A Victory for Scientific Pragmatism

Essay by Arturo CasadevallMichael J. Joynerand Nigel Paneth:”…The convalescent plasma controversy highlights the need to better educate physicians on the knowledge problem in medicine: How do we know what we know, and how do we acquire new knowledge? The usual practice guidelines doctors rely on for the treatment of disease were not available for the treatment of Covid-19 early in the pandemic, since these are usually issued by professional societies only after definitive information is available from RCTs, a luxury we did not have. The convalescent plasma experience supports Devorah Goldman’s plea to consider all available information when making therapeutic decisions.

Fortunately, the availability of rapid communication through pre-print studies, social media, and online conferences have allowed physicians to learn quickly. The experience suggests the value of providing more instruction in medical schools, postgraduate education, and continuing medical education on how best to evaluate evidence — especially preliminary and seemingly contradictory evidence. Just as physicians learn to use clinical judgment in treating individual patients, they must learn how to weigh evidence in treating populations of patients. We also need greater nimbleness and more flexibility from regulators and practice-guideline groups in emergency situations such as pandemics. They should issue interim recommendations that synthesize the best available evidence, as the American Association of Blood Bankers has done for plasma, recognizing that these recommendations may change as new evidence accumulates. Similarly, we all need to make greater efforts to educate the public to understand that all knowledge in medicine and science is provisional, subject to change as new and better studies emerge. Updating and revising recommendations as knowledge advances is not a weakness but a foundational strength of good medicine….(More)”.