After Century of Removing Appendixes, Docs Find Antibiotics Can Be Enough (arstechnica.com) 77
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.
Not as profitable (Score:5, Interesting)
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Re: Not as profitable (Score:1)
For me it was the same, but in Germany. I had to pay 10â per day in the hospital.
Isn't it a cool system? (I was born in a country with a system not so far away from the US one)
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Here in America, it is only for the old folks with expensive medicine.
You're a fucking idiot. (Score:1)
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.
Re:Not as profitable (Score:5, Insightful)
I understand your cynicism, but it is misplaced. More-and-more surgeries that used to require multiple days of recovery, are now being replaced by minimally-invasive procedures that only require a single afternoon. The same will be true with appendicitis treatment.
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This decision is often up to the insurers.
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Easy solution: The CEO of a company that makes an uncommon antibiotic used to treat appendicitis should just jack their price sky fucking high for no reason whatsoever. Another problem solved by the free market!
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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.
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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 treatmen
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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.
Re:biotics backup (Score:4, Insightful)
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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...
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Until (Score:4, Insightful)
Antibiotics no longer work.
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There used to be colon cleansing therapies before the appendix surgeries were made common. e.g. you have a mostly liquid diet until the condition improves. Today doctors are against those therapies because they claim it can lead to a perforated colon.
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In the 21st century accute appendicitis is seen as a medical emergency to be addressed in 24 hours or less, and if it becomes ruptured there is a very high fatality rate --- even though you might survive, it's possible to easily die -- if the appendix ruptures. A colon cleanse takes time, and by the time substantial symptoms emerge --- it is probably already way too late to start a colon cleanse that takes days and have this be a "safe" treatment.
Perhaps how "early" the symptoms are detected is also
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Today doctors are against those therapies because they claim it can lead to a perforated colon.
Is there evidence that those therapies lead to a perforated colon or have higher risks or lower effectiveness, or is it really that those therapies are simpler and can be administered with less doctor involvement?
Studies like this that surgical removal may be unnecessary in many cases make me wonder, yet it was practiced anyways, why?
Was it because surgery was seen as a faster, more technologically inno
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Gut Flora (Score:2)
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).
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The latest thinking is that the appendix plays a role in maintaining beneficial gut flora, people without it suffer much more colitis, if so then preserving it would be wise whenever possible. The Peritonitis risk comes when it bursts.
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>The latest thinking is that the appendix plays a role in maintaining beneficial gut flora, people without it suffer much more colitis, if so then preserving it would be wise whenever possible. The Peritonitis risk comes when it bursts.
Yet more laterer thinking is that gut flora is only beneficial in the context of a fiber rich diet since it's undigestable by humans, and gut flora is largely irrelevant on a carnivorous diet.
Plant adapted primates have a huge secum to accommodate all the bugs that turn fi
Books about poor medical management (Score:5, Informative)
On page 8, that book recommends another book, Overdiagnosed: Making People Sick in the Pursuit of Health [amazon.com]. I haven't read that one yet.
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There's only one industry that's even more corrupt and self-serving than the financial industry, and that's health care.
Never underestimate a human being's willingness to take advantage of others, regardless of profession, ESPECIALLY when money is involved.
DEEPLY corrupt: Finance and Health organizations (Score:2)
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 wi
90% of what we do is make-work (Score:4, Interesting)
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.
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But no problem, because now you own the hospital.
Re:Finish folks take a long time to recover (Score:4)
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.
Recovery time varies (Score:2)
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-
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We landed in Houston and I drove myself straight to
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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.
But...but... (Score:2)
it's the only offal our alien overlords truly enjoy. :(
The saddest moment in my life (Score:2)
But appendectomies aren't that bad! (Score:2)
Appendix (Score:4, Funny)
I don't care if they remove appendixes, but I really wish they'd get rid of endnotes. They're just a hassle.
Gut-buster? (Score:3)
Wait....what's this?
Oh...oh dear. Was that a pun?
Was that ANOTHER surgery pun?
Atta boy for writing style (Score:1)
"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.
The Failure Rate is High (Score:1)
This was in the books for years (Score:2)
but it was in the appendix and nobody read it.
This is already being done in the US (Score:3)
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.)
Again? (Score:2)
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.
The history of appendectomies (Score:2)
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 ev