With Treatment, Less May Be More

As environmental regulators look more and more to scientific experts to devise treatments for contaminated sites, it might behoove those regulators to consider the import a a recent medical study which dramatically suggests that problems may not always be best addressed by the application of aggressive treatments devised by experts.  That study evaluated mortality rates among cardiac patients hospitalized during the period when national cardiology conventions were being held.  Stunningly, cardiac patients fared significantly better if they were hospitalized when cardiologists were away at national conferences.  Indeed, almost 30 percent fewer patients hospitalized for heart failure died when their cardiologists were at professional conferences than when those cardiologists were at the hospital (17.5% v. 24.8% mortality).   Additionally, those patients were subjected to fewer aggressive treatments, during the period when their cardiologists were attending national conferences, suggesting that those aggressive treatments did more harm than good.

While it would be easy to over read the results of the study as a broad indictment of all scientifc expertise, the study is a valuable warning about the risks of overreliance on experts to develop aggressive remedies to problems.  Too often, experts, wanting to show their value, can be biased towards recommending doing something rather than doing nothing, even when what is proposed is supported not by analytical data but by the expert’s speculative intuitions about what might help.  Environmental regulators, just like cardiologists, need to be mindful that succumbing to the human impulse to want to do something in the face of a problem may be worse than doing nothing when there is no actual scientific basis for taking action.  Afterall, the first tenet of Hippocratic Oath is to do no harm.



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