practice of medicine these days. There's a reason why people end up going to Mexico and other places for treatments they can't get here, often as a last ditch effort. It's really sad when you think about things like the politicizing of stem cell research, spinal cell regeneration research, etc.