Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

The Ethics of Intervention – 1

Image credit. Is the Give tPA propaganda loud enough?

Many of us in medicine want to be more aggressive in treating patients with untested/poorly tested treatments.

We’ve got to do something!

What we ignore is the harm that comes from being aggressive with wishful thinking.

Dr. Ryan Radecki points out that we still have no effective way to manage post-thrombolysis intracranial hemorrhage. This is a real problem that is ignored by many proponents of tPA (tissue Plasminogen Activator – Alteplase).

If the widespread proponents of tPA would like to subject ever-increasing numbers of patients to this complication, perhaps they ought to put as much energy into developing new treatments for hemorrhage as they do vilifying tPA skeptics?[1]


Why don’t we clamor for a treatment for the problems caused by tPA aggressive intervention with tPA?

Image credit.

We recite the usual platitudes –

If it helps just one patient . . . .

Yet, if it harms more than it helps – it is bad.

Why is that math so difficult?

An intervention that cannot be shown to be beneficial should be assumed to be harmful until after there is evidence to the contrary. If that evidence never exists, it will be just one more dangerous treatment avoided.


Because almost every treatment that has been tried has been more harmful than beneficial.

There is no reason to assume that this does not also apply to the treatments based on a modern understanding of pathophysiology.

Why does expert opinion seem only to favor the experts who are hopelessly optimistic pro-interventionists?

Why doesn’t critical judgment support pro-interventionist expert opinion?

Why doesn’t history support pro-interventionist expert opinion?

Why doesn’t reality support pro-interventionist expert opinion?

Is reality biased against endangering our patients in the absence of valid evidence that our treatments are safe and effective?


Reality doesn’t care what we want.

If reality cared, the patient would not have the medical condition to begin with.

Reality is neutral, but we are biased in favor of thinking that we know what is best for others.

We consistently provide evidence that we are wrong, then we ignore that evidence and make lame excuses that it wasn’t our fault.

We need to grow up and admit that it is our fault when we harm patients with expert opinion.


[1] tPA ‘Em & Let ‘Em Bleed
Monday, April 28, 2014
Posted by Ryan Radecki
Emergency Medicine Literature of Note