Pendulums in medical practice.

Medicine is often more an art than a science, especially in controversial areas. Physicians rely on the 'standard of care' for guidance and legal protection, but this standard is reactive and temporary. Examples of complete swings in practice include opiate prescribing in the US, which has gone from widespread acceptance to vilification, as well as electroconvulsive therapy for depression and hormone replacement for postmenopausal women. Research funding, such as during the recent pandemic, has also swung. Current debates include medical marijuana and hallucinogens for addiction. These pendulum swings have harmed some patients. Physicians should consider the full body of evidence and act in patients' best interests.

Study at a glance

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.