This is the beauty of evidence based medicine, nothing debunk science except a better science. Not opinions, not emotions and certainly not politics, just pure better science. Thanks for sharing.
I have PTSD from hypothermia protocol during my residency. Honestly it never made sense to me, but that could be because I was exhausted medical resident.
But why even avoid fever so religiously? There is no point at all to treat temperatures up to 40 °C - the human body handles it just fine (courtesy of your friends in the plasmodium clade and a few hundred thousand years of human-pathogen co-evolution). Fever is not inhetently dangerous and might serve a purpose after arrest. The study landscape on antipyretics is a dumpster fire.
Next in line ought to be a trial testing strict vs. lenient fever control, but I suspect the "fever bad" kneejerk is too engrained in intensive care to even study this.
Nice article. Your story is very similar to MAST trousers that I used as a Paramedic in the late 70s. We would routinely apply the MAST trousers before starting IV’s for hypotensive trauma patients. Studies would eventually prove the use of MAST trousers were of no benefit compared to standard volume replacement.
Old habits die hard, even for those supposedly steeped in the sciences!
Question #1 -- given the multitude of biases that are largely ingrained in all of us (patients and their families also, that's a big factor not mentioned), we're not likely to course correct without systemic change. What do you think of the proper role of payors -- insurers, Medicare, Medicaid systems, FEHB, etc. in these situations? Perhaps not simply denying payment, but requiring physician sign off that intervention is not, on average, helpful and may be harmful? It would add friction, hopefully prompt "stop and think" and would help identify physicians who routinely have not adopted practices to latest science (and to intervene appropriately with them). A hospital could also play a similar role, though I think their financial interests introduce an unhelpful bias.
Question #2 -- are hospitals compiling data that would allow a researcher to compare outcomes(with many adjustments for compounds, there's no randomization) for those received TTM vs. not? If not, should they be doing this? I suspect some physicians would be quicker to adopt to new science than others. Sharing aggregated data with physicians on how "their" patients fared (or aggregated with physicians who treat like them) and comparing that with other physicians can be a powerful nudge to counter the biases you mention. That research may also help generate hypotheses on perhaps fine tuning protocols further.
This is the beauty of evidence based medicine, nothing debunk science except a better science. Not opinions, not emotions and certainly not politics, just pure better science. Thanks for sharing.
I have PTSD from hypothermia protocol during my residency. Honestly it never made sense to me, but that could be because I was exhausted medical resident.
Great post on anyway
An Australian study (Barnard et al)
must be An Australian study (Bernard et al) and the correct link https://www.nejm.org/doi/full/10.1056/nejmoa003289
But why even avoid fever so religiously? There is no point at all to treat temperatures up to 40 °C - the human body handles it just fine (courtesy of your friends in the plasmodium clade and a few hundred thousand years of human-pathogen co-evolution). Fever is not inhetently dangerous and might serve a purpose after arrest. The study landscape on antipyretics is a dumpster fire.
Next in line ought to be a trial testing strict vs. lenient fever control, but I suspect the "fever bad" kneejerk is too engrained in intensive care to even study this.
Nice article. Your story is very similar to MAST trousers that I used as a Paramedic in the late 70s. We would routinely apply the MAST trousers before starting IV’s for hypotensive trauma patients. Studies would eventually prove the use of MAST trousers were of no benefit compared to standard volume replacement.
Old habits die hard, even for those supposedly steeped in the sciences!
Question #1 -- given the multitude of biases that are largely ingrained in all of us (patients and their families also, that's a big factor not mentioned), we're not likely to course correct without systemic change. What do you think of the proper role of payors -- insurers, Medicare, Medicaid systems, FEHB, etc. in these situations? Perhaps not simply denying payment, but requiring physician sign off that intervention is not, on average, helpful and may be harmful? It would add friction, hopefully prompt "stop and think" and would help identify physicians who routinely have not adopted practices to latest science (and to intervene appropriately with them). A hospital could also play a similar role, though I think their financial interests introduce an unhelpful bias.
Question #2 -- are hospitals compiling data that would allow a researcher to compare outcomes(with many adjustments for compounds, there's no randomization) for those received TTM vs. not? If not, should they be doing this? I suspect some physicians would be quicker to adopt to new science than others. Sharing aggregated data with physicians on how "their" patients fared (or aggregated with physicians who treat like them) and comparing that with other physicians can be a powerful nudge to counter the biases you mention. That research may also help generate hypotheses on perhaps fine tuning protocols further.