No 36 - Searching for the ideal history of EBM and medications

I have just finished reading Archie Cochrane’s 1971 book “Effectiveness and Efficiency”.

It is a wonderful book. Short, sharp and incisive. It is very critical of how the health service was working at that time and very hopeful that EBM would be applied to all aspects of health and social care.

If you can find a copy then I would highly recommend spending an afternoon reading it.

I’m now reading “Factfulness” by Hans Rosling (https://amzn.to/3tG8CAn).

Both of these books focus on the improvements in global society and health in the last 100 years or so.

Both have made me realise a few things relevant to medical training.

1 - I know longer know the “natural history” of most diseases because I have never seen them unfold.

2 - I don’t think we are taught the “natural baseline or incidence” very well. For example, imagine an NNT for a disease or condition, if we didn’t treat someone with hypertension what is the odds of them dying from it?

3 - If we don’t know what the “natural outcome” is meant to be then it becomes more difficult to see if we are improving. I was just thinking that an important part of any lecture should be to remind clinicians of the historical mortality and morbidity rate. A reminder of how far we have come and proof that we can improve.

4 - Both of these books reminded me how little I know of the history of EBM or drug development. Every time I learn a little, I always think that I should learn more.

5 - Cochrane is especially critical of prescribing treatments without good evidence or of ordering tests or screening without equally good evidence that it will change management or the natural course of the disease.

6 - So, what I am looking for is a paper or a book that gives a very brief (2 page) history of the major classes of modern medications and investigations. And summarises their efficacy. Can anyone recommend a book like this please?

Personally, I think that learning the “story” about a medication or test would help me to remember more of the details. A story is much easier to remember than a list of facts.

I also think this would be inspirational and would help to point out further areas for improvement.

An additional benefit in the modern period might be that a better understanding of the statistics of the natural history and the risk reduction for each medication might help to balance polypharmacy.

This article is more of a note to myself for future reading. But if anyone can recommend some books and papers then that would be much appreciated.