Medical Research Fails to Meet Patients' Needs
June 9, 2000 -- The thousands of medical studies conducted each year help to determine what treatments are available for various health problems and whether insurance will pay for them. But too many of these studies emphasize new drugs or surgical techniques, even though these are not top priorities for patients and the doctors who care for them, new research shows.
That's true at least when it comes to the topic of osteoarthritis of the knee, a crippling condition that afflicts up to a third of people over age 63. Patients want more help managing the condition themselves, while physicians want to know how all kinds of treatments compare to one another and whether surgery should be performed at all, says a group of British physicians.
"We have documented a clear mismatch between the interventions that are researched and those that are regularly used and prioritized" by patients and physicians, says Paul Dieppe, MD, who led the study, published in the journal The Lancet. "We should listen to what they think is important and do more research on that." Dieppe is a professor at the University of Bristol in England and the director of a consortium of eight research universities in the U.K.
The researchers say this discrepancy should be rectified now because health care is headed toward more reliance on so-called evidence-based medicine. This means insurance companies and government programs such as Medicare often refuse to pay for therapies unless there is a "proven" benefit. Some helpful therapies that are not rigorously studied may not be available to people who need them, Dieppe warns.
Using focus groups and surveys, Dieppe and his colleagues determined that patients preferred conservative treatments for osteoarthritis, such as complementary medicine and physical therapy, and thought more research should be directed toward education and advice. Then the researchers pored over more than 900 studies about osteoarthritis of the knee and concluded that there was "a massive concentration of research in drug and surgical treatments."
Dieppe, a rheumatologist, adds that he believes his findings apply to patients with other types of disorders and to physicians in other specialties. "I don't think this phenomenon is peculiar to our field," he says.
Capt. Matthew Garber and fellow physical therapists ran into this situation themselves. Garber treats patients for osteoarthritis of the knee and other disorders at the Brooke Army Medical Center in San Antonio, Texas, where he also directs one of the Army's two training programs for physical therapists.
"There are millions of people who are affected by this disorder. Too many people think the only answers are surgery and drugs. We knew from our clinical experience that we could help people without either of those," but the research literature held little proof, Garber says. "We found that from 1966 to 1993, there were only 15 controlled trials that looked at nonsurgical and nonpharmaceutical interventions for osteoarthritis of the knee. Some of those found that exercise was good, but there were no studies that looked at manual [physical] therapy. We sought to obtain the evidence for ourselves."