GETTING TO THE HEART OF MEDICINE
CARDIOLOGY LESSONS FOR COVID-19
AUTHOR John Mandrola, MD
The world was better without the
new coronavirus. But now we must
fight a novel disease.
The pandemic has forced doctors
(and policymakers) to think
about the best ways to prevent, diagnose
and treat this new pathogen.
COVID-19 highlights the
importance of epistemology.
Enter: cardiology. How we know what works in the treatment of
patients with heart disease is one of my favorite aspects of this field.
When I was young, it was the procedures that most excited me. But
after a couple of decades, what I love most now is our approach to
scientific knowing: our embrace of evidence.
In the pandemic, the urgency in helping patients with a novel
disease has fostered a shortcutting of the principles of science-based
practice. I will argue that revisiting the basics of how cardiologists
know what works for heart disease will teach important lessons for
dealing with this virus.
When Dr. David Sackett coined the term evidence-based medicine
(EBM), he argued that the best approach to patient care occurred
when a clinician combined the best available evidence with
clinical judgement and patient values. 1 Key in this approach is the
ability to appraise the strength of evidence.
Lowest on the strength of evidence is biologic plausibility (this
should work) and anecdote (I’ve seen this work). Then comes observational
evidence–the looking back at groups of patients who
did or did not get treatment. The flaw in observational comparisons
is that even with statistical adjustments, you don’t know whether
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