Sunday, November 24, 2019

Why does it take so many years beforeMedicine changes ?

 For example CHF (Congestive Heart Failure)

People engage in the rhetorical process anytime they speak or produce meaning. Even in the field of science, the practices of which were once viewed as being merely the objective testing and reporting of knowledge, scientists must persuade their audience to accept their findings by sufficiently demonstrating that their study or experiment was conducted reliably and resulted in sufficient evidence to support their conclusions.
Wikipedia

It is 1997. The hearts Of 10 per cent Of elderly people in the UK are failing
to pump blood effectively. Doctors manage them With established
methods such as diuretics (costing the NHS over 60m pounds per year). Drug
companies am producing new ACE inhibitors. Inventors and Wikipedia
manufacturers a new kind of instrument (echocardiographs) for
measuring heart failure that can help guide the use of ACE inhibitors.
Researchers (with the help of research funders, industry, health service
providers, patients, universities, journals) show that the use Of these new
techniques unquestionably improves care. Department of Health civil
servants, anxious to meet political targets and demonstrate NHS
improvements, call on national/ opinion leaders to endorse the research
findings to guide improvements in practice. Royal colleges, R&D centres
and medical journals am strongly promoting evidence-based practice. The
resulting guidelines and exhortations to a large extent fall on deaf ears;
many GPs cavil at such external interference, But they are coming round
to the idea that clinical audit —still in 1997 seen warily by many doct01S
as a suspect innovation — is a Good Thing. Audits are showing that some
patients do well on old-fashioned diuretics but some continue to die
unnecessarily. The NHS management hierarchy exerts pressure through
performance targets for improving the proper use of the new drugs.
Meanwhile public health doctors in Heartshire, anxious to assert their
role in improving health, produce a document showing that thousands of
life years might be gained locally by conforming to the new guidance.
Cardiologists the Heurlshire Hospital are mightily frustrated by the
lack of action to set up a much nccdcd  echocardiography scericc. Local
GP opinion leaders argue for two main changes to combat serious defects
in services for people with heart failure: (1) use more ACE inhibitors and
(2) establish an open echocardiography service directly accessible to GPs.
Others argue that echocardiography should be obtained only through
cardiology out-patients. Those keen to improve the service begin to
examine the research evidence closely and find little clarity about
clinically important details such as the dosages of ACE inhibitors or the
Echocardiographic criteria


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