Beyond Mainstream Medical Wisdom: Problems with Guideline-Based Treatments
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During my four decades as a physician, there have been many dramatic advances in medical care. Studies inform us as to the benefits and risks of new medications and procedures, and guidelines based on those studies are constructed to advise doctors concerning their use.
Problems With Guideline-Based Treatments
That said, there are many important problems with the guideline-based treatment of patients. Here are some of them:
- Information evolves. Guidelines that were believed by all to be right can turn out to have been wrong.
- Guidelines are often based on industry-funded studies that often are not free of bias.
- Guidelines advise what medication or intervention is best for the average patient. If Drug A is effective in 60% of patients and Drug B in only 40%, guidelines will recommend Drug A for all. Consequently, the patients who would respond better to Drug B are never given Drug B.
- Guidelines are based on the results of large drug trials. The invaluable results of a much larger number of enlightened but smaller or briefer studies are ignored.
- Many great drugs, particularly older drugs, are forgotten as the intensely marketed new drugs dominate research and commercial attention. Guidelines are based on large studies, but large studies are funded mainly for the new drugs. Worse, we are at risk of permanently losing some of those older drugs.
- Guidelines ignore valuable clinical experience. In the course of seeing thousands of patients, many practicing physicians make important observations that are not reflected in guidelines. Unfortunately, practicing physicians have neither the funding nor the time or expertise to conduct formal studies and deal with the mountains of red tape. The lessons of their experience will die with them.
In my blog, entitled Against Conventional Medical Wisdom, I will present down-to-earth, valuable information that will surprise you. In many instances, it will address issues that guidelines don’t address. It reflects the art of practicing medicine. It is backed by clinical experience and supported by published studies and by what we know about physiology and pharmacology. It is also backed by logic and common sense. Yet much of it is unknown to most patients and physicians. Its value will be very obvious.
I believe the information I will convey in upcoming blogs will be relevant to the health and treatment of millions of people treated by conventional medical wisdom. I am confident that you will enjoy reading these articles and find them meaningful.
About Samuel J. Mann, M.D.
Dr. Mann is a physician, researcher, author, and specialist in the management of hypertension. He focuses his career on improving the management of hypertension by getting patients onto the drugs, combinations, and dosages, that is right for them. Dr. Mann is the author of two books. “Hypertension and You: Old Drugs, New Drugs and the Right Drugs for Your High Blood Pressure” and “Healing Hypertension: A Revolutionary New Approach”. Dr. Mann currently holds the position of Professor of Clinical Medicine in the division of Nephrology and Hypertension at New York Presbyterian – Weill Cornell Center, New York, NY. He has also written extensively about “mind/body” hypertension, offering a very different view of the link between emotions and hypertension, and has pioneered new approaches to treatment.
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Beyond Mainstream Medical Thinking
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