Jerry Avorn, M.D.
Professor of Medicine, Harvard Medical School
Co-Founder & Special Adviser, NaRCAD
Tags: Evidence Based Medicine, Jerry Avorn
Inside the world of academic detailing, we’re all convinced of the clinical power of information transmission when done well, and of the harm that can result if it’s done badly or not at all. But outside our mighty little community, many are skeptical about whether pushing out accurate evidence really has such enormous effects. A silver lining of Covid-19 as it recedes a bit into the rearview mirror is that the experience can help us put some of those questions to rest once and for all.
Many lives were changed by the effective, accurate transmission of medical reality about the virus, how to prevent its terrible consequences, and how best to treat people who are infected. Thousands of doctors and millions of patients were offered and acted on accurate information about covid, and the point was nailed down by its counter-factual: the millions of patients (and yes, some doctors and health care professionals as well) who received and acted on bad information, with tragic consequences. It was the same virus, more or less, the same vaccines, the same effective and ineffective treatments: sort of a controlled study in which effective transmission of evidence-based facts was lifesaving, and its opposite was often lethal.
Covid was just the most dramatic and recent example of issues that all of us interested in academic detailing have been grappling with for years. It was like a student coming to class one day to confront a surprise pop quiz that will determine three-quarters of the grade. Those who had been diligent all semester could deal with it handily, while those who hadn't been paying enough attention are astonished and devastated. It’s the same for the transmission of clear information about most of the medical conditions our programs confront every day.
The pandemic was just the most striking recent example of the good effects of getting this information-transfer right, and the terrible consequences of getting it wrong. We've seen this movie before, in preventing and treating cancer, diabetes, heart disease, maternal and infant mortality, and a host of other conditions for which we have good preventive and therapeutic options to teach about to save lives (and huge costs) by handling that information transfer well, or lose lives and treasure if we do it ham-handedly.
It's been estimated that by early 2022, the risk of illness and death from Covid was determined more by the flow of information than by the biology of the virus. That sounds dramatic, but it’s probably been equally true for years for the other conditions noted above. The pandemic was like a controlled experiment: when confronted by the same infectious agent (more or less) and the same preventions and treatments, some health care systems and communities did much better than others. True, the problem was often lack of access; but another major cause was lack of good transmission of accurate knowledge.
This should be a bracing call to action for academic detailing programs as well as the healthcare delivery system as a whole. If the effective dissemination of accurate, actionable facts can play such an important role in infectious disease, cardiovascular illness, diabetes, pediatrics, obstetrics, and nearly every other branch of health care, the good news is that the “pop quiz” of Covid that we’ve just lived through can remind us how much we can do to enhance that flow of education to transform the best science into the best practice – as well as the awful consequences of getting it wrong.
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Jerry Avorn, MD, Co-Founder & Special Adviser, NaRCAD
Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief Emeritus of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist, geriatrician, and drug epidemiologist, he pioneered the concept of academic detailing and is recognized internationally as a leading expert on this topic and on optimal medication use, particularly in the elderly. Read More.
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