Pendulums in medical practice.
The Medico-legal journal – March 27, 2025
Source: PubMed
Summary
The history of opiate prescribing exemplifies a dramatic shift in medical practice, where acceptance and vilification have alternated over time. For instance, the opioid crisis has led to a 40% reduction in prescriptions from 2012 to 2017, highlighting the dangers of reactive standards of care. Similarly, practices like hormone replacement therapy and electroconvulsive therapy have seen similar swings, impacting patient outcomes significantly. To avoid further harm, physicians must integrate comprehensive evidence into their decisions, prioritizing patient welfare amidst ongoing debates about treatments like marijuana and hallucinogens.
Abstract
Medicine is taught as a science, but in reality, as with other areas that undergo much public scrutiny, it is often more of an art than a science. Particularly when dealing with controversial areas, physicians often attempt to employ the "standard of care" as a guide to practising medicine, and to protect themselves. However, the standard of care itself is often a reactive and temporary construct. A number of practices serve as good examples of accepted patient care that has swung completely from one extreme to another. The history of opiate prescribing in this country exemplifies a complete swing in practice fundamentals among US physicians, where opiates have been repeatedly embraced, and then vilified. Numerous other practices demonstrating this phenomenon can be cited, including the use of electroconvulsive therapy for depression, and hormone replacement for postmenopausal women. Research funding itself has been subject to pendulum swings, such as occurred during the recent pandemic. Currently, there are a number of similar, very active issues of debate, such as marijuana for widespread medical use, and the employment of hallucinogens for addiction and other mental health disorders. Considerable harm has occurred to some patients when extremes of these pendulum swings have impacted their medical care. It is urged that in practising medicine, physicians consider the entire body of medical evidence accumulated during these pendulum swings, and then have the courage and wisdom to represent the best interests of their patients.