Studies chosen to appear in medical journals adhere to strict protocols. These rigors help to ensure the reliability and applicability of the data, but they also obscure the realities of medicine, argues Abigail Zuger.
“[M]edical reality always diverges wildly from the printed record. Drugs often don’t behave the way they do in studies, and patients almost never do. Labs make mistakes. There is an unending parade of problems for which the received wisdom holds no answers.
“Sometimes I think the oasis of the medical library should be maintained as a pleasant and essential refuge, mirage though it may be. Loose ends are all neatly tied there, and every chart flows nicely down the page. Like the mythic Jerusalem, city on the hill, it inspires us all.
“Sometimes I think it’s a disgrace and a lie. Why not tell it the way it is, for a change? Let journals immortalize all the messes and foul-ups in print, the spurious lab results, the problems that never get solved or the ones that seem to solve themselves despite us.
“Let’s hear about the patients on the placebo, and the ones who drop out of studies, and the ones who can’t get in to begin with.”
These topics clearly don’t have a place in traditional medical journals, so where else can they be addressed? Blogs and forums currently fit the bill. However, blogs suffer from a restricted number of participants, while forums are full of personal experiences from a self-selected group that may or may not be applicable to a larger group. Is it possible to have a more controlled (and thus more reliable) venue for such information? Is it even desirable?