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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.'"
Just wait. Next up will be treatment based on life expectancy and quality. I see this becoming an issue based on my experience working for a group of Eye docs (retinal specialists). I often see very elderly (and often demented) patients receiving very expensive treatment of eye conditions. do they need the treatment - sure, to preserve their sight. Does the treatment improve their quality of life - maybe. So who decides, the patient or family, or BIG government?
Conservative, mod down for violating
The human body is pretty darn good at healing itself. There is absolutely no replacement for a decent diet, moderate exercise, and a positive attitude. The last factor alone has been repeatedly shown to boost immune system health over a variety of drug-based treatments.
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It's well-established that Americans as a whole pay far too much for health for far too little benefit, compared to other first-world nations.
Can some of this discrepancy be explained by high availability of essentially useless or even harmful "treatments"?
My experience with sinusitis definitely confirms this. Every 3 months or so I would come down with another sinus infection. Each time I would goto the doctor and get a prescription for antibiotics. I wasn't asking for antibiotics. I was looking for a solution to the problem. One time the doctor wanted me to switch to a much more expensive antibiotic. Sure enough I ended up getting some nerve damage from the antibiotic. Nothing permanent, but the numbness lingered for over a year.
What the kicker here is that if the doctor had looked at my chart and said, maybe we should take another approach after the 5 or 6th time, the whole situation would have been avoided.
I got a neti pot and I haven't had a sinus infection since, I just use the neti pot whenever I feel my head getting clogged up. $20 dollar solution.
On the other hand, generic beta blockers (ie. propranalol) are so cheap as to be almost free. The conclusion in the cited article does not call for an absolute ban on beta-blocker therapy: Consequently, it might generally be prudent to consider starting beta-blocker therapy in hospital only when the haemodynamic condition after MI has stabilised.
As much as we would like to believe otherwise, medicine is still an inexact science.
Every 3 months or so I would come down with another sinus infection. Each time I would goto the doctor and get a prescription for antibiotics.
This is indeed idiotic. You should shot your doctor. There's plenty of evidence that chronic sinusitis aren't caused by bacteria (the only thing killed by antibiotics).
If the doctor really wanted to try something, he should have made a try with an anti-fungic (some studies tend to show that part of recurring sinusitis might be due to bugs more of the fungi persuasion).
I got a neti pot and I haven't had a sinus infection since, I just use the neti pot whenever I feel my head getting clogged up. $20 dollar solution.
Brilliant. Washing the nasal cavity is a method which also works for viruses which you most likely had like most of the adult population (and against which antibiotics are no use).
It's part of what we prescribe here around (although as I said in another post, I now work in research).
For extra, you can also buy sprays containing carbocisteine (an agent helping making the mucus more fluid), but you should use sprays containing beta-mimetics more than 1-2 weeks.
But the basic "clean the cavity with water" $20 solution works too.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
Unfortunately medicine, just like any other industry is driven by profit.
Eli Lily pushed Prozac and got it approved in many countries even though it causes psychotic episodes in 18% of patents. They even send sample packs to GP's so they can hand them out to patients. Psychiatry in itself is a whole sham, pushing drugs which will never heal the patient, when in many cases counseling or Cognitive Behaviour Therapy will bring about a cure.
Myself, I used to have terrible problems with allergies and get awful migraines. Once I stopped taking pain-killers and antihistamines the problems largely abated. Haven't taken anti-biotics in 13 years and I reckon I get over any nasties I catch mor quickly than I used to. Very rarely get sick though!
The amount of useless drugs administered and useless surgery performed won't go down while there's money to be made. The pressure will always be on the medicos. Either from the drug companies or for the payments on the new sports car.
sudo mount --milk --sugar
In a similar vein, there are some recent studies that suggest that most of the benefit of medicine is the temporary status transfer from a high status individual paying more attention to the patient which perversely causes them to get better. That goes along with the idea that it's important to get your chance to get that status boost.
Degaussing scares the bad magnetism out of the monitor and fills it with good karma.
Perhaps if The New England Journal of Medicine was available free on-line, more patients would know about the conclusions of the cited article Spinal-Fusion Surgery -- The Case For Restraint. Access to the single article costs $10.
The single biggest factor driving health care costs in America is the corruption of doctors. Too many doctors are on the take from Big Pharma.
I personally know one who makes millions dispensing medicines pushed by the pharmaceutical companies. He owns a big house in the Westchester, a swank apartment on the Upper East Side, 2 BMW's, a Mercedes, pays hefty child support, alimony (which includes a third mortgage on his ex-wife's big house in Westchester), and he parties like a freak.
He's not even a surgeon. How does he make so much money? By accepting kickbacks from the pharmaceutical companies for the medicines he prescribes and dispenses (his specialty allows him to dispense certain injections to relieve back pain.)
All this guy does is inject people's backs with something that is clearly ineffective, and then refers them on to his surgeon buddy when the injections don't work. What a scam!
He bragged to me on several occassions, while drunk, how the Big Pharma companies wined and dined him in super-expensive Manhattan restaurants, and how they paid for ultra-luxurious island vacations. I know there was more he wasn't telling me.
I met another "doctor" who actually just owned a bunch of clinics in NJ. He was the dumbest son-of-a-bitch I have ever met, and he walked, talked and dressed like a wiseguy. Yet he drove 2 Rolls-Royces and invested heavily in porn sites and strip clubs in FL. He was scary, really scary, yet he was a "leader in quality private health care in the greater NJ region". *shiver*
It's time we cracked down on medical waste and fraud.
"Crude and slow, clansman. Your attack was no better than that of a clumsy child."
So what about those that dont? When I was a kid, our doctor refused to give me anything based on this reasoning. As a result of chronic untreated ear infections, I developed a speech impediment that i had to have therapy for until i was almost 16 and still lingers today. I attribute a lot of my anti-sociality in my youth (and now) to being embarrassed to talk. Thanks for nothing doc.
At least here in Finland it is common practice to take a rapid CRP test from patients when they show symptoms of for example sinusitis. If the result is less than 10 sinusitis is most likely caused by a viral infection so no antibiotics will do the patient any good.
The numbers are somewhat astonishing, last I heard it was like 14% of GDP going into healthcare in the USA.
If we look at unnecessary procedures like the arthroscopy for osteoarthritis (assuming the study results are repeatable) that's one major way to save money.
Another major way to save money is to make the payment handling a non-profit business. Something like 20% of healthcare spending is going into the insurance business and dealing with payments. That should be more like 2%.
And a third major savings is to be gained by realizing we're all going to die and not spending huge money on someone in their last six months. It makes no sense, but most of the money spent on most of the people in the USA is spent on people within 6 months of death. And most of the time, their life is no longer than if they didn't spend the money, but it is more painful. Curbing this spending could save us as much as 20% of our current healthcare spending.
I suggest that if a person is 2 years beyond average lifespan, no government money be spent on hospitalization or surgery. If they have the money to buy private insurance or can pay for it out of pocket, fine, that's their choice, but otherwise, too bad, don't make the rest of us pay for torturing your granny to death.
Actually, while I'll agree with you that the latest research doesn't support any prophylactic effect from taking vitamin C for colds and the like, I'm going to disagree with your conclusion.
Vitamin C does have a number of effects that make it worth taking during a cold or flu. Biochemically, vitamin C has a number of roles, such as deactivating histamine, which is one of the causes of feeling sick when you're sick, and it plays a major role in free radical clean up.
When you're sick, your immunocytes are attacking the invading pathogen with such wonderful enzymes as myeloperoxidase, which take hydrogen peroxide (produced in the oxidative burst) and turn it into HOCl (bleach) in order to kill the pathogen. This process spews reactive oxygen species (free radicals). When the ROSs interact with your cells, they cause damage, which leads to cytokine release and mast cell degranulation. Mast cells are the primary histamine releasers. So, not only is Vitamin C involved in the cleaning up of free radicals (in that vitamin C will quench the free radical, by itself becoming a free radical, albeit a safer and more stable one), but it also deactivates histamine.
Additionally, if you'd care to do the research, most of the studies showing megavitamin therapy (in the case of vitamin C) to be ineffective have either been performed by those with an interest in showing that it's ineffective (i.e. the drug companies), or had indeterminate conclusions.
Much more research needs to be done on the subject, but since the only problem with (oral, at least) vitamin C therapy seems to be osmotic diarrhea at more than 2g/day intake, in my opinion, there is no reason not use it for this purpose.
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