No 22: A Global Health Challenge: why does everyone treat everything differently?
This title might strike some people as being a poorly worded exaggeration. Surely, in the modern world in 2022 with evidence based medicine then most people will receive standardised care?
EBM is a lovely idea, but a secret of modern medicine is that there is still a huge degree of variation in how patients are treated. It varies by day/night, day of the week, hospital, consultant, region and by country.
There’s also an interesting divide between the English speaking world and everyone else. The Anglosphere has lots of integration and we do read each others journals and papers but how many English speaking doctors know anything about European medicine or Russian medicine or Chinese?
I was just listening to a great podcast discussing out of hospital cardiac arrest RCT in the USA where they apparently routinely use IV Calcium as part of the resus. This is something that I have never heard done in my limited experience in the UK. And it really surprised me. What didn’t surprise me was that the RCT showed that giving calcium didn’t improve survival.
The Rebelcast
https://castbox.fm/x/2rlr-
I raise this podcast as an example of how different practice is even between the UK and USA for an emergency scenario that you would think would have a good evidence base and standardised treatment.
So what I would like to propose is that the “variety in medicine” should be mapped out for the entire world.
This may sound pointless, boring and tedious but I honestly think it would be fascinating to compile a standardised table showing how different countries treat certain things. It would highlight areas for improvement on a global scale and act as a baseline for future improvement.
So for each symptom/ syndrome/ presentation/ disease I propose the following:
List every country 1 to 200
In columns list the investigations, treatments and guidelines.
So a column each for first line treatment, 2nd line etc
A column for list line investigation, 2nd line etc
And then list the national, regional and society guidelines that are followed in that country.
You could even list different approaches as separate lines within each country.
Global health and EBM is still in its infancy and there is still so much we can learn from others. Producing systematic baseline data would be an interesting place to start.