{"id":11118,"date":"2023-11-16T23:59:15","date_gmt":"2023-11-17T05:59:15","guid":{"rendered":"https:\/\/blogs.und.edu\/for-your-health\/?p=11118"},"modified":"2023-11-16T13:50:26","modified_gmt":"2023-11-16T19:50:26","slug":"from-the-dean-covid-and-the-challenge-of-evidence-based-science","status":"publish","type":"post","link":"https:\/\/blogs.und.edu\/for-your-health\/2023\/11\/16\/from-the-dean-covid-and-the-challenge-of-evidence-based-science\/","title":{"rendered":"From the Dean: COVID and the challenge of evidence-based science"},"content":{"rendered":"

A just-published article in the highly regarded journal Annals of Internal Medicine<\/em> raises an important issue related to health science student education. I hesitate somewhat to bring it up because the report relates to the treatment of COVID, and we all are suffering from COVID fatigue and are tired talking (and hearing) about it. That said, I think the issue is important enough to the education (and especially the continuing education) of individuals who work in the healthcare delivery space that I hope you\u2019ll bear with me as I unfold the concepts.<\/p>\n

The article<\/a> explored the well-described rebound phenomenon that has been reported following the treatment of people suffering from COVID with the pill Paxlovid, which is a combination of two anti-viral medications manufactured by the Pfizer pharmaceutical company. It is well-accepted that Paxlovid reduces morbidity and mortality following mild to moderate COVID infection, especially in vulnerable adults such as the elderly, those with other medical conditions, and especially those whose immune system is compromised. In this study, the definition of \u201crebound\u201d was not (as typically used) the reappearance of symptoms after an initial infection with COVID, but rather the reappearance of a significant viral load that could be detected and measured after the initial illness. In fact, the majority of the people in this study who developed rebound after Paxlovid had no rebound-related symptoms. What was striking was that the people who took the medication were about ten times more likely to experience rebound (as defined above) as those who did not (roughly 20 percent vs. 2 percent). As an accompanying editorial<\/a> explained, there are any number of possible reasons for this finding. Maybe the Paxlovid was given too early in the course of the infection and thus blunted the immune response. Or maybe it wasn\u2019t given for a long enough time (typically five days). Regardless of the speculation, however, the only way to get the answer to this finding is to study the matter further.<\/p>\n

And that\u2019s one of the messages that\u2019s especially salient for those of us committed to health education \u2013 we need to convey to students not just current knowledge about clinical management but also inculcate an approach that emphasizes continual learning and updating of \u201cbest practices\u201d over time. As one saying goes, \u201cI know that half of what I\u2019m teaching my students today will turn out to be wrong in the future; I just don\u2019t know which half!\u201d An example of this from my own field of cardiology is the use of aspirin in the treatment of people at risk of \u2013 but without manifest \u2013 heart disease. We used to think that aspirin would reduce the risk of morbid events. And so it did \u2013 and does. But subsequently we learned that this was at the cost of an increased risk of bleeding. It only was through continued study and evaluation that we arrived at the \u201ctruth,\u201d which is that most such patients should not <\/em>be offered low-dose aspirin.<\/p>\n

A practical manifestation of this life-long learning imperative is that in order for physicians (and other practitioners) to renew their state medical licenses, they must show evidence that they have completed a variety of continuing medical education experiences. A second important implication for the educational enterprise is that we need to continue to encourage our students to ask questions and be inquisitive about what we tell them. As I like to remind my students when I\u2019m teaching cardiology, \u201cthe only dumb question is the unasked one!\u201d<\/p>\n

The final imperative extends well beyond the educational sphere but impacts all of healthcare: we need to rely on science and the scientific method if we want to eventually arrive at the correct answer to clinical questions. Yes, the road there may be winding and have cul-de-sacs. But eventually we will get there if we keep at it, as we did with the aspirin issue. As a poignant example of this, consider the following: because of advances in scientific knowledge (among other advances including lifestyle adjustments by patients), the mortality from heart disease fell by an incredible 30 percent between 2000 and 2010! So advances in science do indeed translate into better health \u2013 and longer survival. But we need to continually question \u2013 and continually update \u2013 our assessment of what is the \u201cbest practice\u201d in any given clinical situation.<\/p>\n

Finally, I hope you had a chance to celebrate National Rural Health Day<\/a>, which took place yesterday, and thank the people from all over our state who provide healthcare to our rural citizens (including the North Dakotan who submitted the picture above to the North Dakota Rural Health Association in support of the day). The\u00a0Center for Rural Health<\/a> at the SMHS is a vital resource for North Dakota\u2019s rural communities and a national leader in rural health care advocacy and support. And as you know, the School has been a long-standing advocate for rural healthcare workforce augmentation and support. Thanks again to all those involved in sustaining, supporting, and optimizing rural health care delivery in North Dakota and everywhere.<\/p>\n

Joshua Wynne, MD, MBA, MPH
\nVice President for Health Affairs, UND
\nDean, UND School of Medicine & Health Sciences<\/p>\n","protected":false},"excerpt":{"rendered":"

A just-published article in the highly regarded journal Annals of Internal Medicine raises an important issue related to health science student education. I hesitate somewhat to bring it up because the report relates to the treatment of COVID, and we all are suffering from COVID fatigue and are tired talking (and hearing) about it. That […]<\/p>\n","protected":false},"author":36,"featured_media":11135,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[2703,1709,937,51,2702,41,308,53],"class_list":["post-11118","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-from-the-dean","tag-annals-of-internal-medicine","tag-aspirin","tag-covid","tag-dean","tag-paxlovid","tag-research","tag-science","tag-wynne"],"acf":[],"yoast_head":"\nFrom the Dean: COVID and the challenge of evidence-based science - For Your Health<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.und.edu\/for-your-health\/2023\/11\/16\/from-the-dean-covid-and-the-challenge-of-evidence-based-science\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"From the Dean: COVID and the challenge of evidence-based science - For Your Health\" \/>\n<meta property=\"og:description\" content=\"A just-published article in the highly regarded journal Annals of Internal Medicine raises an important issue related to health science student education. 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