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from the ask-your-doctor-if-this-medicine-is-right-for-you dept.
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The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking. Each year, hundreds of thousands of American patients receive stents for the relief of chest pain, and the cost of the procedure ranges from $11,000 to $41,000 in US hospitals.
But in fact, American doctors routinely prescribe medical treatments that are not based on sound science.
The stent controversy serves as a reminder that the United States struggles when it comes to winnowing evidence-based treatments from the ineffective chaff. As surgeon and health care researcher Atul Gawande observes, "Millions of people are receiving drugs that aren't helping them, operations that aren't going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm."
Of course, many Americans receive too little medicine, not too much. But the delivery of useless or low-value services should concern anyone who cares about improving the quality, safety and cost-effectiveness of medical care. Estimates vary about what fraction of the treatments provided to patients is supported by adequate evidence, but some reviews place the figure at under half.
Naturally that carries a heavy cost: One study found that overtreatment — one type of wasteful spending — added between $158 billion and $226 billion to US health care spending in 2011.
The stunning news about stents came in a landmark study published in November, in The Lancet. It found that patients who got stents to treat nonemergency chest pain improved no more in their treadmill stress tests (which measure how long exercise can be tolerated)than did patients who received a "sham" procedure that mimicked the real operation but actually involved no insertion of a stent.
There were also no clinically important differences between the two groups in other outcomes, such as chest pain. (Before being randomized to receive the operation or the sham, all patients received six weeks of optimal medical therapy for angina, like beta blockers). Cardiologists are still debating the study's implications, and more research needs to be done, but it appears that patients are benefitting from the placebo effect rather than from the procedure itself.
(Score: 3, Interesting) by JoeMerchant on Friday January 05 2018, @03:47AM (3 children)
I think both have their place. If I'm being treated for a skin rash, upper respiratory infection, or even broken bone, I think the traditional practices handed down are more than adequate level of care.
On the other hand, if I'm being treated for cancer, or a brain aneurysm, I think I'll go with evidence based practice.
Basically it breaks down between GP/traditional and the specialists.
One thing I don't want to have happen to me is end up in an experimental protocol (like, say, the annual flu vaccine) shoved through the system via the "evidence based practice" communication channels.
🌻🌻 [google.com]
(Score: 2, Insightful) by Anonymous Coward on Friday January 05 2018, @02:51PM (2 children)
The problem is that with a lot of things like abuse of antibiotics, the actual results aren't obvious. You see the infection clear, what you don't see is the damage that you've done to the patient's immune system that may never completely repair.
Similarly, the harm that comes from recommending low cholesterol diets has all sorts of different manifestations that aren't obvious. Deaths by basically everything other than heart disease increase to the point where you're usually better off not cutting the cholesterol.
Doctors aren't scientists and they shouldn't be doing things for which the science has an answer. A ton of the stock recommendations are harmful to patients, but get recommended because that's how they've been doing things for decades. In many cases, those methods don't even make any sense and have little more scientific validity than leeches and blood letting.
(Score: 4, Interesting) by JoeMerchant on Friday January 05 2018, @04:57PM
Good points, although my pediatrician (who was an old bird in 1970) was already aware of and practicing limited use of antibiotics back in the 1960s, for all the same reasons that are given, and widely ignored, today.
Come to think of it, my infant son's pediatrician in 2001 gave him a big nasty course of un-necessary antibiotics "just to be sure" he would be past his fever in time to get his vaccine series on the next visit. Being new parents, we nodded and went along with "medical advice" - advice that my pediatrician from 1970 already knew was wrong on many levels.
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(Score: 3, Funny) by frojack on Friday January 05 2018, @06:58PM
Contender for the most fucked-up reasoning award of the year.
Everyone dies.
Eliminate one cause, and, wait for it...: people die from something else. Who Knew!??
Lets bring back Smallpox.
No, you are mistaken. I've always had this sig.