Living by the Truth

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There was a time when facts were a highly valued commodity and not available to many people in the world. In medieval times, books were handwritten and held in monasteries in guarded libraries. If someone wanted to read the works of earlier writers they needed to arrange a time when they could go to the library, confirm permission from the librarian (usually a monk) and go to a reading room with the monk, who would watch what was being read to be sure it conformed to some pre-established standard of behavior. In this way, knowledge was carefully metered to those with a need to know such information, and the larger population was not privy to this elevated level of knowledge.

Then along came the printing press. This advance in technology opened the world to information. Its impact on human knowledge and communication is equivalent to the effect of the smartphone today. We need to disseminate information widely. Marconi with radio waves and Bell with the telephone did that for us.

As physicians, our job is always to see through the obfuscation to find the truth so as not to misguide the care of our patients.

Now communication is taken for granted. We can talk or view vast amounts of data on smartphones, we can hold meetings among colleagues without leaving our desks, and we can store and display medical data for the physicians providing care to our patients in our offices, hospitals and homes. But another disconcerting trend is developing in our ubiquitous sea of information. That is the trend to disseminate false information to bias thinking and stir confusion.

Fake data has become a salable product. If you want to create confusion in your workplace, state or country, there is now an industry that will create the fake data and distribute it to targeted audiences to alter thinking on specific topics of interest. All of this comes back to us as practicing physicians. While politics might move in a hazy world of mixed truth and non-truth, as physicians trying to advance health care through research, development of new therapies and high-quality medical practice, bringing the best of care to our patients could not tolerate a mix of true and false data that we are so accustomed to seeing in this modern communication era.

How could we provide good patient care if a portion of the data we receive is false? How do we reassure ourselves that the information we use in making critical judgements about patient care is correct? We have seen isolated examples in the past that were ultimately discovered and stopped, but even with our system of clinical trials, and open publication of data, sometimes false data find their way into our practices.

As a medical educator, my greatest concern is finding ways – within the mix of data from many sources – to educate our students and residents on how to use the best of the data that we produce in their practices, with some reassurance that they are using verified data from which to make their clinical decisions. While this is true for all physicians, our trainees are particularly exposed to the potential for false information. In the world of clinical trials, it is easy to show a negative outcome of a trial in terms that make the data look positive. All of us involved in clinical trials have some obligation to honestly present the data even when there are no important clinical findings to show.

It is likely that the world of fake information will continue to grow. As physicians, our job is always to see through the obfuscation to find the truth so as not to misguide the care of our patients. Education of our students and residents and ourselves should be a high priority in our education portfolio to maintain the trust that is needed to provide our patients with the care they need. It is likely that some formal education in separating truth from falsehood will be needed even in high school and beyond, and will be particularly essential in managing the large amounts of data that confront us evert day to be sure we can separate truth from fiction.


Alfred A. Bove, MD, PhD, MACC, is professor emeritus of medicine at Temple University School of Medicine in Philadelphia, and a former president of the ACC.

Cardiology Magazine DownloadRead the full May 2017 issue of Cardiology at ACC.org/Cardiology

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