What To Do When Treatment Doesn't Work

At the very dawn of modern medicine, 2500 years ago, Hippocrates made its most important and robust finding: 1/3 of patients get better without treatment; 1/3 don't get better even with treatment; and only 1/3 actually benefit from treatment. The ratios do vary depending on the type of disease, it's severity and chronicity, and the power and specificity of the available treatments. Whenever a disease is chronic and/or severe, spontaneous recovery is less likely, treatment will more likely be needed, and full response to treatment is less likely. But on average, Hippocrates' "rule of thirds" stands up remarkably well to systematic study and has been medical lore for hundreds of generations of doctors. One of my early papers (written more than 35 years ago and titled, "No Treatment As A Prescription of Choice") reflected Hippocrates' caution that mindlessly piling on treatments often benefits little and instead can add a substantial burden of side effects to the patient's already heavy burden of illness.  Unfortunately, Hippocratic humility has increasingly been replaced by the hubris of modern medicine. Many clinicians hold the unconscious and unwarranted assumption that there is a cure for every illness and recklessly add on new treatments whenever previous ones have failed. Careless polypharmacy prevails throughout medicine and is particularly prevalent and dangerous in the elderly. Doctors rarely follow the Hippocratic dictum to "First do no harm." Peter Tyrer is the ...
Source: Science - The Huffington Post - Category: Science Source Type: news