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Medicine United States Science

Believing In Medical Treatments That Don't Work 467

Posted by Soulskill
from the take-two-placebos-and-call-me-in-the-morning dept.
Hugh Pickens writes "David H. Newman, M.D. has an interesting article in the NY Times where he discusses common medical treatments that aren't supported by the best available evidence. For example, doctors have administered 'beta-blockers' for decades to heart attack victims, although studies show that the early administration of beta-blockers does not save lives; patients with ear infections are more likely to be harmed by antibiotics than helped — the infections typically recede within days regardless of treatment and the same is true for bronchitis, sinusitis, and sore throats; no cough remedies have ever been proven better than a placebo. Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment, and knee surgery is no better than sham knee surgery where surgeons 'pretend' to do surgery while the patient is under light anesthesia. Newman says that treatment based on ideology is alluring, 'but the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.' The Obama administration's plan for reform includes identifying health care measures that work and those that don't, and there are signs of hope for evidence-based medicine: earlier this year hospital administrators were informed by the Centers for Medicare and Medicaid Services that beta-blocker treatment will be retired as a government indicator of quality care, beginning April 1, 2009. 'After years of advocacy that cemented immediate beta-blockers in the treatment protocols of virtually every hospital in the country,' writes Newman, 'the agency has demonstrated that minds can be changed.'"
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Believing In Medical Treatments That Don't Work

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  • aprilfools (Score:4, Funny)

    by ShakaUVM (157947) on Saturday April 04, 2009 @07:28AM (#27456687) Homepage Journal

    ...will be retired as a government indicator of quality care, beginning April 1, 2009

    April Fools!

    Actually, beta blockers are GREAT for you.

  • And next up (Score:5, Interesting)

    by m0s3m8n (1335861) on Saturday April 04, 2009 @07:28AM (#27456691)
    Just wait. Next up will be treatment based on life expectancy and quality. I see this becoming an issue based on my experience working for a group of Eye docs (retinal specialists). I often see very elderly (and often demented) patients receiving very expensive treatment of eye conditions. do they need the treatment - sure, to preserve their sight. Does the treatment improve their quality of life - maybe. So who decides, the patient or family, or BIG government?
    • Re:And next up (Score:5, Insightful)

      by gerf (532474) <edtgerf@gmail.com> on Saturday April 04, 2009 @07:36AM (#27456725) Journal

      Isn't it Japan that was looking to fine people for being overweight, since it would cost the government more for health care? And don't they stop treating cancer patients in some European countries if they're too old?

      While the idea of universal free happy healthy health care sounds sugary sweet, there are some dire consequences of handing our individual health to governmental control.

      • Re:And next up (Score:5, Insightful)

        by ZombieWomble (893157) on Saturday April 04, 2009 @08:32AM (#27457027)

        And don't they stop treating cancer patients in some European countries if they're too old?

        This is a fairly ubiquitous practice - most cancer treatments are nasty. Invasive surgery, chemotherapy and radiotherapy all potentially have significant negative impact on quality of life. If someone has the option of a certain number of relatively comfortable years, or a few additional years filled with serious complications, many doctors will recommend the latter option, and this is sometimes reflected in treatment options.

        • Re:And next up (Score:4, Informative)

          by iYk6 (1425255) on Saturday April 04, 2009 @09:16AM (#27457279)

          Not to mention the risks. Cancer treatments can kill people, and surgery is always dangerous. Elderly people are the most likely to die from such treatments.

        • Re:And next up (Score:4, Insightful)

          by WgT2 (591074) on Saturday April 04, 2009 @10:45AM (#27457869) Journal

          You used a subtle, but clear distinction, that affirms the GP:

          many doctors will recommend the latter option

          ...but they cannot require it... nor do our laws.

          I will say that the article's use of "evidence-based medicine" is heartbreaking - implying evidence isn't currently used... which I don't believe.

          • Re:And next up (Score:5, Insightful)

            by onionlee (836083) on Saturday April 04, 2009 @11:49AM (#27458327)
            It isn't that evidence isn't used when considering treatments. In fact, there were studies in the 90s that supported the use of beta-blockers. The problem is that when later evidence shows up to prove otherwise - ie that it does not make a difference - the medical community has adopted the usage of such as standard procedure. Hard to change, no matter the evidence.
      • Re:And next up (Score:5, Insightful)

        by cptdondo (59460) on Saturday April 04, 2009 @09:19AM (#27457297) Journal

        As opposed to not having health care at all?

        Having universal gov't health care doesn't stop the wealthy from buying more health care than anyone else; it provides health care for the 30% or so of Americans who have none.

        It would also control some of the ridiculous cost spirals. Doctors have no idea how much treatment costs; I've asked how much a certain procedure might cost and I'm always met with a blank stare. All the doctors know is that they get a kickback from the lab/hospital/etc for ordering some test. They don't really care if it's necessary or useful.

        I'm familiar with both Japanese and European health care systems. The Japanese system provides universal care to everyone. It's basic and no-frills, but it covers nearly all.

        The European System (actually Czech Republic) is much the same way. Its focus is on quality of life; they are less likely to provide life-extending care if it means being tethered to a hospital bed. They'll tell you to go home, have some beer, and enjoy what life you have left. They might even send you to a spa or a hot-springs at state expense.

        • Re: (Score:3, Insightful)

          by pease1 (134187)
          And you assume the US Government can actually manage such a program? How good have they done with Social Security? Medicare? Can anyone name a US Government program to citizens the size of this that is run efficiently? The trust to those in DC to run and control our lives is nothing short of incredible, given all the complaints of the past four years.
        • Re:And next up (Score:4, Informative)

          by Solandri (704621) on Saturday April 04, 2009 @03:24PM (#27459915)

          It would also control some of the ridiculous cost spirals. Doctors have no idea how much treatment costs; I've asked how much a certain procedure might cost and I'm always met with a blank stare. All the doctors know is that they get a kickback from the lab/hospital/etc for ordering some test. They don't really care if it's necessary or useful.

          Actually, the doctors order all the tests because if they don't, and the patient happens to have some disease that would've been detected by that test, they'll get sued for malpractice, and their malpractice insurance rates will go up, and/or they could lose their license to practice. Having universal health insurance wouldn't stop this, it would actually make it worse since the doctors would know the tests would be paid for. (Unless you put some bureaucrat in charge of deciding which tests are necessary, taking that decision out of the hands of the doctor who sees you.)

          The only other ways to stop it are to tighten up the requirements to file a malpractice suit (which would make the lawyers unhappy), or for the government to provided some sort of universal malpractice insurance. But then you'd get the same arguments being raised for/against universal health insurance, but applied to rich doctors instead of poor people (e.g. bad doctors being allowed to continue practice). Personally I think getting people's opinions on both is a great way to detect whether they truly want to fix the health care system, or if they just have an agenda they want to push and have picked health care as their vehicle.

    • Re:And next up (Score:5, Insightful)

      by bargainsale (1038112) on Saturday April 04, 2009 @07:45AM (#27456761)
      This is in fact the way things work now in the UK.

      There is a pretend-independent government committee called NICE (yup) which decides which treatments are to be made available through the free-at-the-point-of-delivery government health service, the NHS.

      They do indeed make heavy use of QALYs, "Quality-Adjusted LifeYears" in much this way.

      Although the way NICE works in specific instances has led to a lot of very justified criticism, there seems to be no realistic alternative to something like this if you have a tax-financed system that the sick don't pay for directly. There just isn't enough money to do everything possible for every patient.

      I don't know the right answer. I work for the NHS (as a retinal specialist too!) and have had endless grief getting funding for some treatments for my patients; on the other hand, I've worked in systems where the first question you have to ask is not "what does this patient need?" but "what can this patient afford?" and I prefer the former despite all its problems and stupidities.
      • Re:And next up (Score:5, Interesting)

        by JohnFluxx (413620) on Saturday April 04, 2009 @07:55AM (#27456815)

        The scientist in me likes the ideas of NICE. If an operation neither extends life nor increases quality of life, then what's the point in the operation?

        Of course, it never works perfectly, but I'd be interested in what the critisms against NICE are?

        • by u38cg (607297)
          Well, Lord knows they could change the name, at least; it reeks of Orwellian doublespeak. Not to mention the associations with the last book of CS Lewis's Cosmic Trilogy.
          • Re: (Score:3, Informative)

            NICE is an acronym and stands for The National Institute for Clinical Excellence.
            • Re: (Score:3, Funny)

              by u38cg (607297)
              I'm well aware of that, thanks. My point is calling an institute whose main job is to decide who gets cancer drugs "NICE" is pretty bad marketing; it makes people suspicious and paranoid. Maybe it should be called the Klinical Kosts Komittee.
        • Re: (Score:3, Insightful)

          by tepples (727027)

          If an operation neither extends life nor increases quality of life, then what's the point in the operation?

          True, but if there is a choice between an operation that extends life and one that increases quality, which does the provider pay for?

          • Re:And next up (Score:4, Insightful)

            by BarryJacobsen (526926) on Saturday April 04, 2009 @09:16AM (#27457273) Homepage

            If an operation neither extends life nor increases quality of life, then what's the point in the operation?

            True, but if there is a choice between an operation that extends life and one that increases quality, which does the provider pay for?

            It depends on if the extended life years are Quality Life Years or just extended life. For example an operation that would keep the patient alive, but in a coma would have a low Quality, so it would be lower in priority than an operation that would give sight to a blind person - which while not changing the length of their life (ignoring any differences in life expectancy between the sighted and the blind) increases quality significantly.

          • Re: (Score:3, Informative)

            by sjames (1099)

            That's where quality adjusted life years comes in. You look at years of life weighted by quality of life for each option and choose the greater. It's an attempt to codify the idea that most people would rather live 2 more healthy years than 4 years wracked in pain.

        • by Kupfernigk (1190345) on Saturday April 04, 2009 @09:15AM (#27457267)
          There is evidence that drug companies have orchestrated campaigns to get the general public to agitate for their treatments when NICE has identified that they do not work, or do not work well. Many cancer treatments are actually pretty ineffective, but of course dying people clutch at straws - as I may do one day - and if they are told that X treatment is very expensive but may prolong their lives, they will probably demand it. They may not be told that, say, the side effects are awful and they will get six months of life instead of three.

          We need NICE because ethical drug companies are no longer ethical, and that in part reflects our demand for magical cures. The really serious problems we face - like TB and avian flu - are of little interest to drug companies because (in the first case) most people affected are poor and cannot afford expensive medicine and (in the second case) vaccines are usually a one or two off and do not represent a continuing revenue stream paid for by insurance. We cannot rely on insurance companies to control public health because their aim is to balance revenue and cost - they are not interested in controlling the diseases of the poor, and they do not want diseases cured to the extent that their revenue goes down. We as taxpayers need agencies like the NIH in the US and the NICE in the UK to advise and regulate in our interests, not those of shareholders only.

      • Re:And next up (Score:5, Insightful)

        by syntaxglitch (889367) on Saturday April 04, 2009 @08:24AM (#27456967)

        Although the way NICE works in specific instances has led to a lot of very justified criticism, there seems to be no realistic alternative to something like this if you have a tax-financed system that the sick don't pay for directly. There just isn't enough money to do everything possible for every patient.

        Who says it has to be tax-financed?

        In the USA, much health care is funded by insurance companies that essentially serve the function of averaging medical expenditure among a group of people. The net result of this is that an individual with insurance has every incentive to spend as much as the insurance while let them, because the costs will distribute to all policy holders. When everyone does this, insurance policy costs keep going up. The insurance companies, trying to get costs back down, have incentive only to pay as little as possible, not prioritize approved treatments by QALYs or any other similar metric.

        Then, due to all that, you end up with people who are uninsured or otherwise unable to afford health care ending up with emergency conditions, receiving expensive treatment, and being forced into bankruptcy. This also drives up cost (as the hospitals are forced to absorb the cost of treatment) and harms society (a financially ruined citizen accomplishes less and pays less tax).

        And thus, we come to this, the worst of all possible worlds.

        • is ass backwards.

          Health Insurance should work like other insurance policies, for catastrophic issues. My auto insurance doesn't pay for maintenance but that is exactly what people expect from medical insurance. The same for dental. There are many services that are expensive simply because a "group/company" is paying for it, not a person. If auto/home/etc insurance worked like how medical/dental does we would have huge premiums to cover for people going in to get their oil changed every 3k and tires rota

          • by nine-times (778537) <nine.times@gmail.com> on Saturday April 04, 2009 @09:20AM (#27457307) Homepage

            I do not mind universal catastrophic health care, I do mind the idea of paying for every kook who thinks his tummy ache is an emergency.

            Well the two might not be directly connected. It doesn't seem to me like giving universal catastrophic health care would encourage people to use the ER more, and in fact having better access to healthcare on a regular basis might decrease ER costs. Setting aside for a second the people who go to the ER for every tummy ache, what about those who do nothing about potentially serious issues until they actually become serious issues? Early detection can often save money, actually.

            A local hospital in Atlanta (actually more than one) reports many cases of people calling 911 to get a ride downtown where by law they are required to be given a "ticket" to get home.

            Well that's just a problem, and again doesn't really have a direct connection to universal healthcare. You can get in trouble (fines, I believe) for calling 911 unnecessarily. You have to figure there will be some abuse, that sometimes a person will get away with something like that. But if it's really all that rampant (the abuse the the ambulance service that you describe) then I would think they should investigate and arrest or fine people abusing the system.

      • Re: (Score:3, Insightful)

        by aurispector (530273)

        I work in a health-related field where a lot of practitioners are focused more on the dollars than the patient's best interest. Unfortunately, this is human nature. The only thing you can really do is try to find the ones that aren't just trying to sell you stuff.

        I think government mandated standards can be harmful in some cases. Practitioners must have the flexibility to treat as they see fit, since not everyone fits the same mold and it's not always clear what's going to work. I've seen instances where

    • Re: (Score:2, Informative)

      by Anonymous Coward
      What you said has nothing to do with the article at all. You just wanted to say "BIG government." Buzzword buzzword! Lions and tigers and bears!
    • Re:And next up (Score:5, Insightful)

      by Anonymous Coward on Saturday April 04, 2009 @07:55AM (#27456817)

      I often see very elderly (and often demented) patients receiving very expensive treatment of eye conditions. do they need the treatment - sure, to preserve their sight. Does the treatment improve their quality of life - maybe. So who decides, the patient or family, or BIG government?

      This isn't about BIG government telling you you can't take homeopathic remedies, or OTC cough medicine, or sit under a pyramid. This is about government funding research that reveals snake oil as snake oil. If the $8 bottle of robitussin is no more effective than lemon tea, what reasonable consumer would buy the robo? Hooray, I say, for a government that encourages open and honest markets.

      • Re: (Score:2, Funny)

        by Anonymous Coward

        If the $8 bottle of robitussin is no more effective than lemon tea, what reasonable consumer would buy the robo?

        Dude. Robitussin is so much more trippy than lemon tea.

      • If the $8 bottle of robitussin is no more effective than lemon tea, what reasonable consumer would buy the robo?

        Someone who wants to do DXM [wikipedia.org], for one. Dextromethorphan hydrobromide (US OTC) is easier to get in some countries than ketamine (US CIII) or phencyclidine (US CI).

    • Re: (Score:2, Interesting)

      by b4upoo (166390)

      I can testify that knee surgery is sometimes a wonderful cure. I suffered terrible pain for years and two new artificial knees are better than the originals in many ways and they never,ever hurt at all.

      • Placebo testimony (Score:3, Insightful)

        by mhelander (1307061)

        According to TFA, you don't actually know that.

        • Re: (Score:3, Informative)

          by ColdWetDog (752185) *
          No, he actually does. TFA is talking about arthroscopy for osteoarthritis [cochrane.org], not knee surgery in general - although that little point isn't very clear. Arthroscopic surgeries for some things seems to be useful, although formal comparative studies haven't been done. Same for knee replacements. The problem is that it's dammned hard to do the experiment. For osteoarthritis ("bone on bone"), the VA docs did a wonderful thing. They managed to get a protocol whereby the "control" patients underwent anesthesia
      • Re:And next up (Score:5, Informative)

        by BarryJacobsen (526926) on Saturday April 04, 2009 @09:19AM (#27457293) Homepage

        I can testify that knee surgery is sometimes a wonderful cure. I suffered terrible pain for years and two new artificial knees are better than the originals in many ways and they never,ever hurt at all.

        The knee surgery being referred to is the kind where they don't replace anything, just dinkering around in there - I believe. They aren't arguing that artificial knees don't work.

    • Re:And next up (Score:5, Informative)

      by similar_name (1164087) on Saturday April 04, 2009 @09:09AM (#27457225)

      So who decides, the patient or family, or BIG government?

      Under our current system, insurance companies decide. It seems disingenuous to imply that patients have the choice and that the current system(private insurance companies) pays for every treatment than anyone could ever want/need. There are plenty of people who have been denied claims. I also don't understand why you can't still have private insurance if there is national health care. Did the advent of Blue Cross/Blue Shield make it impossible to get Aetna?

  • Goes to show. (Score:5, Interesting)

    by palegray.net (1195047) <philip.paradis@pa3.14legray.net minus pi> on Saturday April 04, 2009 @07:30AM (#27456703) Homepage Journal
    The human body is pretty darn good at healing itself. There is absolutely no replacement for a decent diet, moderate exercise, and a positive attitude. The last factor alone has been repeatedly shown to boost immune system health over a variety of drug-based treatments.
    • Re: (Score:3, Interesting)

      by Hurricane78 (562437)

      I'd say in fact, especially for us people who like tinkering and tuning complex machines, getting our body to run perfectly should be a pretty easy and fun thing to do.
      The them "species-appropriate" is the key word. What is the perfect food for our machine called body? How do you maintain it? How does the brain work?

      If you look that stuff up, it all becomes so totally obvious. And much simpler to implement.

      About the last factor: What you mean is the placebo effect. There were experiments, where people becam

      • Re: (Score:3, Interesting)

        by JWSmythe (446288) *

        You're amazingly correct.

        I tell kids, pain is in their head. The sensory impulses tell the brain "this happened". Without the brain processing the input, it never happened.

        Take a kid who just tripped and banged something. Distract them from the pain. Tickle them. Poke them in the arm. Some people just yell "Hey, stop crying!". It distracts them from the pain, and it's either meaningless or just doesn't hurt as bad.

        I've sure you've heard of p

      • Re:Goes to show. (Score:5, Interesting)

        by lawpoop (604919) on Saturday April 04, 2009 @10:08AM (#27457615) Homepage Journal
        I think that the human organism basis some of its healing on its perception of its role in society. We are a social creature. Every culture has some kind of 'theory of medicine' -- that disease has a cause, which can be treated by certain practices, procedures, and bitter plant concoction ( the taste of 'bitter' is the chemical recognition of alkaloids, or drug compounds, in a plant ).

        If we are receiving 'treatment', or attention from the community when we are known to be sick, then our body's healing response will amp up.

        Likewise, people can die basically 'on command' in certain circumstances, when a doctor or sorcerer pronounces them dead. In some tribe somewhere, if a shaman does a certain ritual called a 'bone-pointing', the person who gets cursed will sicken and die in about three days -- shorter than you would die from thirst or hunger. Likewise, back in the 80s when AIDS was first on the scene, people would sometimes die within days of a diagnosis. Doctors didn't find any physical cause; they just kind of willed themself to death, probably because of the severe social stigma and lack of hope that an AIDS diagnosis meant at that point.

        So I think placebo medicine will be a big insight into understanding human health in the future.
    • Re:Goes to show. (Score:5, Insightful)

      by nloop (665733) on Saturday April 04, 2009 @08:07AM (#27456877)

      The human body is pretty darn good at healing itself. There is absolutely no replacement for a decent diet, moderate exercise, and a positive attitude. The last factor alone has been repeatedly shown to boost immune system health over a variety of drug-based treatments.

      While I agree that a lot of our respective societies health issues are preventable, I am 26 years old, can run a marathon, and rarely ever touch red meat and I call shenanigans on the idea that diet and exercise are a cure-all! I have 140/85 blood pressure (high) despite doing cardio work 5 days a week and eating right. I have knee problems when it's cold, back problems all the time, and suffer from bronchitis every winter from exercise in the cold. Sometimes I feel like a healthy lifestyle is making me fall apart.

      However, my qualm is more with more with scientologists, and that various left field christian sects that refuse to immunize their kids or see doctors. Modern medicine is useful. Really. It is. There is more than diet, exercise, and positive thinking.

      • The vast majority of people who don't immunize aren't doing it for religious reasons. There's a growing segment of 'educated' people who have 'researched' the issue and have decided that the risks outweigh the benefits.

        Unfortunately there are 'professionals' within the health care system that spout this idiocy, including nurses and chiropractors.

    • Re:Goes to show. (Score:4, Insightful)

      by nine-times (778537) <nine.times@gmail.com> on Saturday April 04, 2009 @08:22AM (#27456949) Homepage

      There's merit in what you say, but on the other hand, I'll take antibiotics when I have an infection. I'll go in for any recommended cancer screenings, and if they find something, I'll be glad for the best medical treatment I can get, because I don't want to rely on diet, exercise, and attitude to fix that.

      There is no replacement for diet, exercise, and a positive attitude, but those things also aren't a complete replacement for medical treatment.

    • by Kokuyo (549451)

      The human body is pretty darn good at healing itself. There is absolutely no replacement for a decent diet, moderate exercise, and a positive attitude. The last factor alone has been repeatedly shown to boost immune system health over a variety of drug-based treatments.

      In light of this artice, what IS a decent diet? Is it five portions of fruit a day, no fat and no salt, as many people with diverse degrees say, or is it rather a good idea to listen to what your body wants to eat even though it may partially contradict common standards?

      How are we, common citizens, to know when and to what extent certain studies are a sham and when to trust them?

      Personally, I've started to keep an eye open for chewing gums and the like containing sugar. I, and my wife, have made the observa

  • A Nit To Pick (Score:4, Informative)

    by darkmeridian (119044) <william...chuang@@@gmail...com> on Saturday April 04, 2009 @07:50AM (#27456791) Homepage

    Prescription cough syrups may be useful.The linked article regarding cough syrups only covered over-the-counter cough medications. Prescription cough syrups that contain codeine or hydrocodone seem to work really well but are liable to abuse.

    • by DrYak (748999) on Saturday April 04, 2009 @08:19AM (#27456937) Homepage

      Cough syrups *do* work. ...BUT...

      They don't combat the infection. They alleviate the symptoms.
      They don't kill the bug which is causing the cough, they only make the patient cough less (and thus sleep better, feel more comfortable).

      So if you count the days spent being sick, a cough syrup won't make any difference. On the other hand if you look which makes happier the patient, one should prescribe the cough syrup anyway. (Same goes for lots of other ailment : most of the treatment prescribed by doctors for common illnesses are only to make the symptoms more bearable, not to kill the bug faster).

      There's a saying here among doctors telling that a "cold" last one week without treatment and 7 days with treatment.

      I am more astonished about the prescription of antibiotics. Here around in Europe, there have been large campaign to make the public aware that most common infections (bronchitis, sinusitis, sore throats, ear infections, etc...) are due to viruses and thus there's no point in insisting until the doctor prescribes antibiotics.
      I would have expected that the same reduction in use of antibiotics would have happened in the US too.

      Disclaimer : Although IAAMD, I happen to work in research for the last few years so other medical /.ers should have better knowledge than me.

      • by Xenna (37238)

        "Here in Europe?" Here in Holland they're very restrictive with antibiotics. In Greece, however, you just point at your throat and make a painful face at the drugstore and they give you a pack of wide-spectrum AB's.

        It's not that simple with sore throats. Some are viral and some (very painful) are bacterial. With the latter AB's work well. I understand in the US they take a sample and analyse it. In Holland they don't seem to think that's worth while.

        During my last two week bout with a bad sore throat, I dem

        • I understand in the US they take a sample and analyse it. In Holland they don't seem to think that's worth while.

          Switzerland, here. We use a fast antibody test so the doctor knows what to prescribe within minutes.

    • Last month, I would have sworn I was dying of bronchitis (the bacterial variety). I was coughing so hard that I was almost in tears each time I managed to re-gain my breath. The codeine-based syrup calmed it down enough that I could actually function and my chest muscles could recover. The antibiotics had cleared up the infection so I didn't need any cough syrup at all by the next evening.

      The moral? Don't interpret the awful summary literally. We haven't obsoleted medicine just yet.

  • Inefficiency (Score:5, Interesting)

    by syntaxglitch (889367) on Saturday April 04, 2009 @07:58AM (#27456825)

    It's well-established that Americans as a whole pay far too much for health for far too little benefit, compared to other first-world nations.

    Can some of this discrepancy be explained by high availability of essentially useless or even harmful "treatments"?

    • by defile39 (592628)

      This stat is quoted frequently, but is almost always quoted out of context. Americans pay more for health care than any other "first-world" nation. Americans' life expectancy is not significantly better than many other "first-world" nations (I believe America is around #30 or so for life expectancy globally). HOWEVER, America's overall health and life expectancy for those over the age of 65 is by far the best in the world. Americans pay more for health care . . . but these payments actually produce resu

      • by nelsonal (549144)
        The other factor that doesn't get mentioned is that Americans have many pleasurable habits that are associated with negative health outcomes. If Americans eat red meat 10x/week, drink heavily, and exercise less than their first world peers, that medical spending (on end of life care) might be buying them more extra time than is captured by naive comparisons.
    • I think so. But the real question is why these treatments are offered in the first place.

      Here I think it plays a big role that most patients don't have the knowledge to tell their doctor no if he suggests something stupid or overly expensive. So in essence, the salesman tells the customer what to buy, and for the doctor it often seems easiest to prescribe some pills.

      On the political level, the pharma companies are good at lobbying against regulation that would put stronger restrictions on what insurance has

  • Sinusitis (Score:5, Interesting)

    by jonpublic (676412) on Saturday April 04, 2009 @08:02AM (#27456845)

    My experience with sinusitis definitely confirms this. Every 3 months or so I would come down with another sinus infection. Each time I would goto the doctor and get a prescription for antibiotics. I wasn't asking for antibiotics. I was looking for a solution to the problem. One time the doctor wanted me to switch to a much more expensive antibiotic. Sure enough I ended up getting some nerve damage from the antibiotic. Nothing permanent, but the numbness lingered for over a year.

    What the kicker here is that if the doctor had looked at my chart and said, maybe we should take another approach after the 5 or 6th time, the whole situation would have been avoided.

    I got a neti pot and I haven't had a sinus infection since, I just use the neti pot whenever I feel my head getting clogged up. $20 dollar solution.

    • Idiotic. (Score:5, Interesting)

      by DrYak (748999) on Saturday April 04, 2009 @08:36AM (#27457051) Homepage

      Every 3 months or so I would come down with another sinus infection. Each time I would goto the doctor and get a prescription for antibiotics.

      This is indeed idiotic. You should shot your doctor. There's plenty of evidence that chronic sinusitis aren't caused by bacteria (the only thing killed by antibiotics).

      If the doctor really wanted to try something, he should have made a try with an anti-fungic (some studies tend to show that part of recurring sinusitis might be due to bugs more of the fungi persuasion).

      I got a neti pot and I haven't had a sinus infection since, I just use the neti pot whenever I feel my head getting clogged up. $20 dollar solution.

      Brilliant. Washing the nasal cavity is a method which also works for viruses which you most likely had like most of the adult population (and against which antibiotics are no use).
      It's part of what we prescribe here around (although as I said in another post, I now work in research).

      For extra, you can also buy sprays containing carbocisteine (an agent helping making the mucus more fluid), but you should use sprays containing beta-mimetics more than 1-2 weeks.

      But the basic "clean the cavity with water" $20 solution works too.

      • Re: (Score:3, Interesting)

        by nine-times (778537)

        If the doctor really wanted to try something, he should have made a try with an anti-fungic (some studies tend to show that part of recurring sinusitis might be due to bugs more of the fungi persuasion).

        But that would be more work and would not help the doctor any more in what he's really trying to do: get the patient out of his office.

        Seriously, I'm amazed at how lazy most doctors are about actually trying to help their patients, considering how much work it takes to get to be a doctor. I would bet money that none of my doctors in my adult life have bothered to look at my file a single time except when I've been in their presence. As in, I come with symptoms, and when I'm in the office they grab my fil

  • by Hogwash McFly (678207) on Saturday April 04, 2009 @08:03AM (#27456849)

    As any man knows, if you ignore it for long enough, it will eventually go away. Just like the pain in my tooth and the blood on my toilet paper. I haven't been to the doctor in years, and I am as fit as

  • From the abstract linked to about antibiotics not being effective for sinusitis:

    Antibiotics provide a minor improvement in simple (uncomplicated) sinus infections. However, 8 out of 10 patients improve without antibiotics within two weeks. The small benefit gained may be overridden by the negative effects of antibiotics, both on the patient and on the population in general.

    Well, I get sinusitis once or twice a year. I'm one of the 2 out of 10 patients for whom antibiotics are apparently totally necessary. I once had my sinusitis go for over six months with no sign of it abating until I took antibiotics. As an aside, yes, I probably should have gone to the doctor sooner, but it just seemed like a mild head cold until other systematic problems from the infection showed up.

    You'll also note that th

    • by rc5-ray (224544)
      The sham surgeries aren't done by fraudulent physicians. There have been studies done for knee pain, where patients are randomly selected for traditional arthroscopy versus a sham surgery, where arthroscopy style skin incisions are created, and then sewn shut. When the patient awakens, they don't know if they had actual surgery or not. This is the study's design, and all patients in the study agree to the randomization process. This is quite different that a surgeon "pretending" to do surgery to bill patien
    • So the real question is who should get screwed by the Pareto principle?
  • Beta Blockers (Score:3, Interesting)

    by jamesl (106902) on Saturday April 04, 2009 @08:12AM (#27456897)

    On the other hand, generic beta blockers (ie. propranalol) are so cheap as to be almost free. The conclusion in the cited article does not call for an absolute ban on beta-blocker therapy: Consequently, it might generally be prudent to consider starting beta-blocker therapy in hospital only when the haemodynamic condition after MI has stabilised.

    As much as we would like to believe otherwise, medicine is still an inexact science.

  • It's a combination of three things.

    1. The do-something-even-if-it's-wrong mantra that is so pervasive in today's society. You don't need to look any farther than the various bailouts from the feds for financial institutions and auto manufacturers. It also leads to #2.
    2. If I don't do something, I'm going to get sued.
    3. Placebo effect. After numerous studies showing that Vitamin C does nothing to prevent or shorten the duration of cold symptoms, there's still people who'll pop Vitamin C pills like cand

  • The view that high cholesterol is bad, and saturated fats are always a no-no is, on closer examination [opednews.com] another example of problems being created out of nothing in order to sell more drugs.

    A very profitable and corrupt situation has evolved where the FDA is in the pocket of the pharmaceutical industry, the editorial boards of medical journals are bought and paid for, and academic research often dependent on industry money.

  • by misanthrope101 (253915) on Saturday April 04, 2009 @08:26AM (#27456979)

    I'm sure doctors are performing some treatments that aren't warranted. However, I assure you that patients want treatment. I work in the medical field, and the psychology of medicine is weird. Parents want antibiotics for their children, and they don't really care about research that says the antibiotics aren't necessary or may even cause harm. Everyone wants a pill for what they have, and they want it now. I've seen people demand x-rays for their pinkie toe, even though the doc told them outright that it wouldn't make a bit of difference. If the doc doesn't order the x-ray (or fork over the pills), the patient is unhappy, and unhappy patients are vastly more likely to sue.

    I've had a woman bring her kid to the ER with an cold and tell me in the triage room "I can't get in to see the pediatrician till Wednesday, and by then she'll get well on her own." I'm not making this up---she was rushing to make sure her kid got seen by a doctor, because she knew the kid would get well if she waited too long. She wasn't a drooling idiot, but part of her mental checklist of being a good parent included "If kid is sick, see doctor." If docs don't hand out antibiotics for every earache and sore throat, the patient will just come back tomorrow or the next day and complain "I'm still sick." If the second doc gives them pills, they'll tell everyone they know about the first doc, who is obviously an idiot who didn't have the intelligence to see how direly ill they were. "I needed antibiotics, and he didn't give me anything!"

    So all told, I don't blame the docs too much. They are working against hypochondriac patients who demand a pill for everything. In a weird way, people want to be sick, or at least they want their routine aches and pains dignified with snazzy medical terms. I've actually had patients get mad at me when I told them that a contusion is just a bruise, and cephalgia is just a headache.

    • by nelsonal (549144) on Saturday April 04, 2009 @08:44AM (#27457099) Journal
      In a similar vein, there are some recent studies that suggest that most of the benefit of medicine is the temporary status transfer from a high status individual paying more attention to the patient which perversely causes them to get better. That goes along with the idea that it's important to get your chance to get that status boost.
    • Re: (Score:3, Insightful)

      by DavidTC (10147)

      Just because people want medication that's harmful for their health doesn't mean doctors should do it.

      Antibiotics are dangerous. They are dangerous for society as a whole, as they increase resistant strains, but they're also dangerous for each individual use. There is a non-zero risk of causing some sort of harm by using things that, after all, are designed to kill cells in your body. They're supposed to take out bacteria cells, but friendly fire is always happening. Although your body can stand to lose a

    • Re: (Score:3, Insightful)

      by MMC Monster (602931)

      I inherited a subspecialty (cardiology) medical practice from an old-timer.

      In the first year, I discharged between 50 and 100 patients from the practice (averaging between 1-2 per week), likely more.

      A number of these patients refused to be discharged and would continue seeing me, even though I told them that their primary medical doctor could take care of their mild hypertension or "mitral prolapse syndrome" (which was usually just over-called bowing of a mitral valve leaflet).

      I still discharge patients to

  • Frequently the risk involved in testing for a condition, such as taking biopsies from peoples' hearts carry a measurable risk - but produce little or no actionable information.

    In litigious countries (read: USA) they are more often than not carried out as a CYA exercise, rather than for the benefit of the patient. This is an area where "best practice" - meaning perform all possible diagnostics, has run wild.

  • Let's just directly quote the conclusion of the linked paper (a randomised placebo-controlled trial on 45,000 patients - pretty good evidence in medical terms):

    "The use of early beta-blocker therapy in acute MI reduces the risks of reinfarction and ventricular fibrillation, but increases the risk of cardiogenic shock, especially during the first day or so after admission. Consequently, it might generally be prudent to consider starting beta-blocker therapy in hospital only when the haemodynamic condition af

  • by dachshund (300733) on Saturday April 04, 2009 @08:30AM (#27457009)

    "You'll have to pry my Beta Blockers out of my cold, dead hands."

    Point: when the government "retires" beta blockers --- based on strong evidence that they're ineffective --- you can expect objections having to do with 'patient choice' and how the government is telling doctors what to do. Merits be damned: this will be used as an example of why we can't afford government-subsidized health care.

    It's no coincidence that the people who oppose "socialized medicine" are often the same ones who avoid evidence-based medicine in large-scale situations where it might be effective. It's also no coincidence that our health care costs more on average than many other nations, and yet our health outcomes are worse.

  • You might note that the "knee surgery is no better than sham knee surgery" study was only about osteoarthritis. The vast majority of knee surgeries are for repairing injuries, not for arthritis treatment.

    That said, a surprising amount of medical treatment is out of date. Most doctors do the same things they learned in med school, or in the early years of their practices. There are still a lot of doctors who don't believe in (or even know about) the role of Helicobacter Pylori in peptic ulcers.

    On the othe

  • Pressure system (Score:2, Interesting)

    by dov_0 (1438253)

    Unfortunately medicine, just like any other industry is driven by profit.

    Eli Lily pushed Prozac and got it approved in many countries even though it causes psychotic episodes in 18% of patents. They even send sample packs to GP's so they can hand them out to patients. Psychiatry in itself is a whole sham, pushing drugs which will never heal the patient, when in many cases counseling or Cognitive Behaviour Therapy will bring about a cure.

    Myself, I used to have terrible problems with allergies and get awful m

  • PayWall (Score:3, Interesting)

    by jamesl (106902) on Saturday April 04, 2009 @08:44AM (#27457103)

    Perhaps if The New England Journal of Medicine was available free on-line, more patients would know about the conclusions of the cited article Spinal-Fusion Surgery -- The Case For Restraint. Access to the single article costs $10.

  • Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment, and knee surgery is no better than sham knee surgery where surgeons 'pretend' to do surgery while the patient is under light anesthesia.

    He's a quack. Knee surgery is never any good?

  • From the NYT article: Can we abide by the evidence when it tells us that antibiotics don't clear ear infections or help strep throats?

    It has been common medical practice for decades to treat "sore throat" with antibiotics only after a positive throat swab for Streptococcus because of the associated risk of rheumatic fever and its complications. According to the article cited this is still true: A serious but rare complication is rheumatic fever, which affects the heart and joints ... This review of trials f

  • The supplement industry that sells crap like ginko and glucosamine should also be shut down.
  • get the right streptococcus, and you will do permanent damage to your heart valves. they colonize the heart from your throat (same holds true for chronic tooth decay)

    also, cough medicine to me seems to be nothing more than a chance to take psychoactive compounds because you are so miserable. that's not an argument against cough medicine, that's an argument for it. there's the placebo effect, then there is pseudoephedrine. two different things

  • Corrupt Doctors (Score:4, Interesting)

    by bloobamator (939353) on Saturday April 04, 2009 @09:27AM (#27457341)

    The single biggest factor driving health care costs in America is the corruption of doctors. Too many doctors are on the take from Big Pharma.

    I personally know one who makes millions dispensing medicines pushed by the pharmaceutical companies. He owns a big house in the Westchester, a swank apartment on the Upper East Side, 2 BMW's, a Mercedes, pays hefty child support, alimony (which includes a third mortgage on his ex-wife's big house in Westchester), and he parties like a freak.

    He's not even a surgeon. How does he make so much money? By accepting kickbacks from the pharmaceutical companies for the medicines he prescribes and dispenses (his specialty allows him to dispense certain injections to relieve back pain.)

    All this guy does is inject people's backs with something that is clearly ineffective, and then refers them on to his surgeon buddy when the injections don't work. What a scam!

    He bragged to me on several occassions, while drunk, how the Big Pharma companies wined and dined him in super-expensive Manhattan restaurants, and how they paid for ultra-luxurious island vacations. I know there was more he wasn't telling me.

    I met another "doctor" who actually just owned a bunch of clinics in NJ. He was the dumbest son-of-a-bitch I have ever met, and he walked, talked and dressed like a wiseguy. Yet he drove 2 Rolls-Royces and invested heavily in porn sites and strip clubs in FL. He was scary, really scary, yet he was a "leader in quality private health care in the greater NJ region". *shiver*

    It's time we cracked down on medical waste and fraud.

  • by Kral_Blbec (1201285) on Saturday April 04, 2009 @09:41AM (#27457425)

    So what about those that dont? When I was a kid, our doctor refused to give me anything based on this reasoning. As a result of chronic untreated ear infections, I developed a speech impediment that i had to have therapy for until i was almost 16 and still lingers today. I attribute a lot of my anti-sociality in my youth (and now) to being embarrassed to talk. Thanks for nothing doc.

  • Rapid CRP (Score:4, Interesting)

    by Aggrajag (716041) on Saturday April 04, 2009 @10:30AM (#27457759)
    At least here in Finland it is common practice to take a rapid CRP test from patients when they show symptoms of for example sinusitis. If the result is less than 10 sinusitis is most likely caused by a viral infection so no antibiotics will do the patient any good.
  • by Sj0 (472011) on Saturday April 04, 2009 @10:36AM (#27457813) Homepage Journal

    I dated a nurse's aide for about a year, and what always shocked me was how little she knew about the treatments she was suggesting. Every time I got a cold, she demanded we rush to the ER to get some penicillin.

    Now, I'm not one of those assholes who thinks he knows everything, but I know that colds are caused by a virus, and penicillin doesn't work on viruses.

    Since then, I've gone on the philosophy that just because someone who works in a hospital says something, doesn't mean it's gospel. I won't take it as *wrong*, but I'll take it with a grain of salt, like I do medical advice on the Internet.

  • it is about money. (Score:3, Interesting)

    by Organic Brain Damage (863655) on Saturday April 04, 2009 @10:53AM (#27457927)

    The numbers are somewhat astonishing, last I heard it was like 14% of GDP going into healthcare in the USA.

    If we look at unnecessary procedures like the arthroscopy for osteoarthritis (assuming the study results are repeatable) that's one major way to save money.

    Another major way to save money is to make the payment handling a non-profit business. Something like 20% of healthcare spending is going into the insurance business and dealing with payments. That should be more like 2%.

    And a third major savings is to be gained by realizing we're all going to die and not spending huge money on someone in their last six months. It makes no sense, but most of the money spent on most of the people in the USA is spent on people within 6 months of death. And most of the time, their life is no longer than if they didn't spend the money, but it is more painful. Curbing this spending could save us as much as 20% of our current healthcare spending.

    I suggest that if a person is 2 years beyond average lifespan, no government money be spent on hospitalization or surgery. If they have the money to buy private insurance or can pay for it out of pocket, fine, that's their choice, but otherwise, too bad, don't make the rest of us pay for torturing your granny to death.

    • Re: (Score:3, Informative)

      by drwho (4190)

      While lots of the things you say have a ring of truth to them, I think your suggestion is a horrible one. It's too simple. I know people in their nineties who are intellectually fine, want to live, but their bones are fragile. You would say that these people don't get a broken hip mended? no way! But if you were to ask if they wanted a heart transplant, they'd probably turn it down, saying it's their time to go and there's younger people who need a chance to grow old. It's not about the surgery, it's about

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