Last week I made a claim that, on review, might be untrue. This was bound to happen sooner or later. I do research these posts, but except for the posts where I actually include a bibliography, I’m not fact checking every statement I make.
One of the dangers of being smart, of being told that you’re smart, and of repeatedly getting good grades or otherwise being vindicated on matters of intelligence, is that it can lead to a sense of complacency. I’m usually right, I think to myself, and when I think I know a fact, it’s often true, so unless I have some reason to suspect I’m wrong, I don’t generally check. For example, take the statement: there are more people that voted for republicans in the last election living to the south of me than to the north.
I am almost certain this is true, even without checking. I would probably bet money on it. I live north of New York City, so there aren’t even that many people north of me, let alone republican voters. It’s objectively possible that I’m wrong. I might be missing some piece of information, like a large population of absentee Republicans in Canada, or the state of Alaska. Or I might simply be mistaken. Maybe the map I’m picturing in my head misrepresents how far north I am compared to other northern border states like North Dakota, Michigan, and Wisconsin. But I’m pretty sure I’m still right here, and until I started second guessing myself for the sake of argument, I would have confidently asserted that statement as fact, and even staked a sizable sum on it.
Last week I made the following claim: Plenty of studies in the medical field have exalted medical identification as a simple, cost-effective means of promoting patient safety.
I figured that this had to be true. After all, doctors recommend wearing medical identification almost universally. It’s one of those things, like brushing your teeth, or eating your vegetables that’s such common advice that we assume it to be proven truth. After all, if there wasn’t some compelling study to show it to be worthwhile, why would doctors continue to breath down the necks of patients? Why would patients themselves put up with it? Why would insurance companies, which are some of the most ruthlessly skeptical entities in existence, especially when it comes to paying for preventative measures, shell out for medical identification unless it was already demonstrated to be a good deal in the long run?
Turns out I may have overestimated science and economics here. Because in writing my paper, I searched for that definitive overarching study or meta analysis that conclusively proved that medical identification had a measurable positive impact. I searched broadly on google, and also through the EBSCO search engine, which my trusty research librarian told me was the best agglomeration of scientific and academic literature tuition can buy. I went through papers from NIH immunohematolgy researchers to the Army Medical Corps; from clinics in the Canadian high arctic to the developing regions of Southeast Asia. I read through translations of papers originally published in French and Chinese, in the most prestigious journals of their home countries. And I found no conclusive answers.
There was plenty of circumstantial evidence. Every paper I found supported the use of medical identification. Most papers I found were actually about other issues, and merely alluded to medical identification by describing how they used it in their own protocols. In most clinics, it’s now an automatic part of the checklist to refer newly diagnosed patients to wear medical identification; almost always through the MedicAlert Foundation.
The two papers I found that addressed the issue head on were a Canadian study about children wearing MedicAlert bracelets being bullied, and a paper in an emergency services journal about differing standards in medical identification. Both of these studies, though, seemed to skirt around the quantifiable efficacy of medical identification and were more interested in the tangential effects.
There was a third paper that dealt more directly as well, but there was something fishy about it. The title was “MedicAlert: Speaking for Patients When They Can’t”, and the language and graphics were suspiciously similar to the advertising used by the MedicAlert Foundation website. By the time I had gotten to this point, I was already running late with my paper. EBSCO listed the paper as “peer reviewed”, which my trusty research librarian said meant it was credible (or at least, credible enough), and it basically said exactly the things that I needed a source for, so I included it in my bibliography. But looking back, I’m worried that I’ve fallen into the Citogenesis trap, just this time with a private entity rather than Wikipedia.
The conspiracy theorist in me wants to jump to the conclusion that I’ve uncovered a massive ruse; that the MedicAlert Foundation has created and perpetuated a myth about the efficacy of their services, and the sheeple of the medical-industrial complex are unwitting collaborators. Something something database with our medical records something something hail hydra. This pretty blatantly fails Occam’s Razor, so I’m inclined to write it off. The most likely scenario here is that there is a study lying around that I simply missed in my search, and it’s so old and foundational that later research has just accepted it as common knowledge. Or maybe it was buried deep in the bibliographies of other papers I read, and I just missed it.
Still, the fact that I didn’t find this study when explicitly looking for it raises questions. Which leads me to the next most likely scenario: I have found a rare spot of massive oversight in the medical scientific community. After all, the idea that wearing medical identification is helpful in an emergency situation is common sense, bordering on self-evident. And there’s no shortage of anecdotes from paramedics and ER doctors that medical identification can help save lives. Even in the literature, while I can’t find an overview, there are several individual case studies. It’s not difficult to imagine that doctors have simply taken medical identification as a logical given, and gone ahead and implemented it into their protocols.
In that case, it would make sense that MedicAlert would jump on the bandwagon. If anything, having a single standard makes the process more rigorous. I’m a little skeptical that insurance companies just went along with it; it’s not like common sense has ever stopped them from penny-pinching before. But who knows, maybe this is the one time they took doctors at their word. Maybe, through some common consensus, this has just become a massive blind spot for research. After all, I only noticed it when I was looking into something tangential to it.
So where does this leave us? If the data is really out there somewhere, then the only problem is that I need a better search engine. If this is part of a blind spot, if the research has never been done and everyone has just accepted it as common sense, then it needs to be put in the queue for an overarching study. Not that I expect that such a study won’t find a correlation between wearing medical identification and better health outcomes. After all, it’s common sense. But we can do better than just acting on common sense and gut instincts. We have to do better if we want to advance as a species.
The other reason why we need to have hard, verifiable numbers with regards to efficacy, besides the possibility we might discover our assumptions were wrong, is to have a way to justify the trade off. My whole paper has been about trying to prove the trade off a person makes when deciding to wear medical identification, in terms of stigma, self perception, and comfort. We often brush this off as being immaterial. And maybe it is. Maybe, next to an overwhelming consensus of evidence showing a large and measurable positive impact on health outcomes, some minor discomfort wearing a bracelet for life is easily outweighed.
Then again, what if the positive impact is fairly minor? If the statistical difference amounts only to, let’s say, a few extra hours life expectancy, is that worth a lifetime of having everyone know that you’re disabled wherever you go? People I know would disagree on this matter. But until we can say definitively the medical impact on the one hand, we can’t justify it against the social impact on the other. We can’t have a real debate based on folk wisdom versus anecdotes.