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After Century of Removing Appendixes, Docs Find Antibiotics Can Be Enough (arstechnica.com)
After more than a century of slicing tiny, inflamed organs from people's guts, doctors have found that surgery may not be necessary after all -- a simple course of antibiotics can be just as effective at treating appendicitis as going under the knife. From a report: The revelation comes from a large, randomized trial out of Finland, published Tuesday, September 25, in JAMA. Despite upending a long-held standard of care, the study's finding is not entirely surprising; it follows several other randomized trials over the years that had carved out evidence that antibiotics alone can treat an acute appendicitis. Those studies, however, left some dangling questions, including if the antibiotics just improved the situation temporarily and if initial drug treatments left patients worse off later if they did need surgery. The new JAMA study, with its full, five-year follow-up, effectively cauterised those remaining issues. Nearly two-thirds of the patients randomly assigned in the study to get antibiotics for an uncomplicated appendicitis didn't end up needing surgery in the follow-up time, the Finnish authors, based at the University of Turku, report. And those drug-treated patients that did end up getting an appendectomy later were not worse off for the delay in surgery. "This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis," the authors conclude. The finding suggests that many appendicitis patients could be spared the risks of surgical procedures, such as infections.
This will never fly in the USA; a surgical procedure will generate much more profit than a simple prescription. Our medical system is based on a for-profit model.
Yeah, we should keep it inflamed until it bursts so the infection can spread throughout the entire body.
Genius. Let me know how your clinical trials go.
You don't need to nuke it; just assist enough that the body can get a handle on the infection.
RTFA, asshat:
The revelation comes from a large, randomized trial out of Finland, published Tuesday, September 25, in JAMA. Despite upending a long-held standard of care, the study's finding is not entirely surprising; it follows several other randomized trials over the years that had carved out evidence that antibiotics alone can treat an acute appendicitis. Those studies, however, left some dangling questions, including if the antibiotics just improved the situation temporarily and if initial drug treatments left patients worse off later if they did need surgery. The new JAMA study, with its full, five-year follow-up, effectively cauterised those remaining issues. Nearly two-thirds of the patients randomly assigned in the study to get antibiotics for an uncomplicated appendicitis didn't end up needing surgery in the follow-up time, the Finnish authors, based at the University of Turku, report. And those drug-treated patients that did end up getting an appendectomy later were not worse off for the delay in surgery. "This long-term follow-up supports the feasibility of antibiotic treatment alone as an alternative to surgery for uncomplicated acute appendicitis," the authors conclude. The finding suggests that many appendicitis patients could be spared the risks of surgical procedures, such as infections.
Antibiotics no longer work.
The badly named and poorly edited book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer lists numerous ways in which medical procedures in the United States are poor.
On page 8, that book recommends another book, Overdiagnosed: Making People Sick in the Pursuit of Health. I haven't read that one yet.
I'll take removal or antibiotics over death...
of course it's not an issue for me, I've been appendix free for decades now...
When I first read a similar line in Houellebecq's writing, I was skeptical. Since that time, I have seen that in every profession, humans have invented ways of following procedure instead of doing what is necessary. This rewards the individual humans involved with more money but makes them weak because they spend their time on wastage. This bloat affects all human societies once they reach a certain level of internal division.
Alternative Right.
22 days of sick time to recover from an appendectomy?
3 days on average in the hospital?
I woke up with pains in my stomach on a saturday, went to the doctor who sent me off for a CT scan and by midnight the appendix was removed, by lunch the next day I was leaving the hospital, and I was back in school on money.
My appendectomy cost me a weekend, I was on some pills for a few weeks afterwards, and couldn't lift anything heavy during that time... but I was basically back to normal after a few weeks (once the incision healed up).
Huh? Do you not understand the article you are quoting? Did you go to college?
it's the only offal our alien overlords truly enjoy. :(
Care killed the cat, but satisfaction brought it back.
Was when I found out the appendix had a use. Completely ruined the Joke from Hot Shots: Part Duex about the inventor of the artificial appendix... Damn you science, damn you.
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No. It can be treated either surgically, or with mass doses of antibiotics.
Who needs drugs when you have a pocket knife? Just look at this instructional video.
Incipiamus, fratres, servire Domino Deo, quia hucusque vix vel parum in nullo profecimus.
I don't care if they remove appendixes, but I really wish they'd get rid of endnotes. They're just a hassle.
You are welcome on my lawn.
this looks promising. I would like to see further studies done in this, to see if they can validate these results.
Also, 530 people from Finland is maybe a 'large' study, in Finland, but not sufficient to learn if the results would be the same over Europe as a whole, much less the world.
Good work though!
so, what do you suggest? Waiting for the patient to die? Appendicitis is a killer, it kills people if left untreated. Right now the two options are surgery or with this article, antibiotics. What is the third alternative you suggest?
"Governments have been dominated by the corporate entities and citizens have ceased to matter in public policy" true in
Wait....what's this?
Oh...oh dear. Was that a pun?
Was that ANOTHER surgery pun?
Finding God in a Dog
So rather then trying antibiotics far cheaper then a surgery the doctors sold everyone on removing the afflicted organ. This is sort like a mechanic recommended a engine overhaul when it just needed a tune up.
I woke up with pains in my stomach on a saturday, went to the doctor who sent me off for a CT scan and by midnight the appendix was removed, by lunch the next day I was leaving the hospital, and I was back in school on money.
For me I went into the hospital on Friday and had surgery Friday night. I had been symptomatic for about 24 hours prior to going to the hospital - mild fever and lots of vomiting. Was in the hospital until Sunday but wasn't back to school for another week since I could barely walk for 3-4 days afterwards and it took a full week more to be able to get around without substantial discomfort. I was back in school about 10 days after surgery. After that it wasn't too bad - just limited sports activity for 3-4 weeks (to prevent adhesions they told me) but nothing too limiting otherwise. Abdominal surgery is not super fun.
If the acute appendicitis is caused by an appendicolith, the antibiotics will not clear that out. It may resolve the inflammation, even letting the appendix scar over, but decades later it will resurface. Then good luck trying to get that diagnosed.
Just watch the diagnostics of "irritable bowel syndrome" rise over the years as people with damaged appendixes get "reflex ileus". IBS is 21st century quackery.
They're creating a perfect storm of conditions to let new illnesses arise. The appendix is hard to visualize with medical imaging. Guess what? Imaging is far from the sci-fi stuff you see on TV. These tests may not be specific, may not be sensitive, and are operator-dependent. You are looking at clouds on a screen and hoping that someone is able to figure out which of the five positions the appendix is in, assuming it is in the somewhat normal size range.
Given how poor the quality of modern treatments are.
Not correct. Acute appendicitis kills no one. If it perforates, it's the peritonitis that kills. Acute appendicitis is known to resolve itself in 70% of cases, according to early 20th century, pre-antibiotics data.
But an inflamed appendix NEVER heals correctly. You will always have symptoms like constipation, and the risk of recurrent appendicitis, which is even worse.
https://emergencymedicinecases.com/episode-43-appendicitis-controversies/
"appendices"
Mine had become choked off and died. It had to be removed.
"Those studies, however, left some dangling questions ..."
"The new JAMA study, with its full, five-year follow-up, effectively cauterised ..."
There may be others but these jumped out for me.
FYI, I'm an emergency physician and am comfortable with reading medical studies. There are several issues with this study: 1. They performed open vs laparoscopic appendectomies and the complication rate reflects this standard of care in Finland 2. The failure rate of antibiotics only is 40% in this 5 year period 3. The durability and duration of cure is suspect at this time 4. This is for uncomplicated appendicitis only The benefit to patients: 1. Offering another treatment avenue vs surgery alone
Glad I got that little pain-generating sack out of me when I was younger. Totally worth not having a chance at that kind of pain ever again.
There are also risks with antibiotics these days, depending on the particular antibiotic.
Destruction of gut flora can be massively debilitating and the medical community hasn't yet fully grasped how to deal with the consequences of such a thing (fecal transpalants are not widely known about or widely practiced).
Corporation, n. An ingenious device for obtaining individual profit without individual responsibility. - Ambrose Bierce
The problem is that if it fails, you will end up with antibiotic-resistant bacteria. Hence the nuking
The new JAMA study, with its full, five-year follow-up, effectively cauterised those remaining issues. Nearly two-thirds of the patients randomly assigned in the study to get antibiotics for an uncomplicated appendicitis didn't end up needing surgery in the follow-up time
So, of the patients who developed appendicitis and were treated with antibiotics, about a third required surgery within five years. That's an appendectomy for about 1/15th of the sample group each year. The background rate is about an appendectomy 1/1000th of the general population per year.
Looking at it another way: assuming the rate stays roughly constant, if you've had appendicitis treated with antibiotics, you'll probably need surgery within 45 years. That's less than a human lifetime. So treating appendicitis with antibiotics generally *delays* surgery, rather than avoiding it. They checked, and found that at least it doesn't make the surgery any more difficult - but it still doesn't sound hugely preferable to an appendectomy, to be honest.
The parent comment seems correct to me: "There's only one industry that's even more corrupt and self-serving than the financial industry, and that's health care." However, I think the finance industry may be even worse than the health care industry; the finance industry is more hidden.
Suggested SMALL improvements for finance organizations:
1) Links should ONLY be to web sites owned by that financial organization. No Google tracking, for example.
2) CD rates should have very clearly explained early withdrawal penalties.
Suggested BIG improvements for finance organizations:
1) ALL involvement of finance organizations and the government must be explained clearly and with complete detail.
2) ALL receipts for payments with credit cards must show the amount charged by the financial institution for that sale on the receipt.
but it was in the appendix and nobody read it.
For all intensive purposes, "whom" is no longer a word. That begs the question, "who cares"?
That's exactly what happened to me. Had I not had an appendectomy I would be dead. They got to it in the proverbial 'nick of time.' To generalize over this report and claim it is never necessary is rather over-stating the case.
How about a moderation of -1 pedantic.
My cousin had appendicitis less than a year ago, in NYC, and they gave him the choice of surgery or antibiotics; he chose the antibiotics and all went fine. (Interestingly he says they offered him to be in a study where they'd randomly assign him to one or the other; he declined in favor of avoiding surgery.)
Only a few years ago, thousands of surgeons, who were paid vast sums of money to laser or cut out ulcers, who actually weren't caused by stress but just an infection with Helicobacter pylori, curable with a few antibiotic pills and now again, another surgeon's bread an butter operation is hit.
I wonder what's next.
"After a century of removing appendices..." ?
Germany has the world's oldest national social health insurance system,[1] with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889.
I read a fascinating book, "Seeking the Cure: A History of Medicine in America," by Ira Rutkow, that answered some questions I'd always had about appendectomies.
If someone asked you to fill in the blank quickly in the sentence "The surgeon performed an _________" you would probably say "appendectomy." Yet it isn't such a terribly common operation today. Why is it the ur-operation, the one always used for purposes of hypothetical illustration? Why appendectomies?
According to Rutkow, It was a confluence of events. I hadn't realized that abdominal surgery had once been a medical taboo, with a nearly 100% mortality rate. Antisepsis ("Listerism") and anesthesia made it safe. It had once been extremely difficult to diagnose. I hadn't really thought of centrifuges, microscopes and blood counts as being a breakthrough in modern technology, but of course they were, part of the medical technology revolution that emerged from World War I. And they made it possible to diagnose appendicitis reliably. And there was one influential surgeon who promoted the idea that it was a surgeon's disease, that appendicitis "belonged to" the surgeon. Hospitals and surgeons found appendectomies to be lucrative, and they became almost a fad; Rutkow cites a hospital in which 1/5th of all operations performed were appendectomies.
"How to Do Nothing," kids activities, back in print!