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.'"

Comments

And next up

[m0s3m8n]

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?

Re:And next up

[JohnFluxx]

The scientist in me likes the ideas of NICE. If an operation neither extends life nor increases quality of life, then what's the point in the operation?

Of course, it never works perfectly, but I'd be interested in what the critisms against NICE are?

Goes to show.

[palegray.net]

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.

Re:Goes to show.

[lawpoop]

I think that the human organism basis some of its healing on its perception of its role in society. We are a social creature. Every culture has some kind of 'theory of medicine' -- that disease has a cause, which can be treated by certain practices, procedures, and bitter plant concoction ( the taste of 'bitter' is the chemical recognition of alkaloids, or drug compounds, in a plant ).

If we are receiving 'treatment', or attention from the community when we are known to be sick, then our body's healing response will amp up.

Likewise, people can die basically 'on command' in certain circumstances, when a doctor or sorcerer pronounces them dead. In some tribe somewhere, if a shaman does a certain ritual called a 'bone-pointing', the person who gets cursed will sicken and die in about three days -- shorter than you would die from thirst or hunger. Likewise, back in the 80s when AIDS was first on the scene, people would sometimes die within days of a diagnosis. Doctors didn't find any physical cause; they just kind of willed themself to death, probably because of the severe social stigma and lack of hope that an AIDS diagnosis meant at that point.

So I think placebo medicine will be a big insight into understanding human health in the future.

Inefficiency

[syntaxglitch]

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"?

Sinusitis

[jonpublic]

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.

Idiotic.

[DrYak]

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.

Corrupt Doctors

[bloobamator]

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.

Ear infections TYPICALLY recede in a few days?

[Kral_Blbec]

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.