The Uncertainty of Medical Evidence in Critical Care: Jeff Drazen

Jeff Drazen delivers a powerful message on the use of medical evidence in critical care. Medicine is powered by knowledge, but how do we know what is true and what is not? How do we deal with uncertainty in a setting where outcomes are not closely related to known variables? For example, although there are a few people who have survived jumping or falling from an airplane at high altitude, it is a rare event. Thus, a test to determine how to prevent death from such a disaster would only take a small number of participants to see if a particular method works. In contrast, when considering a medical condition where a large fraction of people might seemingly “recover” without treatment, such as tuberculosis, how does one determine if a treatment is effective? In this talk Jeff discusses the trials surrounding blood glucose control in the Intensive Care Unit (ICU). The way we have dealt with increased blood sugar levels in critical care has changed over time. Whereas once upon a time there was little thought given to high blood sugar levels, this changed in the 90s. One single centre paper was the catalyst for a move toward tighter glucose control for patients in ICU. Due to the novel question and well-designed study, this paper was published in a prestigious journal – even if there were questions surrounding its validity. Larger, multi-centred papers were not published until many years later due to normal logistical and financial constraints. In the interim, the initial data had informed policy. Therein lies the problem. Join Jeff as he highlights the benefits and potential pitfalls in medical research by telling the story of tight blood glucose control in the ICU. For more like this, head to https://codachange.org/podcasts/