Funny about Money

The only thing necessary for the triumph of evil is for good men to do nothing. ―Edmund Burke

Overtreatment as Usual?

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Or maybe that’s “Standard Operating Overkill”? Have you seen this eye-opener from ProPublica, “When Evidence Says No, But Doctors Say Yes“? You need to read it.

In very brief summary, the report shows — through surveys of published, peer-reviewed scientific studies — that much of the most commonly prescribed medical treatments and the most commonly performed procedures are unnecessary and unhelpful. Further, the reporters find, many doctors know this and ignore it, because the profitability of these treatments drives profitability of their own practices, and many more well-meaning doctors do not know it because they’re so busy they haven’t found time to read the research.

For example, an American study revealed:

Some of the contradicted practices possibly affect millions of people daily: Intensive medication to keep blood pressure very low in diabetic patients caused more side effects and was no better at preventing heart attacks or death than more mild treatments that allowed for a somewhat higher blood pressure. Other practices challenged by the study are less common — like the use of a genetic test to determine if a popular blood thinner is right for a particular patient — but gaining in popularity despite mounting contrary evidence. Some examples defy intuition: CPR is no more effective with rescue breathing than if chest compressions are used alone; and breast-cancer survivors who are told not to lift weights with swollen limbs actually should lift weights, because it improves their symptoms.

Australian researchers, in a government-funded study there, identified “156 active medical practices that are probably unsafe or ineffective.”

Many of these involve procedures that are presented to doctors and to patients as indispensably life-saving: stents in stable heart patients have been shown to prevent no heart attacks and to save no lives. That’s correct: zero (0). Beta blockers as treatment for high blood pressure turn out to have little effect on stroke and do not significantly reduce mortality or coronary heart disease. Indeed, one such drug, atenolol, resulted in greater frequency of stroke.

Knee surgery for a torn meniscus is routinely performed on countless people who experience little or no benefit from the procedure.

It’s a wide-ranging article, and I can’t regurgitate it all here. You really need to look at it. Especially have a look at the chart that, by way of explaining what the relative numbers of people who are helped, not helped, and harmed, shows in eye-popping clarity the efficacy and relative risk of swallowing a sleep aid. It’s about 3/4 of the way through the article.

Y’know, the women on my mother’s side of the family — ones who grew up in the late 1800s, when medicine was more risk than benefit — were Christian Scientists. My mother and I thought they were crazy (and truly there’s no escaping Mary Baker Eddy’s looniness!). But sometimes one wonders.

My great-grandmother and my great-aunt both lived into their mid-90s, and they never saw a doctor. Never took pills, never had surgical procedures. They were both active and healthy right up to their last days.

Like Mormons, they didn’t drink alcohol or caffeine. They did not smoke. They ate exceptionally well: whole foods with lots of fresh vegetable, fruits, and meats, cooked at home by my great-grandmother, who was supported by my great-aunt. They lived in Berkeley, about halfway down a hill. At the top of this hill, next to the tunnel through which the commuter train to San Francisco passed, was a neighborhood grocery store.

Two or three times a week, my great-grandmother would walk up to this store, dragging what we call a “granny cart” behind her. She would fill it with groceries and roll it back down the hill. She did all the housework, which in those days entailed some pretty vigorous scrubbing. She hung the laundry on a line in the backyard, and she did all the ironing.

Every morning, five days a week, my great-aunt walked up the same hill, caught the train into San Francisco, got out at the station, and walked across town to the bank where she worked.

So…what we have here are a) temperance, b) regular mild exercise; c) whole foods. And d) no pills, no drugs, no procedures, no doctors.

One could argue that d) follows naturally from a), b), and c)…but of course we do know that people get hurt and that any number of ailments may afflict us no matter how righteous we are. My grandmother died of uterine cancer; she delayed going to a doctor until she could stand it no longer, at which point the man told her (vindictively, IMHO) that if he’d seen her three months earlier he could have saved her life.

On the other hand…my grandmother was a wild hare: she indeed did smoke and drink, and she was (from what I’m told) sexually promiscuous. On her deathbed, she told my mother that she believed the agony she was going through was God’s punishment for all the abortions she’d had.

So…well…maybe not God. But yeah…maybe risky behavior hath its rewards. As it were.

The point here is that you need to be careful about what treatments doctors foist on you. Do your research. When a doctor says you have this or that ailment and you must swallow this or that drug or subject yourself to this or that test or surgery, find out for sure whether that’s true. Learn the right questions to ask, and learn what the answers actually mean. And always get a second opinion.

And clean up your act. As the ProPublica report notes:

The health problems that most commonly afflict the American public are largely driven by lifestyle habits—smoking, poor nutrition, and lack of physical activity, among others. In November, a team led by researchers at Massachusetts General Hospital pooled data from tens of thousands of people in four separate health studies from 1987 to 2008. They found that simple, moderate lifestyle changes dramatically reduced the risk of heart disease, the most prolific killer in the country, responsible for one in every four deaths. People deemed at high familial risk of heart disease cut their risk in half if they satisfied three of the following four criteria: didn’t smoke (even if they smoked in the past); weren’t obese (although they could be overweight); exercised once a week; ate more real food and less processed food. Fitting even two of those categories still substantially decreased risk. In August, a report issued by the International Agency for Research on Cancer concluded that obesity is now linked to an extraordinary variety of cancers, from thyroids and ovaries to livers and colons. [My emphasis.]

Ahem. And so, away…it’s off to pump up the bicycle tires and cruise the ‘hood.

 

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Author: funny

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4 Comments

  1. Hmmm….I go back and forth on this. It seems that the Docs are a little too aggressive with the meds IMHO sometimes….Then you have my “Dear Departed Dad”…. DDD was hospitalized at the age of 50 with chest pains which turned out to be angina from clogged heat arteries. It was decided he needed bypass surgery….and this was 37 years ago …he was one of the first “quadruple bypass” surgery patients in the area. He was placed on meds and was carefully watched by a “stellar Cardiologist” for 35 years. During those 35 years he required 17….no misprint….stents and an additional bypass surgery. I’m guessing this care saved my DDD from certain death at the age of 50 and gave him 35 more years before lung cancer came a callin’. .. The last visit with this Cardiologist was very touching as I think they both knew DDD was failing and this would be there last meeting. Upon the conclusion of the exam….they embraced…and both shed tears as did I…

  2. Thirty-five years! So he survived to the age of 85? That is remarkable.

    One of several questions, I guess, is what was the quality of his life. Another is…if you believe the research quoted in the article I’ve dragged to your attention, did the stents really help?

  3. One has to remember back in 1980 bypass surgery was in it’s infancy and MANY folks died on the table and soon after the procedure. DDD truly thought he was a “goner” back in ’80….I’m guessing the meds did prolong his life BUT he still had blockages throughout the rest of his life and thus the need for the stents. He could tell when something wasn’t right and would give the cardiologist a call. The Doc saw him every 90 days without fail for a check up and lab work to see if some of the drugs were damaging his other organs. I’m not sure if the 17 stents were a record but I will share his vascular pics were almost comical looking with all the “patch-work”. The last by-pass was needed so that he could under go surgery to remove the bottom of his left lung…As memory serves only two arteries needed replacement in that one. And the crazy thing was his cardiologist was fresh out of his internship when he first met DDD. I’m guessing he was 30-32 or there abouts …. he took care of DDD for 35 years and now has grandchildren. He was/is a trusted Doctor who I will always be grateful to and I will never forget their last “appointment”. Was his quality of life good? I would say for the most part it was good and he got 35 more years. As for the cancer treatment….that’s a tough one….I would question his quality of life…with the meds…surgeries….infusions…sickness….vomiting…and exhaustion. If I ever get lung cancer I don’t know if I would embrace his treatment….but one never knows until it happens to you….

  4. “one never knows until it happens to you….” is the operative phrase. Uhm…no pun intended.

    Thirty-five years is an admirable survival period, if he wasn’t suffering all the time. I don’t know that I’d want to go through a lot of surgery and meds and side-effects for a year or so…but for the equivalent of a 19th-century lifetime? That might be a different matter.