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Sunday, January 3, 2016

Flawed testing

I saw a young patient in my practice this past week with a very difficult medical problem. She had a recurrent and painful condition which had defied characterization and treatment. I felt bad for her. Her life has been turned upside down.

My approach to such patients is marked by primarily by being persistent, mostly because effective treatment is often more about trying lots of things.  There is an awful lot of guesswork within present day medicine, whether we own up to it or not. My patient was not happy with my approach. I assured her that we could work through her problems and likely find a solution which resulted in clinically significant improvement of her state. It might take a while but I was optimistic. However, she thought I should do more tests. She simply could not believe that there was not some sort of off the shelf diagnostic tool which when applied would yield a quick fix to her problem.

In my opinion, there is a remarkable faith in the ability of diagnostic tests to sort through diagnostic conundrums. I think much of that faith is undeserved. The public's perception as to the power of "testing" is something those within the health care industry are more than willing to cultivate. The magical powers of examining a sample of tissue or blood and divine critical information which allows us to peer into the future or past gives power to those within the industry.

However, the real power and utility of those tests may not be anywhere close to what the perceptions may be. This is not unique to medical tests. A recent story in the Washington Post (Washington post story) underscores this. The FBI has now admitted that tools it has used to analyze hairs found at crimes scenes may not consistently yield useful information.
The admissions mark a watershed in one of the country’s largest forensic scandals, highlighting the failure of the nation’s courts for decades to keep bogus scientific information from juries, legal analysts said. The question now, they said, is how state authorities and the courts will respond to findings that confirm long-suspected problems with subjective, pattern-based forensic techniques — like hair and bite-mark comparisons — that have contributed to wrongful convictions in more than one-quarter of 329 DNA-exoneration cases since 1989. This included 32 death penalty cases.
Admission that the scientific underpinnings of our work has serious holes is a scary proposition. Information is power. The ability to predict and the ability to look back in the past and define truth is power. Power is money.

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