America's Doctors Are Performing Expensive Procedures That Don't Work (vox.com)

"The proportion of medical procedures unsupported by evidence may be nearly half," writes a professor of public policy at Brown University. An anonymous reader quotes his article in Vox: The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking. Each year, hundreds of thousands of American patients receive stents for the relief of chest pain, and the cost of the procedure ranges from $11,000 to $41,000 in US hospitals. But in fact, American doctors routinely prescribe medical treatments that are not based on sound science.

The stent controversy serves as a reminder that the United States struggles when it comes to winnowing evidence-based treatments from the ineffective chaff. As surgeon and health care researcher Atul Gawande observes, "Millions of people are receiving drugs that aren't helping them, operations that aren't going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm"... Estimates vary about what fraction of the treatments provided to patients is supported by adequate evidence, but some reviews place the figure at under half.

Comments

No Money

[Anonymous Coward]

Duh, there is no money in actually healing people. Take the profit out of medicine and it will start actually work again.

Re:No Money

[VeryFluffyBunny]

In the UK, where the NHS is the only real game in town and health insurance is a national govt. system, doctors are allocated budgets for the numbers of patients that they have enrolled on their books. It's in their interests to spend as little as possible on keeping their patients as healthy as possible in order to conserve their budgets. The NHS is one of the best health services in the world in terms of outcomes for per capita spending. Well, that's the last time I heard. The current UK right-wing* administration are doing their best to wreck it.

*right-wing in the UK is still thankfully far left of the Democrats in the USA.

Re:No Money

[VeryFluffyBunny]

Religion is merely one of many tools of the state used to exert control over its population. Thankfully, rates of atheism, agnosticism and religious non-observance are much higher in Europe than in the US and therefore its impact is lesser. I don't think many countries do rabid fundamentalism and legislation based on moral outrage better than the USA.

Re:No Money

[Anonymous Coward]

That "savings-oriented" mentality is something that has been permeating the NHS with the onset of fantastic budget cuts by successive conservative (and effectively-conservative labor) governments. Doctors should generally be oblivious to budgetary considerations, so that, on one hand, they don't encourage patients to perform unnecessary operations or buy unnecessary medication, and at the same time do not try to skimp on effective, attentive care to increase throughput or cut expenses.

And that is not a farfetched or unrealistic thing to achieve.

Re:No Money

[hazardPPP]

I've heard that the right/left difference in Europe is just whether one wants to be controlled by the church or by the state. In the US it is whether one wants to be controlled by the state, or by themselves.

The difference between left and right in the US is whether one wants to be controlled mostly by the state and moderately by giant corporations, or moderately by the state and mostly by giant corporations.

Those in the political arena who advocate actually for people being controlled mostly by themselves are a minority on both continents: "libertarians" in the US and "liberals" in Europe.

Re:No Money

[hazardPPP]

If you want to wait for years for procedures I could get done with in a week in the US. What's the lead time for a knee replacement in the U.K.? 3 years or something, right?

Yeah you could get it done in a week - assuming you have insurance (or the cash to pay upfront). What about all the people who can't afford it? And for those who can afford it, how much does it cost them?

The "waiting time" red herring is invoked every time by Americans who have been brainwashed to think that socialized medicine means "death committees" (leading to such profound statements as "get your government hands off my Medicare" - a, uh, government program) or whatever. Yes, waiting times are a serious problem in poorly funded government-run health systems, mostly in poor countries (think, I don't know, Serbia?). In properly funded health systems in rich countries (Canada, UK, etc.) things that need to be done now will indeed be done now. If you're dying of a heart attack, there's no "wait time" for a bypass, it's done immediately (or as soon as medically possible). Similarly, if someone needs a knee replacement ASAP they will get it ASAP. If someone is waiting for it for 3 years, it means it's not urgent. Also, there is something called common sense - if your doctor thinks you will most likely need a knee replacement in 3 years (even if you don't need it that very moment) you'll be placed on a waiting list. Now think the other way - how many of those instant knee replacements in the US are totally or mostly unnecessary? How many of them are replacing knees in patients who can go on just fine for a couple of more years without it, while submitting them to unnecessary risks that accompany every type of surgery?

Re:No Money

[MobyDisk]

FYI: This is how HMOs operate in the US.

Re:No Money

[VeryFluffyBunny]

No, it isn't. I've never been asked by a doctor or hospital staff about insurance. It's a given, not attached to any employer, status, residence, etc.. National Insurance contributions automatically come out of everyone's salary/pay cheque and the amount is based on ability to pay but everyone gets the same coverage, regardless. In the UK, you can opt for private health insurance but you get essentially the same doctors and nurses, with the same training, for ephemeral procedures/treatments, and if you actually need serious medical attention, you're transferred to the NHS anyway.

The biggest drawback is that some doctors may be reluctant to take on patients who may be disproportionately expensive to treat over the longer term. If you need medical attention, it's always available at hospitals, also regardless of employment status, residence, etc.. It's just plain stupid to refuse citizens necessary medical treatment because it costs the govt. more in the longer term.

Re:No Money

[eric_harris_76]

The patient is not the customer. The insurance company is. That's why things in the health care arena suck, in the various ways.

There's a similar situation for other kinds of patients. The kind that go to veterinarians.

There's a category of medical services that hasn't gone up in price so dramatically: the ones that aren't covered by insurance. Those have generally gone down, or at worst, kept pace with inflation. Laser eye surgery. Cosmetic procedures.

Coincidence? Hell now.

Re:No Money

[MobyDisk]

...doctors are allocated budgets for the numbers of patients that they have enrolled on their books. It's in their interests to spend as little as possible on keeping their patients as healthy as possible in order to conserve their budgets...

That's the part I was talking about.

Set the way-back machinecto 2009...

[kenh]

Remember when this famous politician claimed that doctors were cutting off limbs instead of employing more effective treatments to combat diabetics?

better than getting sued

[known_coward_69]

People want to destroy their bodies then run to the doctor looking for magic. Then they complain it costs money and doesn't fix the root issue and sue the doctors if they don't like the results

Re:better than getting sued

[whoever57]

This simply isn't the real problem.

Doctors in the US over-treat illnesses, use outdated and ineffective treatments and generally run up the costs of medicine.

The above statement is based on my wife's treatment in the USA and in the UK.

In my own case, I had a problem for which one of the treatments is surgery. I was referred to a hand specialist who only discussed the surgical option with me. When I asked about the alternative treatment that I had discovered using Google, his response was that he didn't do that treatment and I would have to see another doctor. Had I not researched it for my self, I would never have known that there was an alternative. That's on top of the fact that I had to pay for a completely useless consultation with the hand surgeon.

Summary, even if you have good insurance in the USA, you may not be getting the best treatment.

Re:better than getting sued

[ArchieBunker]

I've been through this with doctors. It's hard to find a good one. I started waking up with aches and stiff joints and went to a few to try it and get it solved. One told me it was a virus and the other did some more testing. Once they caught wind that I use a computer at various times throughout the day it was "carpal tunnel you need surgery". How about my stiff knees and limping down stairs? In the end I figured out my blood sugar was dipping while sleeping and causing the problem. Most doctors are lazy and won't spend more than two minutes diagnosing someone.

Re:better than getting sued

[Shoten]

This simply isn't the real problem.

Doctors in the US over-treat illnesses, use outdated and ineffective treatments and generally run up the costs of medicine.

The above statement is based on my wife's treatment in the USA and in the UK.

In my own case, I had a problem for which one of the treatments is surgery. I was referred to a hand specialist who only discussed the surgical option with me. When I asked about the alternative treatment that I had discovered using Google, his response was that he didn't do that treatment and I would have to see another doctor. Had I not researched it for my self, I would never have known that there was an alternative. That's on top of the fact that I had to pay for a completely useless consultation with the hand surgeon.

Summary, even if you have good insurance in the USA, you may not be getting the best treatment.

Question...and this is a real question, not a retort, because I am curious. Did the alternative therapy work? I don't know what the problem was with your hand, or what the alternative to surgery was, and I could see this going either way.

I see and hear all the time about alternatives to X or Y medical procedure, but usually I haven't seen them turn out so well. But on the other hand, I totally agree that a lot of doctors follow a narrow path and get a bit heavy handed with surgery and drugs. I think I've been lucky; my doctor is fairly conservative and keeps things simple and it's been working very well for me.

At the end of the day, doctors are service providers...they are vendors. Just as with buying a car, a house, or even a pizza, you have to consider your vendor and choose wisely. The fact that they have all taken the Hippocratic Oath does not guarantee quality, intelligence or skill. The good ones are doing the best they can now, and always trying to improve the definition of "best." The bad ones can be lazy, narrow-minded, or just plain greedy.

Re:better than getting sued

[arth1]

Doctors in the US over-treat illnesses, use outdated and ineffective treatments and generally run up the costs of medicine.

Running up the costs is an inherent problem with for-profit medicine.
The last time I went to a doctor, it was for a broken arm. They wanted to do full blood panel and urine tests and follow-up appointments for those. I asked them what for, and they said that they always had to do that if there weren't recent results on file. I asked whether it would change the treatment of the broken arm from a sling to something else, and the doctor said no, but it could discover unrelated issues. Well, I was not there for unrelated issues or to look for could.
I ended up switching doctors, because of the money grab.

Fuck the doctors and their affiliations.

Re:better than getting sued

[whoever57]

Question...and this is a real question, not a retort, because I am curious. Did the alternative therapy work?

Absolutely, although there is a somewhat higher chance of re-occurrence with the treatment that I chose, but surgery involves risks such as nerve damage.

Google Xiaflex.

Re:better than getting sued

[F.Ultra]

Is Xiaflex not one of the standard procedures in the US? It's been approved as a standard procedure here in Sweden since 2011 due to overwhelming scientific evidence that it works.

Re:better than getting sued

[whoever57]

It's approved, but the first doctor I consulted about my hand did not mention it as an option. That's my point: medicine in the USA is frequently bad.

Re: better than getting sued

[kenh]

In my own case, I had a problem for which one of the treatments is surgery. I was referred to a hand specialist who only discussed the surgical option with me. When I asked about the alternative treatment that I had discovered using Google, his response was that he didn't do that treatment and I would have to see another doctor.

Wow, a hand surgeon that specializes in hand surgery? Wow, that's amazing... it's almost like he's a specialist, focusing on one particular field of study.

Did you ask your general practitioner, the one that referred you to this hand surgeon about the alternative treatment? That would have been the doctor to ask.

You could have cancelled the appointment with the surgeon and investigated alternatives first, but instead you decided the hand surgeon should be up on all alternatives and save you the trouble of having to find a suitable doctor. Then, when the doctor didn't meet your expectations, youfault the US medical industry.

Re: better than getting sued

[whoever57]

Neither my GP nor the first surgeon mentioned the Xiaflex alternative to me. As medical professionals, I expect that somewhere along the line, this options should have been offered without me having to ask for it. They are the professionals. They are the knowledgeable ones providing a service.

As for the hand surgeon: do you think that I should have to research all the options for treatment, and ask his office if he can offer all of these treatments before my appointment? Really?

No, you just have an expectation of ridiculously low standards for your medical care. You don't expect doctors to have up-to-date skills. You don't expect them to provide you with all the alternatives.

So, yes, I fault the medical industry.

Re:better than getting sued

[Anonymous Coward]

This is where I'm waiting for AI the most. Getting random data from patient and guessing what is wrong with the patient. And alternatively suggesting some tests that can help making more accurate guess. Current neural networks would work fine for it. Even a simple lookup table would work. I don't actually understand why we don't already have it.

Re: better than getting sued

[Altrag]

That's kind of the problem. We're not nails, and they're not hammers. Treating healthcare as a for-profit business means the doctors' primary motivating factor is not your health.

Obviously doctors go through a lot of school and other hassles and nobody would argue that they shouldn't be compensated fairly for their work. But there's a difference between "compensated fairly" and "causing patients unnecessary harm and suffering in the blind drive for dollars."

Re:better than getting sued

[ChoGGi]

something something lawyers and liability

(unfortunately)

Re:better than getting sued

[rtb61]

Put simply, a system driven be nothing but greed will eat itself, after it has eaten everything else and die as a result, not sometimes but every fucking time. USA make no mistake you are now eating yourselves alive.

Re:better than getting sued

[dmr001]

It sounds like the GP had Dupuytren's contracture, a common thickening of connective tissue in the palm, with a time course of years that can result in inability fo extend (unbend) one's fingers.

As a primary care physician, I don't think I've yet referred anyone for surgery for this (in 17 years) and instead have people do stretching exercises, but surgery may make sense in severe cases. Collagenase injections (the Xiaflex referred to above)looks like it may be useful for patients who don't do well with stretching, don't want surgery, and don't have severe contractures. It doesn't look totally benign (51% bruising, 37% bleeding, 1% tendon rupture, 0.5% permanent unrelenting pain syndrome) but less invasive than surgery. It looks pretty effective.

That said, I've learned when I do referrals, one needs to be careful of who one refers to. For some specialists, given that they use a hammer a lot, most patients may start looking like a nails. I think pretty much all of these specialists genuinely want to help people, but when you specialize in something there's a risk of tunnel vision. For example, when a patient with annoying (but maybe not disabling) back pain wants to see a specialist —depending on who one sends them to — they've got a good chance of getting surgery done. Most back surgery for common spine conditions isn't clearly better than waiting a year for most patients. It's hard to tell some people you don't want to see a fancy specialist for this: you'd be better off losing weight and exercising more.

That said, though I'm pretty proud of myself for encouraging patients to avoid even seeing a surgeon until I really think it will help, and avoiding brand name medications, and decrying expensive vitamins or supplements with little evidence of effectiveness, this article in the New England Journal of Medicine gave me pause. Sure, Gawande claims with some reasoning that a lot of medical procedures have little benefit, and a lot of money is wasted. But the research leading to those conclusions was somewhat cherry-picked, and there is other research that suggests that higher spending really does improve outcomes. The author notes that "perhaps the most accurate conclusions is that sometimes less is more, sometimes more is more, and often we just don't know." Like a lot of health policy (and a lot of life in general), the issues may be more complex than they first appear.

Re: better than getting sued

[dmr001]

I think this is a good point: a good primary care clinician should provide a good gatekeeping service for referrals. We should refer you only when it's likely to help, and to a competent specialist. I do think some PCP's refer more than they should because they feel pressed for time and/or think that it's simply easier to send the patient for a specialist to give a more detailed opinion. That opinion can be blinkered, though.

In my mind, competency for specialists includes knowing not just the full range of treatments, but spending time with many patients telling them they should do nothing —no fancy procedures or medications. It's not universal, but there are many specialists out there who are willing to risk making patients unhappy by not waving their magic wand, and who are willing to spend the time (and liability) to do so despite it being to their own economic disadvantage. I'm looking forward to changes in the US health care system that will encourage this, instead of encouraging simply doing as many billable procedures as possible.

Re:better than getting sued

[hazardPPP]

At the end of the day, doctors are service providers...they are vendors. Just as with buying a car, a house, or even a pizza, you have to consider your vendor and choose wisely. The fact that they have all taken the Hippocratic Oath does not guarantee quality, intelligence or skill. The good ones are doing the best they can now, and always trying to improve the definition of "best." The bad ones can be lazy, narrow-minded, or just plain greedy.

...and for the greedy types, we need a system that sets up the incentives properly. This is not a solved problem, government-run or funded systems also have this problem in various forms. In ones where doctors work for a fixed salary or have a fixed budget (NHS-type system) the lazy ones will just seek to do as little work as possible since there is no monetary benefit to them in serving 5 vs. 10 patients in a work day for example. In systems where the prices of health services are fixed and doctors charge the government for them (Canada-type system) but are otherwise independent, the greedy ones will do tons of unnecessary diagnostics (if you can't charge more than $100 for diagnostic A, let's do B, C, D, E, and F all at $100 each, even though only A is really required, at least on the first run).

I don't know what this incentive could be - incentivize somehow the health system overall to prioritize the health of individuals (not the treating of particular problems) thus putting prevention at #1...I don't know, this is difficult. We need some sort of regulation because the market for physicians is NOT the same as for pizza, cars, or houses - people are desperate when they have a life-threatening disease, the demand there is inelastic. It's not like pizza which you can choose not to eat and decide to have potatoes for dinner instead.

Re:better than getting sued

[chooks]

That's what being in a sue-happy environment will get you. If there was something more serious going on that a simple and cheap blood test can shed light on, and they missed it, the malpractice headline would be merciless. Generally you would only follow up on abnormal lab tests, but that distinction may not have been communicated (although for a broken arm you would have to have clinical follow up at some point anyways...unless you had another plan for managing your broken arm). As for lab testing, believe me, no physician is making money off of basic laboratory testing. A BMP and urine dipstick is maybe $20 (tops) until the hospital administration charge master gets a hold of it, in which case you can add a zero. At any rate, the doc is following procedures create by administration. If you want to see where the true money grab is, google hospital administration costs versus physicians (or something similar).

Re:better than getting sued

[arth1]

Generally you would only follow up on abnormal lab tests

But pay for the normal ones, with money and with blood and results that according to their small print can then be used in money-generating research without compensating the paying donor.
The normal tests, by virtue of being normal, are at best unnecessary, and help drive up insurance premiums.

By all mean, test for what is suspicious if the customer wants it. Even sell home testing kits that can help tell the nervous ones when to go get a lab test. Heck, even offer free tests if you think the dragnet will bring in enough paying customers.
But don't impose unnecessary tests on customers that haven't expressed a wish for them, at inflated costs that the unwilling customers and other insurance holders pay for.

And no, if I take my car in to replace the air bag, I don't want to be presented with a bill for a 50 point inspection. Especially not a bill written with a fork.

Re:better than getting sued

[Shoten]

Question...and this is a real question, not a retort, because I am curious. Did the alternative therapy work?

Absolutely, although there is a somewhat higher chance of re-occurrence with the treatment that I chose, but surgery involves risks such as nerve damage.

Google Xiaflex.

Interesting...and thank you for answering. I needed that context. I've seen everything from physical therapy accomplishing the same thing as a recommended surgical procedure was supposed to do (good outcome) to an idiot eschewing normal treatments for cancer in favor of herbal remedies...which absolutely did not work at all (very bad outcome). And then of course there's the GNCs of the world, hawking trend after trend for profit, and paying fines to the FTC every few years as a cost of doing business. Every time I hear "alternative" in a medical context, I wonder if it's "do this as an alternative to that," or if it means "oh, you don't need to take insulin for your diabetes! Here...have some dried duck vaginas...it's an ancient alternative remedy that cures diabetes..."

I'm really glad that it worked out for you like it did; obviously, you fall into the first of the two categories described above. Is it weird that I almost feel uncomfortable that this is an Internet conversation about an emotionally-charged topic, and yet everything about our interaction has been totally civilized and truth-based? :)

Re:better than getting sued

[Cro Magnon]

Yup! IME, the average doctor is mediocre. And half of them are below average!

Re:better than getting sued

[mileshigh]

Wow! What city do you practice in? Do you take Blue Cross PPO? I've been looking for a doc like you!

Re:better than getting sued

[kaatochacha]

This is strange, as my experience is the doctors offering multiple options. For example, my father had a shoulder injury, he's 83. The doctor told him they could do surgery, but it would require him to be out of commission for months using the arm, or they could do a limited surgery, less help but less invasive, and finally just physical therapy. They suggested starting with physical therapy , as it was the cheapest and easiest and they could reassess if the problems continued. I think it may sometimes just be the doctors.

Re: better than getting sued

[kaatochacha]

Every doctor I have, including my dentist, offers me multiple options for any given issue. I also have them explain which ones they prefer, and why. None of them seem to have a problem with it.
In fact, my dentist recently went into great detail explaining why a crown for a tooth would cost me less than a small repair ( my insurance covered crowns, not the repair) , but he recommended the small repair even though on his end he made less money. His reasoning was that it was less invasive and he believed it was a better long term option.

Follow the money

[mspohr]

Unfortunately, we have an unrestrained free enterprise system for medicine in the US. Doctors have rigged the payment system (CPT codes) so that specialist procedures are reimbursed many times their worth in time and training. The result is that most doctors train to become specialists and focus on doing highly remunerated procedures such as those enumerated in this report. There is no effective regulation of these procedures and so as long as you're not killing a large number of patients, anything goes. It means big bucks for the doctors and hospitals (insurance companies pay but then just tack on their % O&P so they don't really care either).
Of course, people pay more for inflated cost of medical care and insurance and taxes to subsidize the whole system. The result is that we pay about twice per capita what other developed countries pay for health care but end up with poor quality care (lower health indicators than most other developed countries).
Totally corrupt system.

Re:Follow the money

[currently_awake]

Just try blocking access to "Bleeding Edge Research" medical procedures and watch people get upset. We frequently hear news stories about people having to go to some third world country to get a "medical procedure" that heartless American doctors won't perform.

Re:Follow the money

[known_coward_69]

if you don't want a stent then take care of your body so your blood doesn't clot up inside your arteries

Re:Follow the money

[mspohr]

As you point out, prevention is better than treatment.
The problem is that people do get heart disease (diet, exercise, etc.), have chest pain and then go to the doctor who has a strong financial incentive to put in stents. He ignores the research we now have that stents don't work because his pocketbook depends on it.

Re:Follow the money

[mspohr]

New (unproven) treatments are a different issue. There are good arguments for and against these.
The issue highlighted here is that doctors are continuing to do procedures where there is no evidence of benefit (and, in many cases, evidence of harm). They do this, not because they are ignorant, but because they are greedy.

Re:Follow the money

[JoeRandomHacker]

Quite corrupt, I agree, but that has nothing to do with "unrestrained free enterprise", which we don't have. If we had that, health care provisioning would not be tied to employers and their selection of insurance plans due to government mandates and tax incentives that distort the market. If we had that, I could do proper comparison shopping for medical goods and services based on price and quality. If we had that, I could research what drugs would best treat my condition(s) and buy them without having to go through an agent for a government supported monopoly on medical services. The list goes on. Medicine in the US is about as far from "unrestrained" as you can get without having Single Payer.

Re:Follow the money

[mspohr]

It is unrestrained free enterprise. We need to add government regulations to certify which treatments are effective and will be reimbursed. We need to restrain free enterprise and that is government's job.
As far as your comment on insurance goes, it's a bit difficult to follow. We do have free enterprise insurance markets where you are not forced to buy insurance from any particular provider. Any insurance company can sell you insurance.
You have a good point about comparison shopping. It would be a better market if you could shop for medical services, drugs, etc. and compare prices. Unfortunately, the medical industry has done an excellent job of obfuscating prices. It's extremely difficult to find out how much medical service or drug will cost. Just try to call up a doctor's office and ask them the price for anything. They will obfuscate. The solution here is for the government to require all medical providers to post prices so you can compare. Also, the government should rate the effectiveness of treatments and these should be posted also.
Your point about requiring licensing of doctors, hospitals, etc. comes up frequently. Unfortunately, there are many people who would like to pose as medical providers to take your money without having proper training. You cannot have just any random person claiming to be a medical doctor. People will be harmed. This would be another failure of the "free market".

Re: Follow the money

[kenh]

Why do insurance companies refuse new (unproven) treatments yet cover old (unproven) treatments as this article states?

The article says that stents for heart problems are 'unproven' yet year after year people get the $11-40K procedure done, presumably paid for by their insurance company.

Re: Follow the money

[mspohr]

There is a defect in the regulation system.
New unproven treatments are not covered until they are accepted. This typically only requires small safety studies and not effectiveness studies. This is to ensure patient safety.
Old treatments are grandfathered in after their use has become common medical practice. Unfortunately, sometimes these treatments have not been rigorously studied and they are not effective or safe. The case of stents is illustrative. Stents came into common use after a few small studies seemed to show they were effective. Later better studies showed that they were not effective or safe. However, once they were in common use, it has been difficult to ban their use. A stronger regulatory environment would require both initial small safety and effectiveness studies to gain initial approval for use and larger, longer term studies to prove safety, effectiveness and cost-effectiveness.

Re:Follow the money

[burtosis]

Unfortunately, we have an unrestrained free enterprise system for medicine in the US. Doctors have rigged the payment system (CPT codes) so that specialist procedures are reimbursed many times their worth in time and training. The result is that most doctors train to become specialists and focus on doing highly remunerated procedures such as those enumerated in this report. There is no effective regulation of these procedures and so as long as you're not killing a large number of patients, anything goes.

So what your saying is healthcare is hardly different from any other business. Getting forced to process patients in 1/3 a reasonable time while getting a consistent stream of complaints dosent doubt like my ideal job, it sounds like any production job. But to each thier own. This is what market pressure does to healthcare.

Re:Follow the money

[mspohr]

Yes, unfortunately you're right.
Medicine is big business and is driven by money.
The few idealistic people who went into it to "help people" are soon co opted by the money. They look for opportunities to bill more and work less... just like everyone else.

Re:Follow the money

[JoeRandomHacker]

How is it unrestrained free enterprise when you agreed with at least some of the restrictions I listed? Government is really good at setting up bureaucracy, wasting lots of money in the process, but really bad at preventing bad things from happening.

I agree that my argument about insurance wasn't the best; I'm not expert enough on the topic to put together a great argument quickly. I will say that the insurance model is there to mitigate risk, so it is not surprising that it does a bad job when it is transmogrified into a system for funding services. If people pay for more of their medical services out of pocket, they will demand that prices be made clear. It is easy to ignore costs when "someone else" is paying (even if you eventually end up paying through premiums.)

The AMA is quite capable of going after anyone claiming to be a member as fraud; it doesn't need a government monopoly to do that.

Re:Follow the money

[Solandri]

Doctors have rigged the payment system (CPT codes) so that specialist procedures are reimbursed many times their worth in time and training.

The doctors didn't rig it. They're reimbursed far over cost because hospitals are required by law to treat emergency room patients regardless of ability to pay. Consequently, when you (with insurance) pay for a procedure, you're not just paying for your own procedure. You're also paying for the same procedure for the uninsured guy who was carted into the emergency room last night with the same problem.

One solution to the problem is to free hospitals from the legal requirement to treat all emergency patients (thus making health insurance much more valuable so presumably more people would get it). Another is some sort of universal health care system where everyone is covered.* That's what's baffled me (a conservative) about the opposition to universal health care - for all intents and purpose we've already had it. Anyone with a severe medical problem can simply walk into an emergency room and (after waiting) get treated, leaving the rest of society to pay for it. Requiring hospitals to treat patients regardless of ability to pay has the same net effect as universal health care, just the accounting is a bit different.

Aside from inefficiency, this doesn't affect costs though. If you want to find added costs, look to the lawsuits. My dad was family practitioner with his own medical office, and was never sued until just before he retired. Malprractice insurance ate up 30% of his gross income. There are a ton of tests and procedures which mostly aren't necessary, but doctors do them anyway just to cover their butts in case they get sued. Doctors implant the stent even though research says it doesn't help, because if they didn't and the patient died of a heart attack, the next of kin would sue them for failing to use the "time-proven practice" of implanting a stent. Add the malpractice insurance cost to the cost of "cover your butt" tests and procedures, and you're right around the 2:1 ratio of per capita healthcare costs in the U.S. vs other developed countries.

At some point we're going to figure out that a courtroom with a jury of 12 who have zero medical or scientific training is a terrible place to decide which medical tests and procedures are worth doing.

* It should also be noted that the "universal" in universal health care only applies to who is covered. It doesn't apply to which treatments are offered. Every country with universal health care has a board which looks at the cost of a treatment vs. its efficacy, and decides whether or not that treatment is cost-effective and so should/shouldn't be offered (the so-called "death panels"). So cost still plays a role in determining which services are available even with universal health care. Sometimes these standards are not applied uniformly either. When my Canadian friend's father was dying of late stage cancer, he was adamant that the hospital do everything and anything to try to extend his life, despite the numerous visits from Canada Health Services representatives trying to convince him that it was over and to let go. People like him who complain and refuse to sign off get better/costlier treatment. Conversely, you can purchase supplemental health insurance in countries with universal health care, which you can then use to pay for a procedure the government has deemed not worth the expense, so it's not like universal health care completely supplants market forces.

Re:Follow the money

[beckett]

despite the numerous visits from Canada Health Services representatives

Unless you are referring to Health Services in correctional facilities, There is no such federal governmental organization named "Canada Health Services".

Additionally, In Canada, the responsibilities of healthcare management are devolved to the provincial government, not the federal government. I can't speak to any of your other anecdotes, but your Canadian info is incorrect.

Re:Follow the money

[mspohr]

Doctors (through their specialty societies) set charges. They have monopoly control of prices.
The "free ER" treatment is a myth that has been debunked many times (GoogleIt).
Lawsuits and malpractice insurance has been studied to death. It's only a rounding error in the high cost of medical care (your father's experience notwithstanding).

Re:Follow the money

[mspohr]

We need more government regulations to restrain the evils of unfettered free markets.
People are demanding access to price information (and they are not getting it).
The AMA doesn't regulate the practice of medicine. It is a trade union for doctors. They have no power to prevent people from practicing medicine without proper training. That is the government's job.

Re:Follow the money

[JoeRandomHacker]

The government regulation catechism is common enough, but that doesn't make it true. And I believe we've already established that we aren't talking about an unfettered free market. I didn't even mention Medicare and Medicaid which are major market distortions.

As long as most of the money goes though insurance, there is little incentive for providers to pay attention to the few demands for pricing information. There are exceptions, of course. Some providers have decided not to accept insurance and either provide fee-for-service or subscription plans. They were put at a serious disadvantage by schemes like the ACA which tried to force everyone into the health insurance pigeon hole.

Trade unions like the AMA are supposed to ensure that their members meet certain standards, so why not let them do that? Or a medical provider can provide credentials which individuals or organizations can verify, and we can base our decisions on that, so some other criteria of our choosing.

Re:Follow the money

[dmr001]

I agree with most of the foregoing. I am a primary care physician, and when people ask me for the prices of things —even when I'm able to spend 20 minutes downloading their formulary from some terrible website and then figure out the math of their deductible and out of pocket maximums I typically get it wrong. Every individual plan from every distinct insurance provider is structured differently, and the negotiated prices for the different billable procedures I do are considered (as I understand it) trade secrets of the insurance providers between them and each group of health care providers.

The only way of getting a menu of prices like they have posted at the Jiffy Lube is to go to a place that foregoes insurance and lets you pay cash. My group actually has a "price estimating hotline" staffed by a nice group of people who spend all day trying to tell you what your co-pay might be for a given service, but that's only good for figuring what you're in for, and not useful for comparison shopping.

This isn't a conspiracy of physicians to keep prices obscure: we really don't know. It's a side effect of the complex (expensive, inhumane) insurance system in the United States. (The same one that my Canadian colleagues love to roll their eyes at when we go to the same conferences, wondering why we put up with it.)

There's plenty of medical and insurance regulation in this country (resulting in me needing to fill out 8 page forms to get people 3 unpaid days off work for a cold, or a 20 item form to get diabetic test strips for diabetic patients). It would be nice to see more harmonized regulations, though, that didn't assume private enterprise was the perfect cure for all market problems. Health care isn't the same as oil changes and automobile repair. I'm among those who think the Affordable Care Act represented the hopeful breezes for a better future, and that its Swiss-styled system was not the unmitigated disaster my right wing friends claimed it to be.

Re:Follow the money

[dmr001]

The AMA isn't a trade union (they don't negotiate pay and benefits for physicians, and only 25% of US physicians are members). The AMA contracts with the feds to develop a list of the relative values of chargeable medical procedures (which then get modified by insurance companies, who decided actual remuneration.

The AMA does come up with a code of ethics, but ensuring US physicians meet acceptable standards of competency is up to your state or territorial medical board, which are all quasi-governmental entities.

I enjoyed your comment about the "health insurance pigeon hole." I mean I get everyone hates health insurance, but what about the car insurance pigeon hole, and the fire insurance pigeon hole? The fundamental idea of insurance — spreading out risk — seems like a good one, and all insurance markets are regulated. It's a fascinating question if health insurance needs to be more regulated, or less, or simply standardized like they do in most other industrialized companies so it can be understood by mere mortals.

Re:Follow the money

[dmr001]

Doctors (these days largely through their large, single or multi-speciality practices) in the US negotiate charges with each individual insurance carrier, each in a race to be bigger in order to exact more negotiating power. Or, more precisely, groups and hospitals come up with a "charge master" list of prices which is really just the start of negotiating tactics:

• Medical group: We charge $590 for a checkup.
• Insurance company: If you want access to the patients in our Sapphire Plus Horizons Extra plans, we'll pay you $80 for a checkup.
• Medical group: Your patients will have to drive 20 miles out of their way to see other providers, then, because we won't take anything less than $120

Except in very rural areas, it's not a monopoly in most places in the US — it's more of wrestling giants, with the uninsured getting screwed since they get stuck with the $590 "list price" that is really just supposed to start off the negotiation.

Re:Follow the money

[ChrisMaple]

"Stents don't work" is vastly overstating the claim of the studies. The studies appear to conclude that stents aren't the best, or aren't necessary, treatment for stable angina.

That's very different from treating an active heart attack, where a stent can be (my opinion) the best treatment, preventing death in a one hour operation. Trying to use drugs in this case involves achieving an ongoing delicate balance of blood pressure control medicines and other circulatory medicines that have dangerous side effects.

No placebo will eliminate the pain or the damage of an actual heart attack.

Re: Follow the money

[mspohr]

Stents may be of value in AMI. However, most stents are placed for treating angina and they don't work better than less invasive tx.

Damn stupid story

[Anonymous Coward]

Stents WORK for heart disease - that’s proven and the story stupidly misleads it for click bait (and slashdot editors happily repeat)

The study in question showed that stents don’t necessarily reduce heart pain in patients with narrowed arteries which is contradictory to the theories about how heart pain/disease work.

Regardless a clogged artery will still kill you and a stent resolves that problem!

More piss poor science “reporting”

Re:Damn stupid story

[sjames]

Somebody didn't RTFA! The study was looking specifically at stents used in cases of stable angina that is responsive to medication, and found that the stents were higher risk but provided no benefit over medication in the case of stable angina. The study did not attempt to address the effectiveness of stents in other cases including cases where medication did not control stable angina.

That still represents a lot of excessive costs for no benefit.

Re:Damn stupid story

[modmans2ndcoming]

Lol....try again stupid.

https://sciencebasedmedicine.o...
https://theskepticalcardiologi...

Re:Damn stupid story

[sjames]

And I pointed out what the study ACTUALLY said. Perhaps you need to try reading for comprehension.

Save big bucks!

[kenh]

The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking.

So we will suspend all stent treatments, save tremendous amounts of money AND survival rates will be EXACTLY the same?

Sounds great - one question though, why are insurance companies reimbursing for these expensive, ineffective treatments? Perhaps there is evidence they are effective after all?

Re:Save big bucks!

[sound vision]

Why are they paying? It fits right in with their strategy: Provide what the market wants (not necessarily what patients need) and try to look useful doing it, to justify their continued existence and all the corporate welfare payments. It was probably calculated that "They denied my heart surgery!!" would hit them harder than just paying and jacking up their rates accordingly. Listen to any of their recent radio ads if you want it laid bare that they are spending serious money for nothing more than good PR. They know they aren't getting any more cash out of the individual market, and besides, everyone is legally mandated to be their customer anyway. The ads don't even try to drive sign-ups. They are feel-good spots to make their middleman money-shuffler business look like it actually does something useful.

Perhaps some highly-specialized doctors who only perform stent surgery kick a little extra back to the insurance company, for sending all that business their way. That sort of arrangement plays out all the time. The insurance company controls the purse strings, and if they start denying these claims, well... anyone who works in that specialization will be out of a job. The insurance companies have had decades to set up these kind of arrangements, and they always make sure they come out on top. The costs get shuffled around as best they can, but eventually you end up in the situation we have now, which is that our country spends double what anyone else does, for shittier care.

No, I have no evidence these particular kickbacks are happening, but it sounds just as plausible as your argument, for which there was also no evidence. It'd fit right in with their business model. You think it wouldn't, because your understanding of their business model is incomplete. You've bought the narrative and glossed over the reality.

Re: Save big bucks!

[kenh]

Perhaps some highly-specialized doctors who only perform stent surgery kick a little extra back to the insurance company, for sending all that business their way. That sort of arrangement plays out all the time.

Grow up - exactly howeould this happen, how would a stent doctor 'kick back' to the insurance company? Do they meet in a parking lot and hand over wads of cash? Are they sending crypto-currency back and forth?

Just because you can imagine something doesn't mean "it happens all the time"...

Re: Save big bucks!

[kenh]

Going by my UID? What does my age have to do with anything?

Re:Save big bucks!

[mbkennel]

"Sounds great - one question though, why are insurance companies reimbursing for these expensive, ineffective treatments? Perhaps there is evidence they are effective after all?"

Insurance companies are interested in reducing health care spending to exactly the same degree that casinos are interested in reducing gambling, and for the same reason.

Re: Save big bucks!

[sound vision]

I didn't suggest bags of cash - what I did was state that I didn't know all the details. I don't know the intricacies of all their accounting maneuvers. I do know that they are extraordinarily complex, designed to obscure where costs really are, and designed to generate profit at the expense of actual healthcare. I am glad that someone who has worked in the industry was able to come through and illuminate a tiny bit of how that works.

What I was replying to were assumptions implicit in the post. Something like: "Insurance companies would never pay for something that doesn't improve people's health." The company's feel-good mission statement being confused with their actual business model. Certain politicians and their donors love that narrative, but it's too wrong and too consequential to leave unchallenged.

Same thing happens in dentistry

[ravenspear]

The medical literature clearly indicates that the US is one of the few western countries remaining that routinely extracts nearly all asymptomatic wisdom teeth.

There is no medical reason why this is necessary unless the teeth are severely impacted or arranged in such a way that it is difficult to brush them.

Yet wisdom teeth extraction is a huge multibillion dollar industry for the dentistry practice in the US.

I'm from the government and here to help.

[Charcharodon]

....but the FDA evaluated these procedures and said they were effective and safe. No way that couldn't be the case. The government NEVER fucks anything up

Re:I'm from the government and here to help.

[religionofpeas]

Even if procedures are effective and safe doesn't mean there aren't alternatives that work better and are cheaper.

For example, many diabetics can be helped by simply encouraging them to eat a low carbohydrate diet. Instead we recommend a low-fat diet, and prescribe medicines for the rest of their lives.

Re: I'm from the government and here to help.

[kenh]

Even if procedures are effective and safe doesn't mean there aren't alternatives that work better and are cheaper.

The abstract above compares $11-40K stent procedures to placebo, with identical outcomes. Identical. If an equally effective treatment for heart disease is a placebo, then the original treatment is ineffective...

Of course, US insurance companies don't pay for unproven treatments, and almost every stent procedure in the US is covered by health insurance, so I find HUGE fault in this story.

Re:I'm from the government and here to help.

[lucasnate1]

How wonderful is the libertarian way of thinking, where if a corporation is comitting fraud, the government is still the main culprit.

Re:I'm from the government and here to help.

[modmans2ndcoming]

You're one of those wackos I see

Re:I'm from the government and here to help.

[ceoyoyo]

Yeah, about that.

The medical community only decided that doing randomized controlled trials (i.e. scientific ones) was necessary in the very late 80s. There was a LOT of resistance to that idea (what the hell do statisticians know about medicine?). Things take a while to ramp up, work the bugs out, etc. So treatments that were approved prior to the 90s-2010s (depending on how cynical you are) haven't necessarily been tested very well.

Even then, some drug or procedure might be evaluated as generally safe, and effective in a particular situation. The manufacturer can't officially advertise it's use in other situations, but individual physicians have a great deal of freedom to use it "off-label".

Stenting is a good example. It opens arteries right? And the problem is a clogged artery right? So a stent should fix it! Except that we repeatedly find, both in general and with stents in particular, that it's not that simple. A large clinical trial in the 2000s showed that intracranial stenting for stroke was ineffective, and this more recent one showing it doesn't work in stable angina.

Re: I'm from the government and here to help.

[ceoyoyo]

Of course US insurance companies pay for unproven treatments. They may delist coverage for treatments that are proven to be ineffective, although there's huge momentum there too. And there's always the fudge factor. Even greedy US insurance companies pay for lots of antibiotics for otherwise healthy people who get colds and annoy their physicians until they prescribe them.

Re: I'm from the government and here to help.

[kenh]

Don't confuse 'safe' with 'effective' - avacados are a 'safe' treatment for heart problems, but not particularly 'effective'.

Re: I'm from the government and here to help.

[mspohr]

US insurance companies pay for unproven treatments all the time. The only regulation is about safety, not effectiveness.

Re:I'm from the government and here to help.

[yndrd1984]

How wonderful is the libertarian way of thinking, where if a corporation is comitting fraud, the government is still the main culprit.

How wonderful is the authoritarian way of thinking, where if a government assists thousands of corporations in committing fraud, the government isn't even part of the problem, and giving it more power is the solution.

Re: Kind of like when Russia rigged the US electio

[kenh]

So the Russians influenced Democrat voters in several key states - states the Clinton campaign ignored in the general election - to not turn out for their candidate?

The Russians coerced Clinton into having no clearly articulable vision for America other than her 'superiority' over her opponent?

The Russians convinced Clinton to call all republicans 'deplorables', hurting her chances to win-over reluctant Republican voters?

The Russians advised Trump to have a message that resonated with millions of Americans in so-called 'fly-over' country discussing pocketbook issues?

Did the Russians contrive the Electoral College to thwart Clinton's lopsided vote advantage in certain states?

Are these the ways Russians 'rigged' the election?

I'm more worried about the opposite

[rsilvergun]

Wallet Biopsy. If you haven't heard of it, it's when a doctor evaluates your ability to pay and denies care. Remember, emergency rooms are only good for emergency care. A close family member experienced this when a doctor didn't order CAT scans that should have been done because the insurance was kind of crappy. If you've used any serious amount of care in the American healthcare system I can almost guarantee you've experienced this

All about lawyers

[Vinegar Joe]

Doctors call this situation "defensive medicine"..........When lawyers make the rules, everyone ends up paying.

Re:All about lawyers

[modmans2ndcoming]

The only way to fix that is to give Doctors the ability to have the case dismissed if they show that they treated the patient according to evidence based practice.

We're the best...at Marketing.

[geekmux]

It's odd that America tends to sustain its position as one of the best medical systems in the world

These latest studies tend to confirm that it's simply the best at marketing the appearance of being one of the best.

I guess if you're gonna be a bullshit artist, don't just be a good one. Be the motherfuckin' best.

Re:We're the best...at Marketing.

[ceoyoyo]

I don't think anyone says the US has one of the best medical systems in the world, except maybe the US. The WHO says you're #37, behind Costa Rica and ahead of Slovenia.

Re: We're the best...at Marketing.

[kenh]

The US is ranked lower by the WHO because of cost and "access to care", not because of quality of care.

Agreed, people love to cite positions in lists, assuming the title on the list accurately explains the criteria used in assembling the list...

Kinda like how life expectancy in US is shorter than other countries, ignoring that the main drivers are things outside the doctor's care - for example in America we include every child that comes out their mother, other countries wait until a few days after delivery, or how the current opioid crisis is cutting down so many young americans much too early. Neither is a reflection on US healthcare, but when life expectancy s listed by country, people assume it reflects only on the healthcare system, nothing else.

Re: We're the best...at Marketing.

[Altrag]

Uhh nobody assumes that unless they're intentionally trying to make a misleading point. For that reason, any reasonable argument about the state of "healthcare" in a country will use multiple resources and measurements -- life expectancy of course is one, but also things like infant mortality, outcome rates for cancer/heart/other common treatments and so on. And they try to compensate as best they can for the various differences in measurement between countries and reporting agencies.

And organization as large and important as the WHO doesn't just release reports based on weak and questionable data. They do their research and take as many factors as possible into account.

I should add

[rsilvergun]

that what really makes the practice a problem is the for profit insurance companies. See, if a Doctor orders a test and it comes up blank, the insurance company will refuse payment on the grounds that the test was unnecessary. Heck, they'll site studies like this one to back it up. Eventually, when the problem is so bad that any test will show it, they'll order the tests and begin treatment, often months or years too late. Basically, private (and tacit) 'death panels'

The tacit part is important. Nobody ever says any of this out loud because if they did they'd get sued and maybe even lose a medical license.

Re: I should add

[kenh]

See, if a Doctor orders a test and it comes up blank, the insurance company will refuse payment on the grounds that the test was unnecessary.

Doubtful - you have a very simplistic view of the way the health industry works.

Do you SCIENCE much?

[Anonymous Coward]

TFS is bullshit. It's about one study that seemingly discovered that stents don't appear to reduce chest pains, and the lamesters at Vox twist that into saying stents aren't effective at all.

The actual study doesn't say that stents aren't effective in keeping you alive once you've greased up and clogged your own damn arteries. The study merely notes they don't help angina in certain situations. OK, interesting, but???

Your oh-so-wise outrage at "an unrestrained free enterprise system" is totally baseless. But hey, you got to regurgitate your socialist/Marxist talking points - from the 19th century.

Grow a brain.

And no one's stopping you from moving to Cuba or Venezuela and getting "free" health care.

Re:Do you SCIENCE much?

[mspohr]

There have been many studies which have shown the lack of value of stents over many years.
I'll just point you to the Wikipedia article which references some of these:
https://en.wikipedia.org/wiki/...

(I'd rather get my free health care in just about any European country. They have much better quality care than the US.)

Do they improve other factors?

[b0s0z0ku]

They could improve long-term survival without improving chest pain, which is a benefit as well...

Subsidize something and you get more of it

[RightwingNutjob]

Tell people they "deserve" healthcare services without having to worry about cost and they'll demand all sorts of needless things.

Pay medical practitioners by the procedure and they'll find all sorts of reasons to waste someone else's money.

Get government out of medicine and you might have people making rational decisions again.

Re:Subsidize something and you get more of it

[HiThere]

Did you ever try negotiating payment with a broken arm?

Even with good insurance I once had to negotiate coverage with a broken thumb, because the insurance didn't want to pay. Ever since then I haven't been happy to trust insurance companies, or any other group that has an incentive to not cover your medical problem. And I do recognize that such is essential. Your proposed solution seems to mean the in every medical situation you need to negotiate coverage, which is just about the worst possible approach.

Re:Subsidize something and you get more of it

[RightwingNutjob]

No, it means you
1. Buy the coverage you need and not the coverage someone else tells you you need. As a man in his 30s, I don't need gynecological services, nor do I need breast cancer screenings. But the Obamacare Version 0 we have in Massachusetts says any health insurance I buy in the state must cover those services.

2. Don't elect to have things you don't need. Your flu shot doesn't need to come from an MD, or even an RN. It can come from a trained monkey at less cost. Dentistry is a model here. Don't want the super-expensive clear braces? Don't pay for them. Don't want to have your wisdom teeth out? Don't. Save a thousand or two on each. Same story with kids having their tonsils removed. Completely unnecessary, but expensive and therefore pushed as "best practice."

3. Make sure to pay the strawman his fee. No one is telling you to negotiate with the ambulance company while unconscious. I am telling you to do your homework when you buy coverage.

Re:Subsidize something and you get more of it

[93 Escort Wagon]

Tell people they "deserve" healthcare services without having to worry about cost and they'll demand all sorts of needless things.

Yeah, most medical procedures are so pleasant to go through. In fact, I’d have a stent put in just for the heck of it, if only I could figure out how to get my insurance to cover it! And I’d get a c-section done, if only I were a woman!

Re:Subsidize something and you get more of it

[HiThere]

I *HAD* the goddamn coverage I needed. I just needed to stand there bleeding while I tried to convince some damn office worker several states away that I had an injury that needed the coverage, and he appeared to be under pressure to decide that I didn't need it without knowing anything about the case. The insurance did, eventually, pay, but by god I'm not going to do anything to support that kind of system when I have a reasonable choice otherwise.

Re:Subsidize something and you get more of it

[RightwingNutjob]

And what alternative is that? Stand there bleeding and negotiating with that same office worker several states away, except he's now a federal employee can't be fired and who's under pressure to cut *taxpayer* spending on the biggest and most expensive government program anywhere ever?

And what of the others?

[Okian Warrior]

People want to destroy their bodies then run to the doctor looking for magic. Then they complain it costs money and doesn't fix the root issue and sue the doctors if they don't like the results

What about people who *don't* want to destroy their bodies?

What about people who try to take care of their bodies: aren't obese, exercise, and don't do drugs, smoke, or drink to excess?

There's an *awful lot* of these people. I don't think the "destroy their bodies" crowd is quite as big as your implication "all people".

And yes, I would like my doctor to fix the issue, which is what I expect from *any* expert I hire to fix a problem, and if they charge me lots of money and it doesn't fix the root issue then yes, I want to sue them.

(Let me take a moment to say how entirely offensive I find your post. All the way from the smarmy holier-than-thou attitude, to the emotional straw man argument.)

I went to the auto shop this month, and they told me "you need new bearings, that's not something we can do, check with your dealership". I went to the dealership and they said "yes, we can fix that, it'll cost *this much*." They know how to do it, how much it'll cost, and there's strong protections in my state if they screw it up or charge too much or don't fix the problem.

Go to the doctor and it's "try this and see if it helps". They get all pissy if you go online to get informed about your symptoms, they prescribe to mask symptoms and not fix problems, and there's no real recourse if it doesn't work. "...and if it doesn't work come back and we'll try something else".

Wrong: Here's the original story

[DogDude]

This is the original story that should have been linked to. Not that stupid Vox shit.

https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

Re:Other countries do stents

[HiThere]

A different comment said the study quoted didn't say what the article implied.

From other sources I have heard that the older varieties of stent tended to become quickly clogged with blood clots, but that the current versions incorporate a treated surface that prevents that from happening. Anecdotally, I have friends who have had stents, and their conditions have improved markedly...from unable to walk and incoherent to able to walk up a hill and nearly as reasonable as before their problem. Well, that's been a decade or so, and he's failing again. But I'd hardly say that the stent wasn't effective, and I'm not sure that's the problem now anyway. (He's currently in his mid-to-late 80's.)

Re:America's doctors SUCK

[HiThere]

Sorry, but a personal claim by "Anonymous Coward" isn't very convincing. Make a reasoned argument, or cite an external reference, and I'll take you seriously, but for personal history arguments to carry any weight the person needs to have a track record.

The suggestion to "research it on your own" is reasonable. Of course, you run across the problem of what sources to trust.

Infant circumcision

[Stormwatch]

Pointless procedures? Infant circumcision comes to mind. Medically worthless, known to reduce man's sexual capacity, occasionally very destructive or even fatal. Without any doubt, it is a heinous violation of one's essential human right to bodily integrity.

Re: Infant circumcision

[Stormwatch]

You must like the taste of dick cheese.

Fact: women produce more smegma than men do.

Penile cancer is unknown in circumcised men.

Fact: penile cancer is extremely rare, except among older men who are smokers or have HPV.

No male infant even remembers circumcision.

So rape with roofies is fine and dandy, then?

Re:Infant circumcision

[Stormwatch]

I would assume all of the nerve endings are in the glans and below and the foreskin merely covers this.

It's the other way around. The glans is rich in free nerve endings (rough detection of deep pressure, heat, and pain - much like poking your eyes), whereas the foreskin's ridged band and the frenulum are rich in encapsulated nerve endings (fine touch, light pressure, vibration, stretching - like your lips and fingertips).

In short: you thought it was the wrapper, but it is the candy.

Re:Infant circumcision

[Stormwatch]

The jew card, how quaint.

A long article filled with anecdotes

[SlithyMagister]

and not much else.
I was hoping for a list of treatments and statistical comparisons of their outcomes.

Best wishes for a peaceful, prosperous 2018,

Re: Kind of like when Russia rigged the US electio

[mbkennel]

Clinton called one third of Trump supporters, not all Republicans, "a basket of deplorables".

I think this is quantitatively and qualitatively accurate.

Re:Other countries do stents

[mbkennel]

Stenting for heart attacks is a different issue than the one under question, and is known to be beneficial.

Doctors have to cover their asses

[reboot246]

Doctors perform a LOT of tests and procedures simply as a guard against getting sued. Their malpractice insurance providers insist that the doctors cover their asses.

I know several doctors personally, and one told me that slightly over half his cost of doing business (and medicine IS a business) was malpractice insurance. Next time you walk into a doctor's office, understand that whatever you pay to the doctor goes to rent, salaries, utilities, insurance, supplies, and some $$ to the doctor himself.

It's been suggested many, many times that the solution to the rising cost of healthcare is tort reform or loser pays. Why won't anybody listen?

Re:Doctors have to cover their asses

[Huge_UID]

"2.4% of the nation's total health care expenditure"
Source: Forbes
https://www.forbes.com/sites/rickungar/2010/09/07/the-true-cost-of-medical-malpractice-it-may-surprise-you/#a095cf72ff5b

Re:Well it's better than death panels

[Insanity Defense]

Well it's better than death panels which I know for a fact exist in communist countries like the UK and Scotlirland.

Did I mention that I'm self employed so I can deduct my medical insurance premiums (and everything else, actually)?

--
cayenne8

What about the American death panels that have existed for decades? You know the ones at the insurance companies who decide whether or not to pay for the medical coverage to save your life or to keep the money for bonuses?

Prevent and revert heart disease with nutrition

[katz]

I read the article and agree with their argument that Americans are over-prescribed and over-treated relative to their ailments. However, I did not see a solution to this which would make a significant impact. I've also read about the Ornish study, which describes the results from the only diet known to prevent and revert heart disease. It's a shame that the notion of a low-fat, whole-plant-based diet is only now starting to get noticed in the media, but I am grateful to see it happening. Drs. John McDougall, Neal Barnard, Caldwell Esselstyn, T. Colin Campbell, Pamela Popper and others are doing incredible work, and I am glad to see more people adopting their approach.

Re:Prevent and revert heart disease with nutrition

[rock_climbing_guy]

I read the book "The Pleasure Trap" after seeing it recommended in a comment right here on Slashdot.

The dietary advice inside is based on the works of Doctor Dean Ornish, so for those of you not familiar, here is the dietary advice:

- No alcohol or tobacco

- No meat or seafood

- No added sugar

- No added salt

- No heated oils

- No white rice or white bread

- No exceptions, ever, under any circumstances.

In addition to the above, the author recommends at least 10 hours of sleep every night.

Just letting you know :-)

Re:Prevent and revert heart disease with nutrition

[katz]

Lovely!! Dr. Doug Lisle sure knows how to present his argument. I regularly listen to his podcasts on Dr. McDougall's Youtube page (you too?)

In short, I appreciate how Dr. Lisle breaks down what appears to be a complex behavior into a rather simple set of smaller responses to internal anxieties ("carb bad", can't have have potatoes or some nonsense like that) or stimuli which cynically hijack our mind's response to tastes (like the so-called "flavor bursts" that food scientists work to re-create in the mouths of people eating their snacks).

yeah, tell me something we don't know

[p51d007]

Other than that, also tests after tests because of lawsuits.

Double negative

[petes_PoV]

The point of those operations was not to heal people. It was to avoid a lawsuit. It is much better for a hospital or a doctor to put a patient forward for some treatment than to do nothing. That leaves them open to malpractice or negligence claims. And since they aren't the people paying, it makes no difference to them if the procedure works or does nothing.

Avoiding a cost is just as good as making a profit, if someone else is paying.

Re:Kind of like when Russia rigged the US election

[Tulsa_Time]

Yes.. they bought some facebook ads.. impressive strategy.

Good thing we are spending billions on counter intelligence.

Rolling the dice

[PeeAitchPee]

Sure, but by the time you're in your teens, X-rays can give you a very good idea of whether or not you're going to have problems with your wisdom teeth down the road. In my case, I (with my parents' guidance) chose "wait and see" even though the doc said that I'd likely have wisdom teeth problems later on -- and I did, but not until age 40 (and then, only with two instead of all four they originally wanted to take out). The question is, essentially -- do you want to pull them before they're fully grown and really impacted and causing problems / pain, or preventative yank them when they're smaller and marginally less problematic?

Re: Kind of like when Russia rigged the US electi

[Opportunist]

There has never been a shortage of jobs that pay crap and demand a lot.

The kind of people in short supply is programmers with 20 years of experience in a technology that existed for 10 years working for 30k a year. That's something you'll be looking for for a long, long time.

Re:STENTS

[d.w.mitchell.55]

Wish I had mod points. I remember my mother telling me the procedure was performed by a technician.

Re:Damn stupid story Agreed!!

[Anonymous Coward]

I am alive writing this because of a stent, and because the local rescue squad was WELL trained in CPR. I was in cardiac arrest for 15 minutes, 5 years ago.
I was in reasonably good health, active and reasonably fit but still had a 100% blockage of a critical artery.
To the other commenters in this thread sneering about "people who don't take care of their body then go running to the doctor": FUCK YOU. Just fuck you. You are an idiot, and I hope you learn that the hard way.

Because patients will pay for it

[Chewbacon]

You can get a stent now and take your chance with the chronic process to follow, risk sudden death syndrome, or you can just fucking die right now. Well maybe not now, but soon. Youâ(TM)ll save a lot of money, however.

Re: Kind of like when Russia rigged the US electio

[DNS-and-BIND]

And that is why you lost.

Instead of speaking truth to the powerless, maybe try kindness and understanding towards the lowest in society. The bigoted classism on display was utterly disgusting, and entirely opposite left wing politics.

"evidence-based"

[KeithConover]

Disclosure: I am an emergency physician and a professor at a University. The vast majority of things I do, and that I teach my students and residents to do, are not based on double-blind, placebo-controlled trials, but on weaker evidence, or case studies. Why? Because we don't have such high-quality evidence for most of the decisions we have to make, and we have to make the best decision we can based on the available evidence. But as with the basic sciences, our knowledge is always subject to change, and I expect that stenting for stable angina is likely to go the way of cupping and leeching. I will leave you with a thought from Judith Tintinalli, M.D., a well-known emergency physician, who talks about "six dangerous words": “There is no evidence to suggest that a parachute saves lives when jumping out of an airplane.” “There is no evidence to suggest that looking both ways before crossing a street prevents accidents.” “In a patient with a first seizure who has returned to baseline, there is no evidence to suggest that a CT scan obtained in the ED affects outcome.”

Re: Prevent and revert heart disease with nutritio

[rock_climbing_guy]

Almost forgot to mention - The author says that milk and cheese is even worse for you than meat! He says that if you were a non-smoking vegan, adding meat to your diet would be about as bad for you as adding cigarettes.

sham knee surgry

[minstrelmike]

If you are thinking of getting knee surgery without having an actual accident, here's an idea. Have them x-ray/mri/cat scan _both_ knees and then send both pix to a different doc and have that doc tell you which knee hurts. (There are cuts and tears on both of them). If he can't, don't to the surgery.

This is a simple variation of the null hypothesis. If you only x-ray the knee that hurts, any tears you find are 'obviously' the problem.

search for 'sham knee surgery' for more experiments.

Re: Kind of like when Russia rigged the US electi

[hachigatsu62]

During the American Civil War, Russia supported the Union and we now know that was ultimately good for the country. If Russia rigged the elections like most morons think, then God bless Russia. Thank you Russia for convincing Sillyry Clinton to label half the country as deplorables. Itâ(TM)s obvious people donâ(TM)t always have to open their mouths to sound stupid.

this article is bullshit

[MrPeach]

Neither this article nor the vox article made clear that this was regarding stents inserted for pain relief, not stent used for heart attack patients.

While the fact that stents are being used for pain relief which is unsupported by science is horrible, reporting that doesn't clearly state that stents for heart attack patients are effective and supported by science is highly irresponsible.

Aggregate stats don't tell the full story

[John Jorsett]

Just because there's no overall benefit to the population as a whole doesn't necessarily mean that a treatment is ineffective for everybody. I think you need to tease out a lot of factors and see if it might be effective for, to use a silly example, left-handed redheaded women under 45 who are taller than 5 feet. Examining every potential combo sounds tedious, I know, but maybe that's where AI could shine.

Re: Well it's better than death panels

[Insanity Defense]

It looks like a weak attempt at satire: "Scotlirland". Obviously no one in the US is stupid enough to believe the UK is communist.

Given the way some Americans define communist (apparently not Republican = Communist for a lot of people) I'd say there are an indecently large number of Americans who DO believe the UK is communist.

Re: Kind of like when Russia rigged the US electi

[david_thornley]

In other words, foreigners can take over the government as much as they like as long as they agree with your particular political views. What happens when you've let them over a period of time, and they do something you don't agree with?

Re:Laws that Protect Pharma

[ChrisMaple]

Lawsuits, often frivolous, were causing vaccine manufacturers to leave the business. The law was part of an attempt to ensure that there was at least one U.S. vaccine manufacturer that stayed in business.