Adam Cifu, MD, is a general internist at the University of Chicago who divides his time between clinical practice, medical student education and scholarly work related to evidence-based medicine. His book Ending Medical Reversal with co-author Dr. Vinay Prasad, played a pivotal role in shaping some of my views on how to best help patients as a practicing physician. In this episode, we discuss the troubling trend in evidence based medicine known as medical reversals and how it elucidates key biases in how many medical professionals interpret evidence for clinical practice.
Show Notes:
[0:15] Introduction
[1:30] What are medical reversals and how did Dr. Cifu get interested in this topic?
[4:15] How does Dr. Cifu sell the importance of medical reversals to his colleagues?
[6:15] Key examples of medical reversals and why they matter [Post-menopausal estrogen replacement therapy + PCI with stable coronary heart disease]
[9:45] Why it’s hard to stop medical reversals
[14:30] What Cifu likes to teach med students to better catch medical reversals
[15:45] How medical education incentivizes an over-confidence in biological mechanisms and how we can prevent this
[21:25] How does Dr. Cifu think about his interpretative framework for medical evidence?
[27:10] How does Dr. Cifu approach “water cooler conversations” with colleagues that have different perspectives with the same data?
[31:05] The importance of therapeutic humility
[34:15] What pushes Dr. Cifu to place a high bar for justifying medical treatments?
[38:15] Why Dr. Cifu is a skeptic rather than a nihilist about medicine
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