I am planning a column on the role of experts in translating medical evidence. Evidence is important because it’s how doctors know they are helping not harming people.
It’s hardly news that the new (digital) democracy of information has changed the rules of influence in Medicine.
In the days of old, academic doctors generated, analyzed and translated evidence. We called these people key opinion leaders (KOLs). To become a KOL, you stayed in academics, published lots of studies, and crucially, you were not too critical of prevailing views.
If you did that, you could get invited to speak at meetings, write editorials and participate in expert guideline documents.
This vertical (or top-down) model still exists, but social media and the democracy of information is breaking it down a bit. More and more, ideas can garner influence based on their merit rather than their source. Resistance to expert views seems to be on the rise.
Some recent examples:
- Neurology experts strongly recommend use of TPA (clot-busting drugs) in stroke. Many emergency doctors have looked at the same evidence and are not convinced. I’ve sided with the emergency doctors, but our analyses have been criticized mostly because we are not “experts.”
- Cardiology societies have endorsed recent guidelines for treating high blood pressure. Family medicine leaders have looked at the same evidence and come to a different view.
- The USPSTF (United States Preventive Services Task Force) are an independent voluntary group of scientists tasked with making evidence-based recommendations. Their look at the evidence has sometimes conflicted with those from professional societies–most notably in the review of screening for cancer.
My questions are:
How much a role should experts play in translating evidence?
Can non-expert clinicians come to a more balanced review of the evidence? Perhaps experts are too close to the topic at hand–e.g. AF ablation doctors writing guidelines on AF ablation?
The opposing viewpoint holds that one needs the context of being an expert to understand and translate studies of medical evidence.
A related question is that if you put 10 people on a writing committee for treatment of a medical condition, how many should be experts in the field and how many should be independent experts in evaluating medical evidence, like statisticians and epidemiologists? Now the majority are experts in the field.
When I have written about using stents in patients with stable coronary disease, or TPA in stroke, or screening tests for cancer, some have said that I am an electrophysiologist and should “stay in my lane.”
I am interested in your thoughts on these questions.
P/S: Inherent in this debate is the matter of who is more expert: the hobbiest doctor who spends most of his/her time running trials or the doctor who spends all his/her time seeing and treating patients?