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I work in health care, not as a clinician, but as a person who works with clinical and administrative data. I work for a company that prides itself on “evidence-based” care. Basically, they try to find clinical best-practice in terms of clinical outcomes for a given patient, and make sure those best clinical pathways are followed. Makes sense, right? Do what works.
But there is a weird paradox at the heart of evidence-based medicine, and that is that it runs in the face of innovation. We can’t do something new if we only follow the evidence because something new, by definition, doesn’t have evidence.
Of course, it is more complicated than that, and less absolute, because a new care protocol - let’s say it’s a new drug. There are actually stages (I’ll use an overly-simplified example), where we first see some evidence that, let’s say, a particular protein tells a cell we don’t want (cancer or virus or whatever) from replicating. We have evidence that come compound inhibits the production of that protein. We try them together in a Petrie dish and see a reduction in cell replication. We test the compound for safety and side-effects at various dose levels. We then test the safe dosages for efficacy. We then compare the new treatment against existing alternatives.
So, there is some evidence at each step that tells us to proceed to the next step. But something can’t become “best-practice” until well after many many many treatments and accumulating evidence that it works as good as and with less side effects than what was the previous best practice. That’s the end-game evidence I am talking about. We aren’t pushing the new treatment until the larger health care community has come to consensus.
That’s not to say my company doesn’t run active clinical trials, but they are just that, “trials,” not the care practice that is being rolled out to any and all in the population with the appropriate condition. And how to most people end up in a clinical trial? Well, they need to meet the criteria, and then they need to volunteer. It’s a personal choice.
Let’s think of this as a big analogy for climbing gear or techniques, and frame through that lens of a personal choice. How much evidence do you need before you’d be willing to “volunteer” yourself to change up something in how you approach a piece of your climbing. Also, what type of evidence would you need? Just like above, there is suggestive evidence and then evidence of efficacy in the exact circumstance you are facing and an entire continuum between those two polls.
For me, using a hypoxic tent for pre-acclimatization is definitely one of those “somewhere on the continuum” moments for me. I had reason to want my family and I to try something different (watch the video, to see why). I had some independent and peer-reviewed evidence that hypoxic tents could help (see last week’s video). I had a sense of the safety profile and risks. I had some understanding of the limits of hypoxic tents and the need to keep some other “best practices” in place in terms of acclimatization (again, last week’s video). So, I was willing to talk to my family, and we made the personal choice to try this thing that isn’t yet the standard practice while mitigating against putting too many eggs in that particular basket.
To that point about knowing some of the limits, though, I think anyone who has ever been involved in a clinical trail will likely all report that those running the trial will warn that very few things are “miracle” cures. So, I think it is dangerous to take on a new idea as if it will “fix” whatever climbing issue or risk we might be facing. I still think there are tradeoffs in all things.