Your doctor doesn't know what works

Let's say your doctor does everything right. She follows the best medical guidelines. She only prescribes treatments that have been vetted by the Infectious Diseases Society of America and are widely believed to help. She never tries to make a quick buck, or give a patient false hope, by ordering a test or procedure that's not likely to help. In that world, how many of the treatments that she's prescribing will have high-quality clinical studies supporting their use?

One in seven. Yikes. Michael Mandel looks on the bright side:

The conventional wisdom was that breakthroughs in understanding the human genome would provide better treatments within the existing structure of medicine – like putting better windows or a new floor or more comfortable furniture into an existing house. The implicit belief is that we could build on existing medical knowledge, add in the new knowledge of the genome, and quickly get to new products.

But what if the main lesson of the past ten years is that the house itself has rotten foundations and needs to be rebuilt completely? What if the biosciences sector can't afford to take anything for granted from existing medicine because too much of it is not evidence-based?

This is both bad news and good news. Starting from scratch and rebuilding foundations is obviously a daunting and expensive task, and helps explain why the biosciences sector has struggled to produce breakthrough treatments. On the other hand, when you are rebuilding foundations, a lot of progress can be made without anything visible from the outside.