November 15, 2015

The Sound of Music

From a mathematical perspective, adding and subtracting are equivalent:  with addition, you perform an operation on two positive numbers; with substraction, you perform the same operation on one positive and one negative number. In medicine, by contrast, addition and subtraction couldn’t be more different. Introducing another drug or another procedure is considerably easier than discontinuing a long-standing practice, even when there is mounting evidence that the practice is not beneficial, perhaps even harmful. One way to wean patients and doctors from an established treatment is to substitute a different, more effective or safer treatment. It’s a lot easier to change behavior if you can offer a new, improved treatment rather than just asking people to forgo something that they believe must be helping them. So clinicians ought to be very enthusiastic about the strong evidence supporting the use of music to aid in postoperative recovery, as shown in a systematic review and meta-analysis recent published in the British journal, the Lancet.

Taking all available studies of the utility of music into consideration, the authors conclude that playing music before and/or after an operation decreases the amount of pain medication patients take, it decreases their degree of pain, and it lessens their anxiety. That means opioid medications, currently in the news because of the epidemic of overdose deaths from these drugs, can be given in lower doses, for shorter periods of time, or potentially not at all. Ditto for anti-anxiety medications, which have been associated with increased confusion, increased falls, and other problems in older people.

This is a rare instance where we should go ahead and change the way we practice medicine without demanding additional studies, better studies, or more definitive studies. Here's an intervention that has no disadvantages that I can think of, it's cheap, and there's even moderately persuasive evidence that it is effective. Not only that, but playing music for patients doesn't mean we have to stop doing what we're currently doing, only that we should do a little less of it. 

If we don't introduce music into surgical units and recovery rooms (parenthetically, I'd like to see a study of the effect of classical music on surgical performance in the operating room--my guess is that it would calm the doctors as well as the patients), that will say a great deal about what we value in medicine today. It will suggest that what drives the diffusion of medical care is not so much evidence as advertising. There are, after all, no medical device manufacturers or pharmaceutical companies that will promote and market classical CDs and portable CD players to hospitals. I can't say I'm very optimistic, but I hope we will do the right thing.

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