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Believing In Medical Treatments That Don't Work
Hugh Pickens writes "David H. Newman, M.D. has an interesting article in the NY Times where he discusses common medical treatments that aren't supported by the best available evidence. For example, doctors have administered 'beta-blockers' for decades to heart attack victims, although studies show that the early administration of beta-blockers does not save lives; patients with ear infections are more likely to be harmed by antibiotics than helped — the infections typically recede within days regardless of treatment and the same is true for bronchitis, sinusitis, and sore throats; no cough remedies have ever been proven better than a placebo. Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment, and knee surgery is no better than sham knee surgery where surgeons 'pretend' to do surgery while the patient is under light anesthesia. Newman says that treatment based on ideology is alluring, 'but the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.' The Obama administration's plan for reform includes identifying health care measures that work and those that don't, and there are signs of hope for evidence-based medicine: earlier this year hospital administrators were informed by the Centers for Medicare and Medicaid Services that beta-blocker treatment will be retired as a government indicator of quality care, beginning April 1, 2009. 'After years of advocacy that cemented immediate beta-blockers in the treatment protocols of virtually every hospital in the country,' writes Newman, 'the agency has demonstrated that minds can be changed.'"
Prescription cough syrups may be useful.The linked article regarding cough syrups only covered over-the-counter cough medications. Prescription cough syrups that contain codeine or hydrocodone seem to work really well but are liable to abuse.
A NYC lawyer blogs. http://www.chuangblog.com/
Cough syrups *do* work. ...BUT...
They don't combat the infection. They alleviate the symptoms.
They don't kill the bug which is causing the cough, they only make the patient cough less (and thus sleep better, feel more comfortable).
So if you count the days spent being sick, a cough syrup won't make any difference. On the other hand if you look which makes happier the patient, one should prescribe the cough syrup anyway. (Same goes for lots of other ailment : most of the treatment prescribed by doctors for common illnesses are only to make the symptoms more bearable, not to kill the bug faster).
There's a saying here among doctors telling that a "cold" last one week without treatment and 7 days with treatment.
I am more astonished about the prescription of antibiotics. Here around in Europe, there have been large campaign to make the public aware that most common infections (bronchitis, sinusitis, sore throats, ear infections, etc...) are due to viruses and thus there's no point in insisting until the doctor prescribes antibiotics.
I would have expected that the same reduction in use of antibiotics would have happened in the US too.
Disclaimer : Although IAAMD, I happen to work in research for the last few years so other medical /.ers should have better knowledge than me.
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NICE is an acronym and stands for The National Institute for Clinical Excellence.
You do realize I hope that carcinogenic and toxic chemicals are present in great quantities in the natural environment too? For example the human bloodstream naturally contains small amounts of formaldehyde. It is hard to imagine how it would be possible to eliminate exposure to these materials when they are present in every plant or animal through their natural metabolisms.
Sperm count studies that claim reductions in sperm count over time are very questionable. There have been a number of publications in the literature that claim sloppy investigative practices are the reason for this perception. And it definitely has not been world-wide. The data vary greatly by region.
As far as immune system affects of nuclear testing - there is no evidence of such effects even in areas directly downwind of radiation hotspots like Hanford. The only studies showing such affects are in populations exposed to far greater doses, i.e. Nagasaki survivors or children exposed in the Chernobyl accident.
So who decides, the patient or family, or BIG government?
Under our current system, insurance companies decide. It seems disingenuous to imply that patients have the choice and that the current system(private insurance companies) pays for every treatment than anyone could ever want/need. There are plenty of people who have been denied claims. I also don't understand why you can't still have private insurance if there is national health care. Did the advent of Blue Cross/Blue Shield make it impossible to get Aetna?
Not to mention the risks. Cancer treatments can kill people, and surgery is always dangerous. Elderly people are the most likely to die from such treatments.
I can testify that knee surgery is sometimes a wonderful cure. I suffered terrible pain for years and two new artificial knees are better than the originals in many ways and they never,ever hurt at all.
The knee surgery being referred to is the kind where they don't replace anything, just dinkering around in there - I believe. They aren't arguing that artificial knees don't work.
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From your nic, I assume ze jsi cech. I'm not sure where you live, but try the health care here in the US. When my kid broke his arm, my insurance refused to pay for the doctor, as it was "elective surgery", the doctor was not one of our preferred providers, and we did not get prequalified.
I guess we could have set his arm ourselves, or perhaps let it heal crooked....
For this we were billed $7,000....
One of my relatives is a doctor in the CR. As everywhere, there are good doctors, and bad doctors. All in all, the care I've received in the CR and Japan rivals that in the US, at a much lower cost.
Actually, the doctors order all the tests because if they don't, and the patient happens to have some disease that would've been detected by that test, they'll get sued for malpractice, and their malpractice insurance rates will go up, and/or they could lose their license to practice. Having universal health insurance wouldn't stop this, it would actually make it worse since the doctors would know the tests would be paid for. (Unless you put some bureaucrat in charge of deciding which tests are necessary, taking that decision out of the hands of the doctor who sees you.)
The only other ways to stop it are to tighten up the requirements to file a malpractice suit (which would make the lawyers unhappy), or for the government to provided some sort of universal malpractice insurance. But then you'd get the same arguments being raised for/against universal health insurance, but applied to rich doctors instead of poor people (e.g. bad doctors being allowed to continue practice). Personally I think getting people's opinions on both is a great way to detect whether they truly want to fix the health care system, or if they just have an agenda they want to push and have picked health care as their vehicle.