bobbywg:

"However, the sheer abundance crowds out an important—in fact, the only—skill that matters in treating a patient: how to critically appraise published clinical trials. Few doctors ever read them."

I don't know how far removed from medical school you are, but as a current medical student, I can say this comment is absolutely insane. The skill of critically analyzing clinical trials is taught extensively both at the undergraduate and medical school level...

Now, now, let's not be careless here, Student Doctor Bobbywg!

Dr. Sanghavi's comment is not "absolutely insane". While critically analyzing medical studies is taught in medical school, that does not mean it is taught well, nor does it mean that it is learned by the students. In any event, Dr. Sanghavi's primary point (you really should read what you quote!) was that few doctors read the published clinical trials in the first place. Further, his point is that over the whole course of medical training, there is a much much stronger emphasis on diagnosis, and all this time and attention crowds out the more important training in skills needed to manage a patient's illness or condition. You may disagree with his conclusion, but that does not make in an "insane" line of reasoning.

Out in the "real world", I see evidence that supports Dr. Sanghavi's assertions. Many, many doctors focus on simply prescribing medications rather than formulating a real treatment plan. Many, many doctors jump on the latest drug to come out without critically assessing whether there is any valid evidence the new medication is any better or safer than the current medications we use. One example: I see many of the local cardiologists starting patients on Crestor first for lipid lowering, even though there aren't any studies that show evidence of clinically relevant benefits--lowered risk of heart attack, stroke, death, etc. None. Nada. Zippo. They ignore medications (e.g., Pravachol, Zocor) with multiple studies showing clinically relevant benefits and a proven track record of safety when treating high-risk patients with high cholesterol and just skip to the "latest and greatest". Now that is what I call "absolutely insane"!