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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.'"
Further proof that the O admin really does believe in the scientific method.
...will be retired as a government indicator of quality care, beginning April 1, 2009
April Fools!
Actually, beta blockers are GREAT for you.
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.
512 MB RAM, 20 GB disk, 200 GB transfer, five datacenters. $19.95/month.
If you think of pseudoscience as a practice that looks like science, but suffers from an ideologically motivated disconnect between evidence and conclusion, medicine suddenly seem to fit the bill.
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/
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.
As any man knows, if you ignore it for long enough, it will eventually go away. Just like the pain in my tooth and the blood on my toilet paper. I haven't been to the doctor in years, and I am as fit as
Mother, do you think they'll like this sig?
From the abstract linked to about antibiotics not being effective for sinusitis:
Antibiotics provide a minor improvement in simple (uncomplicated) sinus infections. However, 8 out of 10 patients improve without antibiotics within two weeks. The small benefit gained may be overridden by the negative effects of antibiotics, both on the patient and on the population in general.
Well, I get sinusitis once or twice a year. I'm one of the 2 out of 10 patients for whom antibiotics are apparently totally necessary. I once had my sinusitis go for over six months with no sign of it abating until I took antibiotics. As an aside, yes, I probably should have gone to the doctor sooner, but it just seemed like a mild head cold until other systematic problems from the infection showed up.
You'll also note that the paper describes only one type of sinusitis (acute maxillary sinusitis), which the summary then expands to all "sinusitis". So, it's not accurate to say that antibiotics are not effective against "sinusitis", because the flip side is that they are effective and necessary in 20% of maxillary sinusitis patients.
Obviously fake knee surgery is just fraud unless the surgeon does it for free, but some of the treatments do work for some patients in which the conditions aren't resolving themselves. The question is, which patients and which treatments?
Inflammation from my low grade sinus infection eventually caused crazy autoimmune problems which almost landed me in the hospital. Antibiotics cured the infection in 10 days, but the secondary conditions took five specialists to figure out (at one point I heard two of them arguing about what I had). I was off work and in pain for about two months while things healed up. Had I seen the doctor early on, a week of antibiotics would have cured the infection before anything else happened.
From the tone of the summary and article, what I get is that the author thinks maybe health care costs could be cut if we stop treating people who may not respond to the treatment - but the real issue is that some of these common treatments that are not necessary for every patient could be 100% necessary for some of the patients.
Putting moderation advice in your
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.
It's a combination of three things.
1. The do-something-even-if-it's-wrong mantra that is so pervasive in today's society. You don't need to look any farther than the various bailouts from the feds for financial institutions and auto manufacturers. It also leads to #2.
2. If I don't do something, I'm going to get sued.
3. Placebo effect. After numerous studies showing that Vitamin C does nothing to prevent or shorten the duration of cold symptoms, there's still people who'll pop Vitamin C pills like candy at the slightest sniffle or cough. Thank you, Linus Pauling, and the Vitamin manufacturing world.
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.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
The view that high cholesterol is bad, and saturated fats are always a no-no is, on closer examination another example of problems being created out of nothing in order to sell more drugs.
A very profitable and corrupt situation has evolved where the FDA is in the pocket of the pharmaceutical industry, the editorial boards of medical journals are bought and paid for, and academic research often dependent on industry money.
I'm sure doctors are performing some treatments that aren't warranted. However, I assure you that patients want treatment. I work in the medical field, and the psychology of medicine is weird. Parents want antibiotics for their children, and they don't really care about research that says the antibiotics aren't necessary or may even cause harm. Everyone wants a pill for what they have, and they want it now. I've seen people demand x-rays for their pinkie toe, even though the doc told them outright that it wouldn't make a bit of difference. If the doc doesn't order the x-ray (or fork over the pills), the patient is unhappy, and unhappy patients are vastly more likely to sue.
I've had a woman bring her kid to the ER with an cold and tell me in the triage room "I can't get in to see the pediatrician till Wednesday, and by then she'll get well on her own." I'm not making this up---she was rushing to make sure her kid got seen by a doctor, because she knew the kid would get well if she waited too long. She wasn't a drooling idiot, but part of her mental checklist of being a good parent included "If kid is sick, see doctor." If docs don't hand out antibiotics for every earache and sore throat, the patient will just come back tomorrow or the next day and complain "I'm still sick." If the second doc gives them pills, they'll tell everyone they know about the first doc, who is obviously an idiot who didn't have the intelligence to see how direly ill they were. "I needed antibiotics, and he didn't give me anything!"
So all told, I don't blame the docs too much. They are working against hypochondriac patients who demand a pill for everything. In a weird way, people want to be sick, or at least they want their routine aches and pains dignified with snazzy medical terms. I've actually had patients get mad at me when I told them that a contusion is just a bruise, and cephalgia is just a headache.
I used to get at least one ear infection a year, usually more. If I took antibiotics, I would be functional again within about 24 hours. If I didn't, I couldn't sleep, was crabby, dizzy and otherwise non-functional for several days. So even though I could possibly recover just fine without them, I'd much rather not miss work and be in pain for several days. I'll take the antibiotics thank you very much.
I take much better care of myself these days and I only get one ever couple of years instead of twice or more a year. I don't know how much I can attribute to better diet, and more to following my doctors suggestion of taking decongestants when I feel my ears getting plugged up. Either way, it is nice to be on antibiotics less.
In litigious countries (read: USA) they are more often than not carried out as a CYA exercise, rather than for the benefit of the patient. This is an area where "best practice" - meaning perform all possible diagnostics, has run wild.
politicians are like babies' nappies: they should both be changed regularly and for the same reasons
Let's just directly quote the conclusion of the linked paper (a randomised placebo-controlled trial on 45,000 patients - pretty good evidence in medical terms):
"The use of early beta-blocker therapy in acute MI reduces the risks of reinfarction and ventricular fibrillation, but increases the risk of cardiogenic shock, especially during the first day or so after admission. Consequently, it might generally be prudent to consider starting beta-blocker therapy in hospital only when the haemodynamic condition after MI has stabilised."
In other words, beta-blockers (well, metoprolol) do reduce deaths from some of the problems arising from acute MI, but can raise the risk of death from other problems arising from acute MI.
This doesn't blow beta-blockers out of the water by any means. As a doctor, these side-effects are entirely predictable. It is the last sentence of the conclusion that is the 'art' of medicine rather than the science - using a physician's experience to determine WHEN to introduce certain treatments to a patient.
Unfortunately, there is no way of measuring this 'art' in a scientific way.
"You'll have to pry my Beta Blockers out of my cold, dead hands."
Point: when the government "retires" beta blockers --- based on strong evidence that they're ineffective --- you can expect objections having to do with 'patient choice' and how the government is telling doctors what to do. Merits be damned: this will be used as an example of why we can't afford government-subsidized health care.
It's no coincidence that the people who oppose "socialized medicine" are often the same ones who avoid evidence-based medicine in large-scale situations where it might be effective. It's also no coincidence that our health care costs more on average than many other nations, and yet our health outcomes are worse.
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 ]
I agree with this guy's main point, but I think he's a little too harsh. He keeps harping on "ideology." If you think that back surgery or cough medicine works, does that mean you're "blinded" by your "faith" in pills and surgery?
We're not talking about homeopathy or some other treatment that couldn't possibly work. These are plausible treatments that at one time seemed promising, but the evidence didn't back them up. If you think that some of them work, maybe you're just misinformed. It doesn't mean you're an ideological zealot.
You might note that the "knee surgery is no better than sham knee surgery" study was only about osteoarthritis. The vast majority of knee surgeries are for repairing injuries, not for arthritis treatment.
That said, a surprising amount of medical treatment is out of date. Most doctors do the same things they learned in med school, or in the early years of their practices. There are still a lot of doctors who don't believe in (or even know about) the role of Helicobacter Pylori in peptic ulcers.
On the other hand, due to the insane amount of regulation in the medical field, getting the word out on new procedures is often like running through a minefield. If you come out with something new and useful, and make claims about how effective it is, you're setting yourself up for huge lawsuits if some doctor screws up the treatment (or if someone isn't cured when they really think they should be).
(please read through before thinking this is flaimbait!)
This has been covered on the documentary The Enemies of Reason by Richard Dawkins. Don't prejudge this based on its name or the author: look for the documentary online, especially "Episode 2: The Irrational Health Service".
Here's the especially relevant part: Enemies of Reason Ep.2 (5 of 5)
Entomologically speaking, the spider is not a bug, it's a feature.
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
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.
Do medications count as medical treatments? Such as how statins do not lower your risk of death? Which is not surprising because cholesterol is a symptom not a cause.
I'd be interested why you conclude that. This abastract and this article, and quite a few other sources, offer good evidence that statins lower the risk of death in the general population.
I understand in the US they take a sample and analyse it. In Holland they don't seem to think that's worth while.
Switzerland, here. We use a fast antibody test so the doctor knows what to prescribe within minutes.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
Get some exercise, stretch, lose the gut, and you'll see your lower back pain disappear! Oh, get up away from the idiot boxes - TVs, computers and the internet - speaking of which; bye!
If the $8 bottle of robitussin is no more effective than lemon tea, what reasonable consumer would buy the robo?
Someone who wants to do DXM, for one. Dextromethorphan hydrobromide (US OTC) is easier to get in some countries than ketamine (US CIII) or phencyclidine (US CI).
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.
He's a quack. Knee surgery is never any good?
From the NYT article: Can we abide by the evidence when it tells us that antibiotics don't clear ear infections or help strep throats?
It has been common medical practice for decades to treat "sore throat" with antibiotics only after a positive throat swab for Streptococcus because of the associated risk of rheumatic fever and its complications. According to the article cited this is still true: A serious but rare complication is rheumatic fever, which affects the heart and joints ... This review of trials found that antibiotics shorten the illness by an average of about one day and can reduce the chance of rheumatic fever in communities where this complication is common.
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.
is ass backwards.
Health Insurance should work like other insurance policies, for catastrophic issues. My auto insurance doesn't pay for maintenance but that is exactly what people expect from medical insurance. The same for dental. There are many services that are expensive simply because a "group/company" is paying for it, not a person. If auto/home/etc insurance worked like how medical/dental does we would have huge premiums to cover for people going in to get their oil changed every 3k and tires rotated just because someone else is helping pay for it.
I do not mind universal catastrophic health care, I do mind the idea of paying for every kook who thinks his tummy ache is an emergency. This recent story explains why it can be so out of control, http://www.msnbc.msn.com/id/29998460/
A local hospital in Atlanta (actually more than one) reports many cases of people calling 911 to get a ride downtown where by law they are required to be given a "ticket" to get home. So what happens? Many abuse the system only to waste our money and the valuable time of doctors and nurses just so they can come downtown and see friends or do shopping.
Any UHC system is going to have to set real boundaries so stuff like this gets stopped. It isn't the treatment of real medical issues that is sinking the system, its the abuse of anyone who cries "I got a boo boo" doesn't even need a "boo boo" to get something and worse not be held accountable when it is nothing.
* Winners compare their achievements to their goals, losers compare theirs to that of others.
The supplement industry that sells crap like ginko and glucosamine should also be shut down.
get the right streptococcus, and you will do permanent damage to your heart valves. they colonize the heart from your throat (same holds true for chronic tooth decay)
also, cough medicine to me seems to be nothing more than a chance to take psychoactive compounds because you are so miserable. that's not an argument against cough medicine, that's an argument for it. there's the placebo effect, then there is pseudoephedrine. two different things
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
According to TFA, you don't actually know that.
We need NICE because ethical drug companies are no longer ethical, and that in part reflects our demand for magical cures. The really serious problems we face - like TB and avian flu - are of little interest to drug companies because (in the first case) most people affected are poor and cannot afford expensive medicine and (in the second case) vaccines are usually a one or two off and do not represent a continuing revenue stream paid for by insurance. We cannot rely on insurance companies to control public health because their aim is to balance revenue and cost - they are not interested in controlling the diseases of the poor, and they do not want diseases cured to the extent that their revenue goes down. We as taxpayers need agencies like the NIH in the US and the NICE in the UK to advise and regulate in our interests, not those of shareholders only.
From scarped cliff or quarried stone she cries "A thousand types are gone, I care for nothing, no not one."
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."
The recommendations for beta blockers in ST Elevation myocardial infarction and Non ST Elevation myocardial infarction are set forth by the American College of Cardiology, after careful review of the literature. Link.
Implying that physicians don't know what they are doing when administering beta blockers to ST/Non-STEMI is ridiculous. We fully acknowledge that data is conflicting or insufficient. It is rightly up to the physician to decide whether or not to administer beta blockers after physicial examination of the patient and all the associated data.
Arguably no less harm can be done by doctors who fail to prescribe antibiotics even in cases where these conditions are less harmless than they'd "typically" expect them to be. Its not a good choice either to just look at "the protocol" rather than at the patient...;-/
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.
The Whole Foods store near my home has whole aisles filled with nonsense like homeopathy, herbal medicines, etc. Okay, not all herbs are useless (e.g. there's evidence St. John's Wort helps depression). But much of this stuff is, if you ask me, flat out fraudulent product.
I support a free market so I don't want to get rid of these products. But at the same time... it bugs me that companies basically prey on people's ignorance of science to make money.
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.
I dated a nurse's aide for about a year, and what always shocked me was how little she knew about the treatments she was suggesting. Every time I got a cold, she demanded we rush to the ER to get some penicillin.
Now, I'm not one of those assholes who thinks he knows everything, but I know that colds are caused by a virus, and penicillin doesn't work on viruses.
Since then, I've gone on the philosophy that just because someone who works in a hospital says something, doesn't mean it's gospel. I won't take it as *wrong*, but I'll take it with a grain of salt, like I do medical advice on the Internet.
It's been a long time.
Please! No more!
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.
Yes, early administration of IV beta blockers caused more heart failure. It also caused people have fewer additional heart attacks and to drop into nasty rhythms requiring painful shocks.
The take home of the big study wasn't not to give beta blockers - it clearly showed they worked for the reason we had always given them - but to be judicious. Don't push them IV at the first sign of a heart attack. Give them to people who seem to have enough cardiac output to spare. In essence, think - don't just give them because a) the study protocol says the get it, or b) the hospital guidelines says to give them.
+--------------------- You idiot! I told you we were facing the wrong way!
Sorry after reading the first 10 lines of the summary I stopped. The problem is that maybe often the infection goes away without treatment. But also very often it does not and to the worse becomes chronic. I once had such a hard stuck sinusitis, it never went away until I started treatment, what do I have to say, antibiotics and 1 month of treatment via infrared light did wonders...
I am glad that it did not become chronic however...
The problem is we need to be very careful in how widely we apply the results of medical studies. We need to depend on them, Doctors should be aware of the results of the ones in their field, and there should be rigorous peer review, but they shouldn't be enforced as a determinitive factor in care except perhaps where results are extreme, because statistics in a given study aren't necessarily indicative of what is likely to happen in a particular case--for example, a huge Danish study said a few years back that extensive lymphadenectomies (i.e. taking out a good portion of the body's filtering and draining system) didn't result in longer life for patients recovering from gastric cancer resections, and that it was a bad idea because higher mortality rates occured in-hospital.
But it's harder surgery, and if a surgeon doesn't do it all the time he or she may not be able to do it well. That doesn't mean that it's not the best operation for the patient, and a patient's best chance for surival continued to include a radical lymphadenectomy from an experienced surgeon as part fo the procedure--despite the establishment's research-backed arguments against it.. Further, the study used to support arguments against it was only applicable in cases where splenectomy was done at the same time as gastrectomy, which wasn't the case for many if not most of the cases the argument was applied to.
And, to top it all off, after years of this debate new results came out from the patients of the Danish study showing their five or ten year survival rates were a lot higher with the radical lymphadenectomy.
I would hate to be a gastric cancer patient in the interim who understood why the study showed such bad results but who wasn't allowed to have the more radical procedure because "it's a medical treatment that doesn't work" according to the establishment. And worse than my hating it, I could easily die because of it.
Similarly, that back surgeries to relieve pain are usually no better than nonsurgical treatment doesn't mean back surgery should not be used--it means that either it should be more targeted or surgeons should be better-trained in that kind of surgery.
There are many calls for doing less medicine because of its skyrocketing costs. But we don't need less medicine, we need smarter medicine.
--- Thousands are enslaved every day.
Unfortunately, a lot of medical papers use statistical tests improperly. As a result, many of the conclusions about what does and doesn't work in medicine are wrong.
Scientology is the one that hates psychology. Christian Science is the one that says only God cures you. (I exist on this Earth in part because my grandmother refused my Christian Scientist grandfather and took my dad to the hospital with pneumonia when he was little.)
Both loathsome in their own way, but get em straight.
It's rare that you're presented with a knob whose only two positions are Make History and Flee Your Glorious Destiny.
Amen to that! My rule is "Never Generalize". And it works in every situation.
I am not a crackpot.
I had lasik done there back when the FDA still thought it was too risky.
Sub-Saharan Africa has problems that money can't fix.
Chemotherapy is not tolerated by the old well, but radiation therapy is, and is often the only option, other than surgery to treat malignancies in older folks - either for palliation or treatment.
..........FULL STOP.
Elderly easily tolerate radiation therapy, and surgery is only not an option for when it doesn't make sense, or if the person is really quite frail, end of life, etc.
..........FULL STOP.
Part of the problem of the euphemistically-named "evidence-based medicine" is that it treats conditions statistically instead of individually. Oh, you have an ear infection; statistically, 95% of cases clear up, so no antibiotics for you. Someone I know had a similar problem -- the infection would occur, it wouldn't go away on its own, antibiotics would be prescribed, and it would go away. Then it would come back a few weeks later. Turns out there were two infections, a strep infection which caused the obvious symptoms, and a staph infection which was largely asymptomatic but was depressing the immune system. The drugs would eliminate the strep but the staph was partially resistant. So the staph would remain and lay the groundwork for re-infection by strep. A longer course of different anti-biotics, and no more infection. But that's a bit on the zebra side, so "evidence-based medicine" wouldn't admit to its existence.
First, I want to get this out of the way: if a placebo works, USE IT! The human body is amazing--if you convince it that you're treating it, it behaves well. Where placebos have been shown to be effective, use them! They're good, inexpensive medicine.
Next, how much is this affected by our fear-mongering instant-gratification capitalist society? If you anticipate difficulty in trying to convince patients that throwing a bunch of money at a problem is completely ineffective, then just wait 'til you try to convince doctors and hospitals that taking patients' money is a bad thing.
This reminds me of the bicycle helmet fiasco. They've been proven, repeatedly, to do no good at all (for on-road recreational and utility cyclists), and yet people keep selling them and trying to scare consumers into buying them, because "it's obvious that they work!" There were also some early studies done really badly by irresponsible morons. We seem to have a fundamental need to throw money at perceived problems--especially when the alternative is educating ourselves and taking responsibility (in this case, learning how to bike safely, which has been shown to have a huge effect on safety; I suppose that the analogue in the medical example is something more akin to preventative medicine). However, it's partly cultural--different societies take it to different extremes.
I don't claim that there's a link between preventative medicine and good statistics (not a causal one, anyway ;) but I'm bemused by the ease with which even scientists accept science that confirms their biases, and with which conclusions become grandfathered into a culture. Why is that?
Remember Zombie Feynman! Good methodology is icing on the cake; the real problem is that people hate being wrong, but they usually are.
Is the solution education? How does one teach skepticism and willingness to examine new evidence? How does one teach a willingness to be wrong?
"The biggest problem with communication is the illusion that it has taken place."
If my experience of moving from minimum wage to upper-middle class in the span of 3 years has taught me anything, its that the amount you're paid is inversely proportional to how hard you work. I still work, but not nearly as hard as when I was an intern. And when I was an intern, I didn't work nearly as hard as when I was a janitor. Looking up on the pay scale, I see that most of the execs at my company make $300-500k to sit around and talk out thier asses, and come up with ideas that lose the company millions of dollars.
People believe in "medical treatments that don't work" for exactly the same reasons that people believe in gods and other things whose existence cannot be objectively demonstrated: emotional need. Some people so badly need to eliminate uncertainties in their existence that they resort to imagining conditions that allow them a necessary degree of it. With that certainty comes a feeling of safety, and perhaps a reduction in stress.
Another word for this behavior is self-delusion. Collective reinforced self-delusion is frequently a threat to democracy and freedoms, not to mention personal health as in the instances related here. It's possible that people prone to self-delusional behavior have an extremely low tolerance to hormones induced by stress. If we could treat the stress some other way, we might eliminate their reliance on delusions.
If they don't already, medical schools should teach basic mathematical probability (as part of evidence-based medicine). One time, I had chicken pox late (about 28), and at the surgery, I asked one of the doctors what would be the chance I would develop deadly condition x if I took treatment y (treatment y would otherwise potentially help in other ways). I got something along the lines of:
"Well if you're the one who gets the (deadly) condition in the end, what matter is it that there was z chance of getting it?".
I went on to explain I'd rather have a 1 in 1,000,000 chance, than a 1 in 10 chance and I think that brought the message home. Still it was quite painful to hear...
It would nice to see a study at hand to back up most treatments given out, rather than just the doctor's experience/hunch.
Why OpalCalc is the best Windows calc
Knee surgeries work, atheletes and the team owners have way too much money invested and knee injuries lead to knee surgeries often with remarkable success.
DXM has kept me from coughing. It's not expensive, I'll continue to buy it, whenever I get bronchitis. It beets seperating a rib.
Beta blockers slow your heart rate and lower your blood pressure, they have uses.
It has been statistically shown that helmets increase the risk of head injury.
I was stunned to read, in the article, that "No cough remedies have ever been proven better than a placebo."
As I write this, I'm recovering from a stress fracture of a rib caused by a persistent cough.
Let me describe the sequence of events. I coughed nonstop for two weeks. I experienced rapidly-worsening pain in one rib. My doctor prescribed codeine-based cough medicine. I took it. Cough stopped; I slept through the night without coughing for the first time. My rib is getting better.
Placebo effect? I don't believe it.
So I followed the link to TFA... the second FA... the one that TFA cites. The title of that article is Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled trials.
It's the over-the-counter cough medicines that haven't been proved to work.
Which I can quite believe. Because I was taking them before the doctor wrote me the prescription.
"How to Do Nothing," kids activities, back in print!
Liberal Fascists should be careful, because the more power they grab now, will just mean more power that the Conservatives get to use when it is their turn again. All the Liberal are happy that they get to tell everyone what to do, but they forget that eventually the Conservatives will be in the same position. The last time the Conservatives where in power they basically wasted it by doing nothing. Do you honestly think that they will do that again? The Liberal are showing the Conservatives how do it. Which I think is also a bad thing.
I'm currently halfway through medical school and this axiom is being beaten into us repeatedly. It's not like academic medicine is in denial. Thanks to the influence of post-modernism and self-reflexivity, modern medical education is perfectly comfortable with telling its students, over and over, that only around 50% of what is taught today will turn out to be "correct" in 20 years or so, and half of it will turn out to be incorrect, and that there is of course no easy way today to tell which is which.
Some people take this to heart and will remain lifelong learners open to new evidence and the retirement of discredited approaches. Others will simply freeze in amber what they learn in their first few years and overly rely on this body of gradually discredited knowledge for the rest of their lifetime. In this regard, doctors as a population are very similar to a lot of other professionals. The proportions of those willing to update their knowledge versus those unwilling may vary between some professions, but humans and human emotions remain the same.
Da Blog
Well, speaking as an MD/PhD, I can tell you that even though useless treatments DO exist (for example cough medication), there is a lot of controversy for several other issues. Even guideline groups cannot always agree on a specific attitude.
For example, beta blockers are clearly indicated for myocardial infarction with evidence grade IA (the highest possible!) in the guidelines of the european society of cardiology (freely available in http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-AMI-FT.pdf). Anyone with half a brain and ten years of training knows that beta blockers (especially IV) should not be given to someone who is hemodynamically unstable, which is the conclusion of the cited study above (published in Lancet 2005) and the aforementioned guidelines. Saying that beta blockers should not be given is completely wrong.
Things are much less clear for low back pain surgery, even though recent reports have shown it to be more effective.
In conclusion, the original article incorrectly criticizes and mixes good treatments that should be avoided in specific subgroups (beta blockers) with useless treatments (cough mediciation) with controversial treatments (low back surgery). Such oversimplification is dangerous, especially if strongly motivated by cost concerns.
P.
Oh what the heck, I have karma to burn.
Using electroconvulsive therapy and "restorative" therapy to attempt to make a gay or transsexual person straight is another example of medicine that doesn't follow the evidence.
Of course the problem is the religious fundamentalists have tons of money to burn in the pursuit of attempting to change someone's sexual orientation.
If it ain't broke, don't fix it? Well, not unless there are plenty of people who will pay plenty of money to plenty of doctors to show that it really is broken by using bad science.
Doctors can accept bribes just as easily as anyone else.
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There are plenty of treatment in "established medicine" that aren't actually established. Along with all the ones they mention, for decades women's doctors put them on hormone replacement therapy following menopause in part to reduce their risk of heart attacks, where there had NEVER been any evidence that they would do so. And after decades and millions of women on hormone replacement, when someone finally bothered to look into it for the first time, it turns out that hormone replacements increase the risk of heart attack.
But what about the opposite, scientifically proven remedies that have inexplicably shifted into the realm of "home remedies?" A pertinent example is Epsom Salts for curing infections. Soaking wounds and infections in Epsom Salt solutions is a highly effective treatment, and one that used to be prescribed by doctors and used in hospitals. Research has shown it to have great efficacy. But now doctors use antibiotics and even surgery to try to cure things that can be fixed much more safely and painlessly with a $1 box of Epsom salts and a tub of water. Is it just undue influence from pharmaceutical and medical device reps? Another example is just using pressurized air to evacuate and cure oral infections, because most bacteria that colonize mouths are highly susceptible to oxygen poisoning and dehydration. But instead, doctors and dentists rely on courses of powerful antibiotics. There are many more examples. I'm not talking about homeopathic remedies with no scientific trials demonstrating their efficacy, but treatments that are actually shown to be effective. If there's no money in a solution, does it get lost because no one is championing it?
Can anyone tell me how to set my sig on Slashdot?
Here in Australia private insurance has to compete. All of them offer the exact same thing and many are a different front to the same company.
... alternative medicine
... they al sell by law the same stuff. How do they differentiate ... sell crap at a high markup and given you walk into a "respected" establishment the rest of the junk gets credibility.
So the problem is how do you differentiate to get customers.
Well you offer
Same goes for a Pharmacy/chemist
So you have over the counter "medicine" in chemists which is just snake oil. You get "stone message" from health insurance companies.
Continuous, long-term use of Ketamine will result in a loss of the phenotype of a particular subset of your GABAergic inhibitory interneurons. This has a good chance of increasing your risk of progression along the schizophreniform axis. Is that really something you want?
Da Blog
A lot of the sorry physical state you see in retired athletes may have as much to do with the playing injuries (especially in contact sports like rugby, American football, boxing, etc.)
Sure, you have a point with the moderation comment, but I doubt that's the whole picture
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
I also read that Medicare costs four times as much per patient in Miami than in LA. In Miami, doctors are scheduling Medicare patients for monthly MRI scans just on general preventative principles.
My point is that huge battles await government when it tries to truly reign in wasteful health care spending. Both the doctors and the patients will fight like hell, not to mention drug companies, and clinics. Congressmen on the other hand are cowards when it comes to bucking public passion.
I, for one, have little faith in our government's ability to manage such challenges. I think it will fail.
This interesting article, which just happens to mention Obama+Healthcare, reminds me of watching The Daily Show the other night. Peter Orszag, the fellow who was in charge of the new federal budget was on. Even though Jon Stewart never brought up Healthcare, Mr. Orszag did. Over and over, without any prompting. I don't suppose this is part of a tightly scheduled media blitz, is it? Nah.
The government making choices about people's lives is horrible.
I'm old enough to remember the 1970s and that "I'm from the government and I'm here to help." really was terrifying, because government fucked up so many things so badly.
"I don't know, therefore Aliens" Wafflebox1
There is not "strong evidence that beta blockers are ineffective." The article refers only to the use of beta blockers for acute MI. There is strong evidence that beta blockers are effective in reducing the death rate post-MI, and also in patients with heart failure.
These are knee surgeries for acute injuries. TFA is talking about arthroscopic knee surgery for osteoarthritis.
Auto insurance protects the policyholder from a different kind of risk. Criticizing health insurance for not being like auto insurance is a big mistake. Auto insurance protects against episodic risks; you get into a car accident, so you require a fair chunk of money right away, but after the claim is paid, you don't need any more money.
Health insurance, on the other hand, needs to insure you both against episodic issues and chronic ones. A chronic risk is a risk where, one day, you need a significant amount of money for health care over many years, maybe even the rest of your life. In the general population, people will have acute episodes at some statistical rate, and some proportion of the population will be chronic sufferers. You want to insure yourself both against the episodes, and against the risk that you'll turn out to be one of the chronic sufferers.
Now, the reason health insurance pays for "maintenance," in theory, is because routine care reduces the risk that people will be chronic sufferers. In practice, the private insurers in the USA do not want to insure chronic sufferers, nor pay for routine care, so they structure their products accordingly, by charging chronic sufferers much higher premiums than healthy people, and pushing for higher deductibles and HMOs in order to reduce their routine care costs. These pricing schemes and practices ultimately make it impossible in practice to insure oneself against acquiring chronic health issues.
The reason we need universal health insurance is to force everybody to insure themselves against the chronic risks, because the private sector is just systematically unwilling and incapable of doing so, because they can make more money by not providing that kind of coverage. So it makes sense to have the government provide the compulsory chronic health risk insurance. and private insurers to provide supplemental coverage for episodic risks.
Are you adequate?
ugh....why do people make the same mistake all over. "Evidence Based Medicine" isn't meant to imply that all other medicine did not use evidence or even good evidence. It's an *idiom* from crying out loud representing a number of things that Sackett and others considered wrong with medical practice. One of which is there was not a standard for interpreting and ranking evidence in medicine.
Well, it really depends on the condition, doesn't it? I am pretty familiar with back pain, having one herniated and one blown disk in my back. This is extremely painful. I know that some procedures, for certain types of back pain, is just as likely to not help as it is to help and can sometimes make it worse. However this is not always the case. Some procedures for certain conditions are showing to be VERY effective for those patients that can not get relief otherwise. That said, back surgery should be a last resort after trying the other remedies. Many back problems go away on their own, or with proper exercise, or medical treatment. However, sometimes it does not. There are quite a few different types of surgery you can get, and some surgeons clearly seem to have a much better success rate than others. Minimally invasive surgeries also seem to, at the very least, decrease the risks of making things worse. I have two friends who had long term back pain, and who eventually had surgery. One had titanium rods put in, and he is much better. The other had a minimally invasive procedure, where they heated up the disk, cut off the bad portion, reformed it, and cooled it down again. He was able to walk off the table and has done well since. With any procedure, always check your options, and if you can, take the time to go through all your available options before turning to surgery. I still have options available to me, which I will explore, but if they do not work, I will not hesitate to go the minimally invasive route in order to get rid of this pain. The pain is what drives people to accept surgery as an alternative, even if they are outright given a 50/50 chance of getting better. Why? Because the pain is awful, as is collapsing in public from searing pain. If you haven't had severe back pain, I hope you never do. I would do just about anything to rid myself of it.
Open Source: Eroding the Digital Divide
I used to get ear infections regularly. My ear canal would swell up and close, and i'd be in pain and hard of hearing. I haven't had them in a while until now. I found that antibiotics did LOTS of good. But so did anti-inflammatory drugs like Naproxen Sodium. I am going to the doc tomorrow to get some antibiotics.
No cough remedies better than placebo? I know from first-hand experience that expectorants can stop a cough. Also, honey is highly effective in clearing out my throat.
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
In the early 70s, the government spent millions in scientific studies to support the "food pyramid" with inconclusive results. They went on with the recommendation anyways and somehow population started getting fat.
Our whole food industry is based on a unproven government recommendation to the point is hard to find high-fat foods in the supermarket anymore, everything is low-fat with a bunch of sugar on it.
It kinda makes sense: don't want to get fat?, then don't eat fat. Don't want cholesterol?, avoid foods with cholesterol. But studies on human metabolism are showing the opposite is true: a high-fat, low-carb diet (Atkins kind) helps reduce weight and cholesterol levels... weird, uh?
HTML is obsolete. It's time for a new, simpler and richer markup language.
I hope Dr. Newman never suffers from the bone on bone knee condition my friend Bill is currently suffering from. Bill tells me the pain can be severe. If I can get my hands on them I'll be very happy to FAX Bill's X-Rays to Dr. Newman (as well as posting a link to them on slashdot) so the readers can judge for themselves.
Yes, because that's exactly what any rational person would do when they have a screaming child with a broken arm. Jesus Christ... I hope GP fought the hell out of the charges. I did for my treatment and managed to receive just treatment. After a year of haggling, yelling, stressing, and tracking down points of contact. Good times.
I fell into the classical trap for germans:
"bekommen" = getting
"werden" = become
"bekommen" != become
I am embarassed. ;)
Any sufficiently advanced intelligence is indistinguishable from stupidity.
... I bought on line don't work! My pecker _is_ getting bigger. But women still hate me.
Have gnu, will travel.
By way of comparison, my dad had complications with hip replacement that led to partial loss of use of his leg. The doctors here (in the US) basically gave him 4 days of therapy and a cane, and sent him home. Told him he would limp for the rest of his life. His bill for 3 days in the hospital plus the therapy was $70K.
That summer, in the Czech Republic, the doctor sent him to a therapeutic spa for 6 weeks of therapy. And, since he and my mom are retired, offered to send my mother there as well, with the state picking up half the charges for her so he would not feel lonely. Total bill for 6 weeks, meals included? About $3,000US.
After 6 weeks of intensive therapy, no limp.
Which health care system is better?
Emergency admit, 4 days, 7 hour surgery, $106k here. :-P Believe me, I have a thing or two to say about the insurance / medical billing industry in the states.
Dude, if you haven't caught on, there are *NO* emergency room doctors on a preferred provider list of *any* network. None, zip, nada, zilch. I'd have to go to Mexico or Canada to find one.
Adam Curtis did a fantastic documentary series called Century of the Self that explored this topic.
Nick
I have a hell of a lot of stories about people being given unnecessary/ wrong treatment. I am a strong believer that we, the patient must educate ourselves about the way the body and mind work and make ourselves knowledgeable about the different therapies out there. Doctors generally will not let you know about what options are available to you unless you ask or question.
http://www.natural-healing-for-all.com/