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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.'"
...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.
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/
Medicine is more like some unknown mixture of actual science and cargo-cult pseudoscience, both using the same tools and terminologies.
Separating the two is a nontrivial problem.
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?
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.
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 ]
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.
"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 ]
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.
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.
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."
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.
Well the two might not be directly connected. It doesn't seem to me like giving universal catastrophic health care would encourage people to use the ER more, and in fact having better access to healthcare on a regular basis might decrease ER costs. Setting aside for a second the people who go to the ER for every tummy ache, what about those who do nothing about potentially serious issues until they actually become serious issues? Early detection can often save money, actually.
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.
Well that's just a problem, and again doesn't really have a direct connection to universal healthcare. You can get in trouble (fines, I believe) for calling 911 unnecessarily. You have to figure there will be some abuse, that sometimes a person will get away with something like that. But if it's really all that rampant (the abuse the the ambulance service that you describe) then I would think they should investigate and arrest or fine people abusing the system.
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.
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.
Are you seriously retarded enough not to realize those were the same people?
Amen to that! My rule is "Never Generalize". And it works in every situation.
I am not a crackpot.
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.
IAAMedStudent
I refuse to engage in a duel of wits with the unarmed.
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.
And do you know what one of the complaints against Bush's No Child Left Behind was?
That it required pedagogical methods to be scientifically proven [1].
Teachers didn't like that because then they couldn't use anecdote-based or other methods that they would prefer than methods that were "scientifically proven".
Expect similar complaints from the doctors (after all, if they were really scientists, they would've gone into research; there's a reason they chose the career that they chose), and yes, the "O admin" believes in the scientific method just as much as the Bush administration did—it's just the left-wing distortions in the media that made you think somehow Bush stood against scientific progress (remember last year, Bush proposed a relatively generous science budget, but it never got past the Democratic congress).
[1] From Department of Education website, "It only funds curricula and teaching methods that are scientifically proven to work."