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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.
it's the only offal our alien overlords truly enjoy. :(
Care killed the cat, but satisfaction brought it back.
But no problem, because now you own the hospital.
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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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.
Remember averages include a wide range of cases. At one extreme you have someone who is young and fit, has an occupation that doesn't involve much physical stress and where they succeed in doing the procedure keyhole. At the other extreme you have someone who is old, works a manual job and has some complications during surgery that require them to fully open the abdomen.
note: i'm known as plugwash most places but i screwd up registering that here somehow in the past and now can't register
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.
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
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.
I woke up at 3 am in a NYC hotel with abdominal pain. I tried to defecate, I made myself vomit thinking it was gas or a stomach bug. I got back in bed for another hour before meeting up with the rest of my family to go to the airport for a flight back to Houston. At the airport I tried a few more times to go to the bathroom, still thinking it was some kind of food poisoning or constipation. By the time we were in the air, I knew it wasn't food poisoning.
We landed in Houston and I drove myself straight to the hospital. I waited in the ER for at least 5 hours during which they would intermittently check on me and drew some blood to check my white cell count. Eventually they confirmed it was appendicitis and gave me some morphine so I could finally get a little rest. Around midnight I finally was taken in for laparoscopic surgery.
I spent the next 3 days in the hospital with an IV and a little suction bulb in my side. I was barely 30 years old at the time and in good physical shape.
No one cares what your captcha was
Houston TX, USA
"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
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 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.
Back in mid 70s, mine burst, and I was supposed to be in hospital/Student Med. Center for 1-2 weeks. I walked out of the student med center after 4 days. They were MAD at me for that.
I prefer the "u" in honour as it seems to be missing these days.
Back in mid 70s, mine burst, and I was supposed to be in hospital/Student Med. Center for 1-2 weeks. I walked out of the student med center after 4 days. They were MAD at me for that.
Probably mad as they figured you'd be back a day later with complications and try to sue them for letting you leave without being fully recovered in the first place.
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!