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Why Doctors Hate Science
theodp writes "A 2004 study found some 10 million women lacking a cervix were still getting Pap tests. Only problem is, a Pap test screens for cervical cancer — no cervix, no cancer. With this tale, Newsweek's Sharon Begley makes her case for comparative-effectiveness research (CER), which is receiving $1 billion under the stimulus bill for studies to determine which treatments, including drugs, are more medically sound and cost-effective than others for a given ailment. Physicians, Begley says, must stop treatments that are rooted more in local medical culture than in medical science, embrace practices that have been shown scientifically to be superior to others, and ignore critics who paint CER as government control of doctors' decision-making."
Evidence-based medicine is not the norm in the US, but you can't necessarily blame the doctors for failing to consider it: the whole system is the problem. Consider the case of Dr. Daniel Merenstein, a family-medicine physician trained in evidence-based practice.
... there is little evidence that early detection makes a difference in whether treatment could save your life. As a result, the patient did not get a PSA test. Unfortunately, several years later, the patient was found to have a very aggressive and incurable prostate cancer. He sued Merenstein for not ordering a PSA test, and a jury agreed--despite the lack of evidence that it would have made a difference. Most doctors in the plaintiff's state, the lawyers showed, would have ignored the debate and simply ordered the test. Although Merenstein was found not liable, the residency program that trained him in evidence-based practice was--to the tune of $1 million.
In 1999 Merenstein examined a healthy 53-year-old man who showed no signs of prostate cancer. As he had been taught, Merenstein explained
This game will waste your life. Don't clicky!
The quote I like best is: "What do you call 'Alternative Medicine' that works?" "Medicine"
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If you want my opinion, the article sounded suspiciously like insurance company propaganda. The doctor is the one person in the equation who basically has the same vested interest the patient has -- keeping the patient alive.
The cost effectiveness arguments she makes are bunk. E.g., if the old line drugs for schizophrenia are so great, why haven't they worked? And why is dehydrating someone the best way of treating high blood pressure? Give me a break.
Politicians may hate science, and certainly the health insurance companies hate science, and both like to think in terms of cost effectiveness, unless of course it's their own health that's at stake, in which case they want the best "science" available. And maybe some journalists hate science if they've absorbed enough behind the scenes insurance lobby propaganda.
But of all the groups mentioned in the article, it is the doctors who hate science least, and who are most about trying to find the right answer, the right answer meaning the one that is best for the patient's health, as opposed to the insurance company's bank account.
(And in case you're wondering, I'm not a doctor, and have never even had any relative or personal friend who is a doctor; but I do remember my first doctor, who had, under a large glass dome, a giant gold microscope, which occupied the central place of honor in his office... a clear homage to his love and reverence for Science. And in practice he cared for the lives of his patients as though they were his own. And I guess they were.).
Ray Beckerman +5 Insightful
I had an unfortunate incident of that. I came in with depression/anxiety, and my doctor put me on Paxil. Not because it was the best choice, but because it was the NEWEST one, and the lovely dinner the pharamceutical company paid for had these nice salesmen who told all the doctors how safe and effective with it.
After one night on it, I stopped it and made another appointment with the doctor. To say I had a bad reaction would be an understatement. I'd describe it as extreme anxiety with hot sweats and other wonderful symptoms. Cut to a few years later, I start reading in the news about "unreported" side-effects of Paxil and the drug maker being forced to issue updated clinical notes. Now the warnings list all these things.
The appallingly bad knowledge, especially about new drugs, family doctors have is downright frightening.
If you want to know how my story turned out, I got a referral to a psychiatrist who had many, many years of experience and helped me figure out my problem was a combination of biology, a sleeping disorder I'd recently been diagnosed with and really bad work environment. He helped me figure out which drug worked better for me (one that was new, but was relatively less marketed), talked me through how to make the appropriate changes in my thinking and lifestyle to survive bad times and then after the appropriate monitoring time, sent me on my way, and I've been overall pretty good.
The lesson here is our doctors need real medical knowledge to draw on--not just what the marketers and sales people tell them. Family doctors are usually over worked trying to pay the office rent, the receptionist, the malpractice insurance, etc. And they don't have the time or energy to keep learning anymore, and what they do have time for is usually not of high quality to begin with.
I for one am looking forward to this. It doesn't just benefit America--it could benefit everybody.
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I thought insurance companies helped pay for regular checkups and the like because it helped prevent worse illnesses that would potentially be much more costly?
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The other proposal came from McCain, who wanted to eliminate the employer's tax-credit (the part Obama emphasized during debates) in favor of giving each individual a tax-credit (the part Obama never acknowledged) to be spent on their own health care. This would've created the same kind of market for health insurance as exists for, say, auto, term-life, house, and other insurances. The decoupling of health care from employment would've been much more fare, and the prices would've come down because of genuine competition.
"fare" is right! What kind of negotiating position does someone who needs life-saving care have versus an insurance company? A poor one. The only people who would be able to afford health insurance in that plan are people who don't need it. You'll note that McCain himself didn't seem to eager to buy his own insurance rather than take his employers.
The most efficiently run medical payment service in this country right now is medicare with over 95% efficiency in terms of money going to treatment vs. overhead.
E pluribus unum
You are seriously misinformed. There are two important things wrong with what you're saying.
First, the cost of providing emergency care for accidents isn't something that can be reduced, period. What we can do to reduce health care cost is to increase participation in early detection and treatment of disease, which is *FAAAR* more effective (and cheaper) than treatment later on. It's like a city providing free needle exchanges, because that's are far cheaper than treating someone who contracts HIV or some other horrible disease.
Of course, US health care doesn't run on logic, but rather puritan morals and vague capitalist ideology. The most effective way to prevent teen pregnancy, as determined empirically, is early sex education and free condoms, not home schooling and regular church attendance. But we can't use the most effective method.
Secondly, health care is something that people need throughout their lives. As our population gets older, it's not "insurance" for accidents, but rather an on-going part of their care. Which means there is a continuous, fixed cost that must be paid to take care of someone. Therefore, an "insurance" scheme, where risk/profit is calculated to determine premiums doesn't really work. It's much better to spread the risk to the whole population, and have full benefits for everyone.
The reason health care system in the US is so broken is because it's dominated by interest groups that want a continuous supply of "sick" but rich people. Think of the drug and insurance companies, the plastic surgeons and viagra peddlers. Nobody is really interested in the well-being of the people, and those who should--the citizens of this country--can only imagine a world they see in commercials made by drug and insurance companies. Sad indeed.
In Soviet Russia, articles before post read *you*!
Sorry but you are massively uninformed. There are different kinds of health insurance just like there's different kinds of auto and disability insurance. What you are talking about is a "major medical" policy that only kicks in when your costs exceed ~$2k. This is the exact kind of policy I have. Why do I have this kind of policy? Because to get a policy that starts at $0 would cost me over a $1k a month. So, these policies already exist and they are already VERY common. The fact that you and the parent poster don't know about them is utterly fucking shocking to me. Even with major medical, I still have to pay over $200 a month for health insurance just for myself (non-smoker, non-obese).
The bottom line is that the cost of health care has skyrocketed compared to average income. It becomes less and less affordable and is becoming a greater and greater burden on the economy. In fact, the idiots that perpetuate the system we have today are driving us into socialized medicine (their worst fear) just because there will be no other way to deal with the costs. Frankly, I can't wait just so I can laugh my fucking ass off. Most doctors fucking suck anyway. Like everything else, 90% of them are worthless. Too bad you don't have time to shop around while you're in the middle of a heart attack.
"After all, if the government was or is so efficient at providing health care then why not have them provide other things too like cars, vacations, computers, designer clothing, and everything else that people want."
You must be fucking kidding me. It would be impossible for even the government to be less efficient than what we have today. Socialized systems in other western countries are far more efficient. We spend TWICE what England and Canada do per capita on health care.
Seriously, you need to actually READ about this stuff before you spout your mouth off. You have no idea what you're talking about.
Are agnostics skeptical of unicorns too?
And what team would that be? For the record, I'm an Independent and always have been. I loathe the two parties nearly equally, but I have to admit, I find the Republicans particularly more onerous lately. That doesn't mean I support the Democratic agenda in any way, shape, or form.
You know, normally I love anti-partisan rants like this, but re-read my post. I never advocated for any healthcare reform proposal. All I did was dispute the history behind HMOs as stated by the GP. It was a statement of fact. I never even talked about Obama and his healthcare proposal.
I shouldn't have to qualify any critique of the Republicans with a critique of the Democrats. Buying into the false dichotomy of the two-party system is part of the problem...
-Grym