Myths in anesthesiology

Abstract

The article by Soppitt et al. in this issue concludes that “many anesthesiologists use a single dose of propofol in expectation of an antiemetic effect, even though scientific evidence supporting this is lacking”. Specifically, this article sets forth that 84% of all surveyed participants use propofol for its antiemetic effect, with 63% using that drug in procedures lasting more than one hour. Curiously enough, this is despite results of recent scientific studies that have conclusively shown that the plasma level of propofol after one hour’s duration is well below any effective concentration. In other words, it appears that a majority of anesthesiologists are using the drug for an ineffectual purpose. Assuming that randomly questioned anesthesiologists are a representative sample of the anesthesia community, a majority of anesthesiologists have incorporated a false belief into their daily routine. False beliefs or myths of any type are rarely written down; rather, they are passed down through generations, leading one to ask: How do these myths or false beliefs develop among anesthesiologists? Despite existing standards in monitoring, pharmacology, and better understanding of physiology, much of the practice of anesthesiology still remains largely a clinical art, with further advancement dependent on quality of research and education. Research—animal or human—is stimulated mostly by the intellectual curiosity of individuals who desire to verify or refute clinical experience. Research is conducted at research institutions, medical schools, and independent industrial research departments, and the outcome is integrated into lectures at residency programs, presentations at scientific conferences, publication in medical journals, audiovisual material, reinforced in part by representatives of industries manufacturing either drugs or equipment. How significant is the contribution of each of these vehicles in disseminating the scientific based evidence or creating myths? Lectures in anesthesiology residency programs include results of scientific studies; however, even in the academic environment, daily activities are not always based on scientific methods. Primarily because institutional biases and attending anesthesiologists’ personal experiences affect daily practice, residents are not always taught material that has supporting evidence. Such false or unsupported beliefs are then reinforced by repetition, until they become habit and convenience. Eventually graduate residents carry them to their respective practices. Pharmaceutical companies affect daily practice of all physicians, not only anesthesiologists. Interaction between physicians and pharmaceutical companies starts as early as medical school and continues well into practice. Numerous studies have been conducted, and articles published about the results of that interaction show that the relationship between practitioners and companies has an impact on the rapid introduction of new drugs and their prioritization. Although none of the studies referred to in a recent review article, have shown