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Knowledge gaps and mistakes, and how both can lead to better things
In the business of journalism, you get used to seeing a lot of hyperbole. To read my email some days, you’d think that every new product and discovery by every company was a game-changer or revolutionary.
That’s less the fault of the public relations and marketing folks than it is their bosses who insist on what I like to refer to as “superlatives.” But they are a staple of my workday. And, as it happens, we editors and writers on the journalism side of the fence aren’t immune to using them.
In a piece we ran last month titled “Possible explanation for lithium efficacy,” the article began with a paragraph that included a statement that lithium, “with the exception of electroconvulsive therapy [ECT], has come to be known as the single most effective treatment in psychiatry.”
An alert reader sent me an email asking about that statement—not as a criticism but with genuine curiosity about possible literature on the issue of ECT efficacy and its “ranking” in the hierarchy of psychiatric modalities. I did do some poking around and sent him some links to literature showing ECT benefits—despite the fact it certainly was overused and misused at various points in the past—and, interestingly enough, some literature that talked about the benefits of lithium and ECT in combination.
This was clearly a case where something slipped past me that I should have caught. This would have been a time to say something like “one of the most effective treatments in psychiatry” or the like. And I didn’t do that (though it's something I've since fixed in the online version of the article). In part, this is my “mea culpa” moment, as I like to address my missteps rather than ignore them. Everything is a learning opportunity, even when I have around a quarter of a century of experience in medical and life-sciences journalism.
But beyond that, it seemed a good entry point to talk about how much we don’t understand in therapeutic circles. So many times researchers and medical practitioners have stumbled upon treatments by accident. Sildenafil, which most of us know by the trade name Viagra, is a good example; it was originally intended for certain cardiovascular disorders before its erectile dysfunction applications were realized secondarily. Going back much farther would be the accident in a Petri dish that led to Alexander Fleming discovering penicillin in 1928.
Dealing with disease and dysfunction can be an art as much as a science sometimes—or, at times, at least an exercise in being observant when mistakes, accidents and/or serendipity give an opportunity for discovery. And even when we have the science, by way of things like clinical trials, we sometimes don’t know for a long time how certain things work, lithium and ECT being two good examples. We forge ahead, having knowledge of many benefits and risks, but not always knowing for certain how or why certain things work.
That’s not all bad, though it does feel a bit humbling at times even to me, a person who doesn’t do any of the research or prescribing.
The idea of gaps in knowledge leads me to another thing I wanted to mention this issue. My editorial last month addressed the topic of underrepresentation of non-white people in clinical trials and how that can negatively impact our ability to match treatments to the right people and to appreciate differences in biology related to race and ethnicity (also a problem with gender and age). I had mentioned it was a topic we had covered before but not recently.
And, lo and behold, I no sooner say that than not one but two items related to race-specific efforts arrived in my inbox. One led to an article in this month's Clinical Trials section and talks about the first clinical trial to test newly approved breast cancer drug Ibrance (palbociclib) specifically on African-American patients. The other resulted in a piece in Business & Government Policy about using genetic technologies to reduce health disparities rather than widen them, in which Tufts University researcher Jose Ordovas notes how genetically based diagnoses and treatments have brought great opportunities for personalized medicine—but also how some racial groups may lack access to these advances and how knowledge of one non-white group is not necessarily applicable to others.
So, keep your eyes open for mistakes that you can correct—and mistakes that can lead to breakthroughs.