Category Archives: medicine

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Promising the Impossible

The OC Register had a concise and important editorial in today’s newspaper regarding the healthcare issues.  As always please share your thoughts with us.

Promising the impossible

Reformers’ health care promises not worth a wooden nickel.

John Stossel

John Stossel
Syndicated columnist,
Co-anchor of ABC News’ “20/20”

I keep reading about health-care “reform,” but I have yet to see anyone explain how the government can make it easier for more people to obtain medical services, control the already exploding cost of those services and not interfere with people’s most intimate decisions.

You don’t need to be a Ph.D. in economics to understand that government cannot do all three things. (Judging by what Paul Krugman writes (http://tinyurl.com/lgpr4o), a Ph.D. may be an obstacle.)

The New York Times describes a key part of the House bill: “Lawmakers of both parties agree on the need to rein in private insurance companies by banning underwriting practices that have prevented millions of Americans from obtaining affordable insurance. Insurers would, for example, have to accept all applicants and could not charge higher premiums because of a person’s medical history or current illness” (http://tinyurl.com/knzczq).

No more evil “cherry-picking.” No more “discrimination against the sick. But that’s not insurance. Insurance is the pooling of resources to cover the cost of a possible but by no means certain misfortune befalling a given individual. Government-subsidized coverage for people already sick is welfare. We can debate whether this is good, but let’s discuss it honestly. Calling welfare “insurance” muddies thinking.

Such “reform” must increase the demand for medical services. That will lead to higher prices. Obama tells us that reform will lower costs. But how do you control costs while boosting demand?

The reformers make vague promises about covering the increased demand by cutting other costs. We should know by now that such promises aren’t worth a wooden nickel. The savings never materialize.

Some of the savings are supposed to come from Medicare. The Times reports “Lawmakers also agree on proposals to squeeze hundreds of billions of dollars out of Medicare by reducing the growth of payments to hospitals and many other health care providers.”

With the collapse of the socialist countries, we ought to understand that bureaucrats cannot competently set prices. When they pay too little, costs are covertly shifted to others, or services dry up. When they pay too much, scarce resources are diverted from other important uses and people must go without needed goods. Only markets can assure that people have reasonable access to resources according to each individual’s priorities.

Assume Medicare reimbursements are cut. When retirees begin to feel the effects, AARP will scream bloody murder. The elderly vote in large numbers, and their powerful lobbyists will be listened to.

The government will then give up that strategy and turn to what the Reagan administration called “revenue enhancement”: higher taxes on the “rich.” When that fails, because there aren’t enough rich to soak, the politicians will soak the middle class. When that fails, they will turn to more borrowing. The Fed will print more money, and we’ll have more inflation. Everyone will be poorer.

The Times story adds: “They are committed to rewarding high-quality care, by paying for the value, rather than the volume, of [Medicare]services.”

Value to whom? When someone buys a service in the market, that indicates he values it more than what he gives up for it. But when the taxpayers subsidize the buyer, the link between benefit and cost is broken. Market discipline disappears.

Listening to the health-care debate, I hear Republicans and Democrats saying it’s wrong to deny anyone anything. That head-in-the-sand attitude is why Medicare has a $36-trillion unfunded liability (http://tinyurl.com/72bm5h). It’s not sustainable – and they know it.

They’ve given us a system that now can be saved only if bureaucrats limit coverage by second-guessing retirees’ decisions. Government will decide which Medicare services have value and which do not. Retirees may have a different opinion.

One may be willing to give up the last year of life if he’s in pain and has little hope for recovery. Another may want to fight to the end. But when taxpayers pay, the state will make one choice for all retirees.

Now, to reduce the financial burden of the medical system, Obama proposes a plan that inevitably will extend the second-guessing to the rest of us. So much for his promise not to interfere with our medical decisions.

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Obama’s Outlandish Statements Against Physicians

Obama has accused doctors of doing tonsillectomies to make money, and he has falsely implied that surgeons cut off legs for a profit. The actual reimbursement for an amputation is approx 800$ NOT 40,000$. This kind of rhetoric is alarming and disturbing. Please spread the news that this must stop.

Please contact our state senators and voice your concerns regarding the healthcare reform proposals: Barbara Boxers number is 213-894-5000 and Diane Feinstein’s number is 619-231-9712.

CMA Objects to Obama’s Misleading Statements about Physicians

President Obama has recently made his case for health reform by using some misleading and inflammatory rhetoric. While discussing the importance of prevention, he has implied that physicians’ treatment decisions are financially motivated and incorrectly stated that surgeons are paid $30,000 to $50,000 to amputate a foot. CMA wholeheartedly agrees with the President on the importance of prevention, but the examples he used were inaccurate and offensive and could undermine the trust central to the physician-patient relationship.

At a town hall meeting in New Hampshire on August 11, President Obama said, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. (Watch the video here.)

At a press briefing on July 22, President Obama said, “Part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works…. Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that’s out there. … the doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out … I’d rather have that doctor making those decisions based on whether you really need your kid’s tonsils out, or whether … something else would make a difference…. So part of what we want to do is to free doctors, patients, hospitals to make decisions based on what’s best for patient care.” (Watch the video here.)

CMA released the following statement to the media regarding the President’s statements.

August 13, 2009

Sacramento – The California Medical Association issued the following statement today, attributable to CMA President Dev GnanaDev:

“CMA is deeply concerned about two examples of medical treatment recently used by President Obama to make his case for health reform.
“In the first example, he stated that surgeons make $30,000 to $50,000 to amputate a foot of a diabetic. This assertion is false. Medicare pays surgeons $589 to $767 for a foot amputation. Medi-Cal pays $420 for the same. Hospital and other associated costs may add up to the greater amount, but it is incorrect and misleading to suggest the surgeon’s costs are responsible for that figure.

“We share the President’s belief that we need to put greater resources towards primary and preventive care in order to keep people healthier and help address the nation’s rising health care costs. However, preventive care will never obviate the need for qualified physicians and surgeons to take corrective action to improve or save people’s lives.

“In the second example, the President suggested that physicians take out children’s tonsils to make more money. This implication is inaccurate and offensive.

“Doctors treat patients based on the health needs of the patient, not the financial incentives. When science suggests overutilization may be occurring, the medical profession has responded with improved guidelines to more fully inform physicians of the risks and benefits of any treatment or procedure.

“The California Medical Association is committed to reforming our health system to increase access to quality care and reduce rising health care costs. To achieve health reform, the American people must be able to trust our elected officials and the statements they make regarding health care.

“Patients trust their doctors. That trust is critical to an effective and successful doctor-patient relationship. We urge the President to stick to the facts and avoid the kind of misleading and inflammatory rhetoric that would erode that trust and derail our efforts to increase access to quality care and control rising health care costs.”

Dr. GnanaDev is a trauma surgeon and chief of the medical staff at Arrowhead Regional Medical Center, San Bernardino County’s public hospital.

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Healthcare Reform: Better off being a dog

Here is a very sobering, humorous, and truthful article about what is at stake in the healthcare reform debate from the WSJ:

In the last few years, I have had the opportunity to compare the human and veterinary health services of Great Britain, and on the whole it is better to be a dog.

As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs or hamsters come first.

The conditions in which you receive your treatment are much more pleasant than British humans have to endure. For one thing, there is no bureaucracy to be negotiated with the skill of a white-water canoeist; above all, the atmosphere is different. There is no tension, no feeling that one more patient will bring the whole system to the point of collapse, and all the staff go off with nervous breakdowns. In the waiting rooms, a perfect calm reigns; the patients’

relatives are not on the verge of hysteria, and do not suspect that the system is cheating their loved one, for economic reasons, of the treatment which he needs. The relatives are united by their concern for the welfare of each other’s loved one. They are not terrified that someone is getting more out of the system than they.

The latter is the fear that also haunts Americans, at least those Americans who think of justice as equality in actual, tangible benefits. That is the ideological driving force of health-care reform in America. Without manifest and undeniable inequalities, the whole question would generate no passion, only dull technical proposals and counterproposals, reported sporadically on the inside pages of newspapers. I have never seen an article on the way veterinary services are arranged in Britain: it is simply not a question.

Nevertheless, there is one drawback to the superior care British dogs receive by comparison with that of British humans: they have to pay for it, there and then. By contrast, British humans receive health care that is free at the point of delivery. Of course, some dogs have had the foresight to take out insurance, but others have to pay out of their savings. Nevertheless, the iron principle holds: cash on delivery.

But what, I hear social philosophers and the shade of the late John Rawls cry, of British dogs that have no savings and cannot afford insurance? What happens to them? Are not British streets littered with canines expiring from preventable and treatable diseases, as American streets are said by Europeans to be littered with the corpses of the uninsured? Strangely, no. This is not because there are no poor dogs; there are many. The fact is, however, that there is a charitable system of veterinary services, free at the point of delivery, for poor dogs, run by the People’s Dispensary for Sick Animals, the PDSA. This is the dog’s safety net.

Honesty compels me to admit that the atmosphere in the PDSA rather resembles that in the National Health Service for British humans, and no dog would go there if he had the choice to go elsewhere. He has to wait and accept what he’s given; the attendants may be nice, or they may also be nasty, he has to take pot luck; and the other dogs who go there tend to be of a different type or breed, often of the fighting variety whose jaws once closed on, say, a human calf cannot be prised open except by decapitation.

There is no denying that the PDSA is not as pleasant as private veterinary services; but even the most ferocious opponents of the National Health Service have not alleged that it fails to be better than nothing.

What is the solution to the problem of some dogs receiving so much better, or at least more pleasant, care than others? Is it not a great injustice that, through no fault of their own, some dogs are treated in Spartan conditions while others, no better or more talented than they, are pampered with all the comforts that commerce can afford?

One solution to the problem of the injustice in the treatment of dogs would be for the government to set up an equalizing fund from which money would be dispensed, when necessary, to sick dogs, purely on the basis of need rather than by their ability to pay, though contributions to the fund would be assessed strictly on ability to pay.

Of course, from the point of view of social justice as equality, it wouldn’t really matter whether the treatment meted out to dogs was good or bad, so long as it was equal. And, oddly enough, one of the things about the British National Health Service for human beings that has persuaded the British over its 60 years of existence that it is socially just is the difficulty and unpleasantness it throws in the way of patients, rich and poor alike: for equality has the connotation not only of justice, but of hardship and suffering. And, as everyone knows, it is easier to spread hardship equally than to disseminate blessings equally.

I hope I shall not be accused of undue asperity towards human nature when I suggest that the comparative efficiency and pleasantness of services for dogs by comparison with those for humans has something, indeed a great deal, to do with the exchange of money. This is not to say that it is only the commercial aspect of veterinary practice that makes it satisfactory: most vets genuinely like dogs at least as much as most doctors like people, and moreover they have a pride in professional standards that is independent of any monetary gain they might secure by maintaining them. But the fact that the money they receive might go elsewhere if they fail to satisfy surely gives a fillip to their resolve to satisfy.

And I mean no disrespect to the proper function of government when I say that government control, especially when highly centralized, can sap the will even of highly motivated people to do their best. No one, therefore, would seriously expect the condition of dogs in Britain to improve if the government took over veterinary care, and laid down what treatment dogs could and could not receive.

It might be objected, however, that Man, pace Professor Singer, is not a dog, and that therefore the veterinary analogy is not strictly a correct or relevant one. Health economics, after all, is an important and very complex science, if a somewhat dull one, indeed the most dismal branch of the dismal science. Who opens the pages of the New England Journal of Medicine to read, with a song in his heart, papers with titles such as ‘Collective Accountability for Medical Care Toward Bundled Medicare Payments,’or ‘Universal Coverage One Head at a Time – the Risks and Benefits of Individual Insurance Mandates’? On the whole, I’d as soon settle down to read the 110,000 pages of Medicare rules.

A few simple facts seem established, however, even in this contentious field. The United States spends a greater proportion of its gross domestic product on health care than any other advanced nation, yet the results, as measured by the health of the population overall, are mediocre. Even within the United States, there is no correlation between the amount spent on health care per capita and the actual health of the population upon which it is spent.

The explanation usually given for this is that physicians have perverse incentives: they are paid by service or procedure rather than by results. As Bernard Shaw said, if you pay a man to cut off your leg, he will.

But the same is true in France, which not only spends a lesser proportion of its GDP on health care than the U.S. but has better results, as measured by life expectancy, and is in the unusual situation of allaying most of its citizens’ anxieties about health care. However, the French government is not so happy:

chronically in deficit, the health-care system can be sustained only by continued government borrowing, which is already at a dangerously high level. The French government is in the situation, uncomfortable for that of any democracy, of having to reform, and even destroy, a system that everyone likes.

Across the Channel, there is very little that can be said in favor of a health system which is the most ideologically egalitarian in the western world. It supposedly allots health care independently of the ability to pay, and solely on the basis of clinical need; but not only are differences in the health of the rich and poor in Britain among the greatest in the western world, they are as great as they were in 1948, when health care was de facto nationalized precisely to bring about equalization. There are parts of Glasgow that have almost Russian levels of premature male death. Britain’s hospitals have vastly higher rates of methicillin-resistant Staphylococcus aureus (a measurement of the cleanliness of hospitals) than those of any other European country; and survival rates from cancer and cardiovascular disease are the lowest in the western world, and lower even than among the worst-off Americans.

Even here, though, there is a slight paradox. About three quarters of people die of cardiovascular diseases and cancer, and therefore seriously inferior rates of survival ought to affect life expectancy overall. And yet Britons do not have a lower life expectancy than all other Europeans; their life expectancy is very slightly higher than that of Americans, and higher than that of Danes, for example, who might be expected to have a very superior health-care system. Certainly, I would much rather be ill in Denmark than in Britain, whatever the life expectancy statistics.

Perhaps this suggests that there is less at stake in the way health-care systems are organized and funded, at least as far as life expectancy is concerned (not an unimportant measure, after all), than is sometimes supposed. Or perhaps it suggests that the relationship of the health-care system to the actual health of people in societies numbering many millions is so complex that it is difficult to identify factors with any degree of certainty.

In the New England Journal of Medicine for July 3, 2008, we read the bald statement that ‘Medicare’s projected spending growth is unsustainable.’ But in the same journal on Jan. 24, 2008, under the title ‘The Amazing

Non-collapsing U.S. Health Care System’ we had read that ‘For roughly 40 years, health care professionals, policy-makers, politicians, and the public have concurred that the system is careening towards collapse because it is indefensible and unsustainable, a study in crisis and chaos. This forecast appeared soon after Medicare and Medicaid were enacted and have never retreated. Such disquieting continuity amid changes raises an intriguing question: If the consensus was so incontestable, why has the system not already collapsed?’

The fact that collapse has not occurred in 40 years does not, of course, mean that it will not collapse tomorrow. The fact that a projection is not a prediction works in all directions: prolonged survival does not mean eternal survival, any more than a growth in the proportion of GDP devoted to health care means that, eventually, the entire GDP must be spent on health care.

Therefore I, who have no solution to my own health-care problems, let alone those of the United States, say only, beware of health-care economists bearing statistics that prove the inevitability of their own solutions. I mistrust the fact that, while those people who work for commercial companies (rightly) have to declare their interests in writing in medical journals, those who work for governmental agencies do not do so: as if government agencies had not interests of their own, and worked only for the common good.

The one kind of reform that America should avoid is one that is imposed uniformly upon the whole country, with a vast central bureaucracy. No nation in the world is more fortunate than America in its suitability for testing various possible solutions. The federal government should concern itself very little in health care arrangements, and leave it almost entirely to the states. I don’t want to provoke a new war of secession but surely this is a matter of states’ rights. All judgment, said Doctor Johnson, is comparative; and while comparisons of systems as complex as those of health care are never definitive or indisputable, it is possible to make reasonable global judgments: that the French system is better than the British or Dutch, for example. Only dictators insist they know all the answers in advance of experience. Let 100 or, in the case of the U.S., 50 flowers bloom.

Selfishly, no doubt, I continue to measure the health-care system where I live by what I want for myself and those about me.

And what I want, at least for that part of my time that I spend in England, is to be a dog. I also want, wherever I am, the Americans to go on paying for the great majority of the world’s progress in medical research and technological innovation by the preposterous expense of their system: for it is a truth universally

acknowledged that American clinical research has long reigned supreme, so overall, the American health-care system must have been doing something right. The rest of the world soon adopts the progress, without the pain of having had to pay for it.

Theodore Dalrymple is the pen name of Anthony Daniels, a British physician.


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Healthcare Issue: Free Our Health Care NOW!

Please sign the petition and join those of us who are deeply concerned that a government run healthcare plan is NOT the solution to our healthcare problems.

Use the Action Pack http://actionpack.ncpa.org to sign the petition, to print the petition or to access our Learning/Teaching Tools about health care so that you can educate your friends, family and neighbors.

The current healthcare plan under discussion will cripple our economy with more debt and taxes, and it doesn’t even address what the vast majority of doctors believe is the most important piece of the problem–tort reform.

Below is a letter from the National Center for Policy Analysis, please sign the petition, spread the word, and share your thoughts.

 

Friends –

Thank you for your support of the “Free Our Health Care NOW!” petition. More than 870,000 Americans have joined you in saying “NO!” to the federal government becoming their health care provider. We now have a tremendous opportunity! The probable delay in the vote until September in Congress allows you to use the tools available below in “What can you do about this?” to educate everyone you know.

Your continued support is crucial in the fight against nationalized health care. In the last week, the proponents of nationalized health care have continued to champion legislation which will increase cost, limit choice and decrease quality of your health care. Please continue to tell your network, friends and family that government-run health care is a threat to the quality of their health.

The non-partisan Congressional Budget Office (CBO) estimates that ObamaCare will cost over $1 trillion. Notwithstanding President Obama’s promise to oppose legislation “if that reform adds even one dime to our deficit over the next decade,” the CBO estimates that recent House proposals will increase government spending by $1.04 trillion. Additionally, as for the Administration’s most recent cost-savings plan – to create an independent advisory council to set Medicare fees – the CBO concluded that “the probability is high that no savings would be realized”.

ObamaCare will dramatically reduce the choices you have over the cost and quality of your health insurance plan. Here’s how:

  • ObamaCare will create an artificial market called a Health Insurance Exchange. The mandates the Exchange imposes will reject plans that don’t ‘measure-up’ to the federal government’s expectations for health care plans. As a result, millions of Americans will be forced to abandon their current plans and to accept a plan that they do not want or need.
  • Additionally, ObamaCare will create a board of bureaucrats empowered to define which health benefits are “essential”. However, these “essential” benefits may exclude health care which most Americans and their doctors believe are essential – such as MRI scans and blood tests.

The bottom line: Under ObamaCare, Americans will face higher taxes and receive less take-home pay– all for a health insurance plan that forces them to pay for benefits they do not want and refuses to pay for procedures their doctor may recommend.

What can you do about this?

Thank you again for your support of the “Free Our Health Care NOW!” and for fighting against nationalized health care.

 

Jeanette Nordstrom
National Center for Policy Analysis
www.ncpa.org

 

Click here to support the National Center for Policy Analysis.

Click here to view the privacy statement

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Medical Myth #6 (example #2): Placebo’s don’t work

Here is our 2nd example from the medical literature regarding the power of the human mind to generate healing by placebo. Enjoy and share your thoughts with us.
Hippocrates’ Shadow: Secrets from the House of Medicine (David Newman):

“In the late 1930s, cardiac surgeons developed an innovative procedure to help those suffering from repeated chest pains due to severely blocked coronary arteries. The surgery consisted of making two incisions in the chest wall to tie off two unnecessary arteries that supply blood to the inside walls of the chest. Theoretically this could shunt extra blood flow back to the heart, thereby increasing flow through the hearts arteries and reducing chest pain. Initial reports indicated it was highly effective, and case studies showed success rates of up to 75 percent. For the next two decades the surgery became common, until the late 1950s, when two researchers studied the procedure separately and found strikingly similar results. The studies compared the surgery to a sham (placebo) procedure in which two incisions were made in the chest wall and then sutured without tying off the internal arteries. The studies showed the real surgery to be as successful as surgeons had believed. In the true surgery groups, 67 percent of patients showed major reductions in pain and in the need for medicine, and major improvements in the ability to exercise without serious chest pain. But the sham surgery was an even bigger hit: in the sham group 83 percent of patients showed the same improvements.”

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Flu Update

  • A very detailed article came out last week in the New England Journal of Medicine outlining the origins of the swine flu.  They have found that the swine flu is a 4th generation virus from the 1918 strain.  We are in a 90 year pandemic era all originating from 1918 strain, and finally,  “it appears that successive pandemics and pandemic-like events generally appear to be decreasing in severity over time. They say this is probably due to medical and public health advances.”
  • Another article points out that Tamiflu is not all that great and that rushing to be seen at the doctor’s office has contributed to the spread of this virus:

“The most puzzling, and most consistent, point of information in these algorithms was a recommendation to treat virtually everyone with antiviral medicines. The departments of health recommended that patients with even mild URI symptoms and virtually any history of any medical problem, or common contact with anyone who has a medical problem, be prescribed anti-influenza drugs.

On what evidence did the NYC DOH recommend prescription-only antiviral medications for all? Cochrane and other large-scale reviews show that oseltamivir and zanamivir reduce influenza symptoms by roughly one half day to a day compared to placebo, though only when given <48 hours after the illness begins. Unfortunately, the medicines frequently seem to add nausea, vomiting, or diarrhea, and cost roughly $100 per prescription. They also only work for those with test-confirmed influenza. The simple use of NSAIDs, it would seem, could rival these agents for symptom control, and without the side effects or cost.

With such a tepid, selective, symptom-only impact, and at such considerable expense, why use them? I asked my local infectious disease specialists this question. Treatment, they said, may reduce complications such as death, pneumonia, or hospitalization.

I looked further. Interestingly, despite the fact that 10,000-20,000 people typically die each year in the U.S. from influenza, antivirals have never been shown to decrease either mortality or critical illness. As for other complications, one meta-analysis of ten trials suggested small reductions in pneumonia and a 1% reduction in hospitalization. But the meta-analysis was retrospective, it used only cherry-picked secondary outcomes, and the studies were hand-selected from a Roche database. And yet this remains the only combined data ever to report any significant benefit on complications. Two much larger reviews have since concluded that the drugs have no appreciable effect on the use of relief medications or subsequent need for antibiotics. “

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Brown Widow Spiders

Who knew? We found a brown widow spider on the outside of our garage door AND we found one at our kids school!  So they are definitely out and about.  Be aware that when your kids are ‘hunting’ the huge orb spiders that come out in October every year that they could run into one of these.  Has anyone else seen these? brown-widow(link to article from Emegency Medicine Journal)

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healthcare Reform: Of NICE and men

I have not chimed in about the healthcare ‘crisis’ but here is a sobering article from Wall Street Journal pointing out the rationing of care that may occur under the changes that might be voted in.

An article in the Stanford Magazine in November of 2008 pointed out that:

1. over 70% of people were happy with their healthcare

2. CEO of Safeway thinks that we need to consider legislature to make people who smoke and who are overweight must pay more for their healthcare.  He experimented with such a plan within his organization.

3. California’s experience and H. Clinton’s attempts point to the issues not being resolved in one feld swoop, but only through slow incremental changes.

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Flu Update

It has been awhile since I updated the swine flu so here is a summary:

  • There have been over 1 million cases in the U.S.!
  • The mortality rate is similar or lower than typical influenza (about 0.4%)–so DO NOT WORRY if you or your kids get it unless you have shortness of breath, can’t keep anything down, or any major concerns that are alarming–most get symptoms like a common cold
  • The only worry is if a second wave hits and the swine flu mutates to a strain that is more lethal…therefore it is important to get a vaccine or if you come down with the flu then you will have immunity or partial immunity to the next wave
  • Looks like the vaccine may be delayed unfortunately
  • If you go to your doctor and they decide to test you for the flu be aware that the test for the flu can often be falsely negative.
  • Here is a great blog resource that seems to post accurate information
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Medical Myth #6 (example #1): Placebo’s don’t really work

Medical Myth #6 is the notion that placebo’s don’t work.  The fact is that they work incredibly well, and we all should embrace them as a legitimate means of healing.  Here is our first incredible example—
Hippocrates’ Shadow: Secrets from the House of Medicine (David Newman):
“In 2002 an unusual study from Houstons VA Medical Center was published. It was a study about surgery for osteoarthritis of the knee, a condition that causes pain and disability due to thinning and breakdown of cartilage (the padding) in the joint. Patients occasionally have surgery to shave off the rough edges of the cartilage, or sometimes to wash out the knee joint. There were three groups of patients in the VA study: one group got the cartilage in their knees shaved, another group got their knees washed out, and one got an elaborate act. When the patient arrived in the operating room he was given anesthetic and the surgeon was then handed a sealed envelope telling him which surgery to perform. If the card inside the envelope said placebo, three incisions were made in the skin but nothing surgical was done to the knee joint. In case the patient was able to subconsciously hear or feel, water was splashed to simulate the sounds of the surgical procedure. In addition, the patient was kept in the operating room for the length of an actual surgery, during which the surgeon asked for all instruments and manipulated the knee as if surgery was being done. The operating room staff was sworn to secrecy, and outside the operating room no one was told which surgery the patient had undergone. The study results were shocking to many, including the orthopedic physicians who perform knee surgeries every day: the two real surgeries had been no more effective than the sham surgery. In retrospect, perhaps this should not have been surprising. Osteoarthritis is due to thinning of the knee cartilage, and there never was a good or even very feasible argument for why either of the treatments, shaving or washing, should work; after all, neither cures or reverses the thinning. But what is surprising even in retrospect is that all of the groups showed significant improvement in knee pain and function. In an article about the study and a closely related smaller study by the same researchers, one gentleman who had been enrolled told an interviewer that he was now able to mow his lawn and walk wherever he wanted, and added, The surgery was two years ago and the knee has never bothered me since. Its just like my other knee now.  He was in the placebo surgery group.”

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Medical Myth #5: Strep Throat

Another Medical Myth is the diagnosis and treatment of strep throat. Here is a GREAT summary written by Dr. Newman and some very good comments. The excerpts below are from a carefully researched book: Hippocrates’ Shadow by Newman. As always share your thoughts.

How do we diagnosis strep throat?

physical exam: “The signs and symptoms of strep throat have been exhaustively studied, and from this research we know that there are four important markers of strep throat infections: tender lymph nodes, fever, visible pus on the tonsils, and absence of a cough. When patients have all four of these characteristics, the chance that they have a strep throat infection is about 50 percent. But when they have zero, one, or even two of these characteristics, 10 percent or less will have strep throat.”-Hippocrates’ Shadow

throat cultures: “The problem with throat cultures is that they find too much strep. More than 10 percent of schoolchildren (the group at highest risk for strep throat infections), for instance, have live strep bacteria permanently and harmlessly in their throats, so even when there is no infection, a culture will be positive.”

But if we “use the test on a group of schoolchildren that has fewer than three of the four hallmark signs of strep throat. Only 10 percent or less will have a true case of strep throat, therefore no more than 10 percent of them can have positive test results that are right. But we also know that more than 10 percent of those being tested will have positive test results that are wrong (due to the harmless bacteria in their throat). Therefore, a positive test result in this group is mathematically guaranteed to be wrong more often than right. More positive results will be due to harmless bacteria than due to a strep infection. More positive results will be due to harmless bacteria than due to a strep infection.due to harmless bacteria than due to a strep infection. This situation, in which a positive test is more likely to be wrong than right, is very undesirable. We perform the throat culture test because we would like to accurately select the patients who should have antibiotics. But when we test people who have a less than 10 percent chance of strep throat, most of the people who are given antibiotics will be taking an unnecessary drug with potentially serious side effects. Unfortunately, the great majority of patients (schoolchildren and otherwise) that have a throat culture have fewer than three of the hallmark signs of strep throat, and often two, one, or even zero. Therefore most people who are given antibiotics because of a positive culture for strep throat don’t have strep throat.”-Hippocrates’ Shadow

Treatment: Antibiotics appear to do more harm than good? “In a brilliant sequence of six studies, the physicians used placebos and other modern scientific research techniques to examine the impact of antibiotics on the strep throat infection itself, and also on the rate of rheumatic fever that followed it. They published their landmark results for the first time in 1950, and established definitively that treating strep infections with antibiotics had reduced the chances of developing rheumatic fever. While the antibiotics had little impact on the strep throat itself’which seemed to last equally as long and cause symptoms equally severe’rheumatic fever occurred roughly 1 percent of the time after antibiotics were used. In those patients given placebos, it occurred roughly 2 percent of the time. Using antibiotics had cut the rate of rheumatic fever occurrence in half.”-Hippocrates’ Shadow

This is AMAZING to me. We are trained to treat ALL strep throats with antibiotics. But the reason we have been taught to treat with antibiotics (to prevent rheumatic fever) is rare and the antibiotics only reduce the risk of this complication by 1%!!! In fact “today we would likely have to treat more than a million in order to prevent a case of rheumatic fever. This changes things. The basis of treatment for any condition is the presumption that the disease poses more danger than the treatment. But 1 million prescriptions for antibiotics (to prevent one case of rheumatic fever) will cause more than twenty-four hundred potentially fatal allergic reactions…, as well as a hundred thousand cases of diarrhea and a hundred thousand rashes. In addition, long-term rheumatic heart disease is the target that antibiotics aim to prevent, but only a third of rheumatic fever cases result in heart disease. Therefore, the number of antibiotic prescriptions it takes to prevent one heart problem is three times as high as the number it takes to prevent rheumatic fever. To prevent one long-term heart problem it would take 3 million antibiotic prescriptions, and more than seven thousand [life threatening reactions].”-Hippocrates’ Shadow

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Cephalosporins can be prescribed safely for pencillin allergic patients

I have been asked this question weekly for the last 12 years so here are the references to confirm that it is ok to give Cephalosporins in patients allergic to pencillin.

Summary articles:

#1. Journal of Family Practice, February 2006

* The widely quoted cross-allergy risk of 10% between penicillin and cephalosporins is a myth (A).

* Cephalothin, cephalexin, cefadroxil, and cefazolin confer an increased risk of allergic reaction among patients with penicillin allergy (B).

* Cefprozil, cefuroxime, cefpodoxime, ceftazidime, and ceftriaxone do not increase risk of an allergic reaction (B).

Undoubtedly you have patients who say they are allergic to penicillin but have difficulty recalling details of the reactions they experienced. To be safe, we often label these patients as penicillin-allergic without further questioning and withhold not only penicillins but cephalosporins due to concerns about potential cross-reactivity and resultant IgE-mediated, type I reactions. But even for patients truly allergic to penicillin, is the concern over cephalosporins justified? It depends on the specific agent. What is certain is that a blanket dismissal of all cephalosporins is unfounded.

The truth about the myth

Despite myriad studies spanning decades and involving varied patient populations, results have not conclusively established that penicillin allergy increases the risk of an allergic reaction to cephalosporins, compared with the incidence of a primary (and unrelated) cephalosporin allergy.

* Results

True incidence of reactions to cephalosporins

The most frequent reactions to cephalosporins are non-pruritic, non-urticarial rashes, which occur in 1.0% to 2.8% of patients; (4-8) for most, the mechanism is idiopathic and not a contraindication for future use. (38) Retrospective studies suggest a 1% to 3% incidence of immune or allergic reactions to cephalosporins independent of any history of penicillin/amoxicillin allergy. (31) Anaphylactic reactions from cephalosporins are extremely rare, with the risk estimated at 0.0001% to 0.1%. (31,38) A seminal study suggested approximately 0.004% to 0.015% of treatment courses with penicillin results in anaphylaxis. (5,9-11) Several studies suggest that cephalosporin-induced anaphylaxis occurs no more frequently among patients with known penicillin allergy than among those without such allergy. (23,27,38-41)

#2. Annals of Allergy, Asthma, and Immunology, February 1995


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Judge NOT & love and understand as Jesus would (Matthew 7:1)

As I write this I am STILL recovering from the tongue lashing that I got from a patients wife yesterday.  We were having a congenial discussion about her spouse (the patient), and as I prepared to write orders and discuss the possible diagnoses, she went OFF.  I mentioned that his chronic abdominal cramps may, in the end (IF all the tests continue to come back negative) be entirely from stress.  Well she did NOT like that option at ALL.  “Don’t tell me it is stress! It is NOT stress! I KNOW it is not stress.  There is something wrong with him. That is what the other doctors said….”  She proceeded to sware at me for a good solid 2 minutes which seemed like a lifetime.  I was so frustrated and mad! I just finished a great book on how to be a better doctor, and I continue to try and improve my doctor skills.  In the book that I had just read, the author spoke about what a disservice doctors have done by just ordering more and more tests without getting at the heart of the matter and just talking with the patient.  It is SO frustrating to try to spend the time and show compassion and try and educate the patient to get spit in the face for it.  When you see over and over again that the patient is NOT interested in hearing what you have to say then you become hardened and numb and just give them what they want even if it is not necessary or the best treatment option!

After this very stressful situation, I found from the patients primary doctor that his wife has ‘gone off’ on him many times in the past, but that she is a professing Christian.  Now I was even more frustrated and angry.  I SO wanted to go back in to tell her how angry I am at her behavior.  How dare she act like that and claim to worship my precious Savior.

Now this is where the healing, the importance of fellowship, and the lessons were learned comes in.  I talked it over with one of my colleagues who is a believer.  And he challenged me to not judge her in that way.  OUCH!

He said: 1. just think how tough she would be without Christ and most importantly 2. you have never acted that way??? really never??? we are ALL like this at some time in our lives.  You MUST consider HER situation.  She is frustrated; she is scared; she has been dealing with this without any answers for months….WOW!

Now a day later, I see that God was teaching me a powerful review lesson on forgiveness, understanding, judgment, compassion, love, AND that I MUST continue to strive to love and go against the grain–and communicate with my patients with MORE compassion and understanding!

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Medical Myth #4: Mammograms

Once again Dr. Newman’s research has found some astounding findings.  Here are some summary statements from his research regarding mammograms:

Roughly 25 percent or more of cancers are missed.
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So how often do mammograms produce false positives? The cumulative risk of having a false-positive mammogram in ten years is 50 percent; therefore half of women undergoing regular mammograms for ten years will receive a positive result that is incorrect. Indeed, 97 percent of positive mammograms are false rather than true.

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During ten years of mammograms about 20 percent of women, or one in every five, will have a false positive that leads to a biopsy.

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For every 10,000 women screened routinely over ten years, it has been estimated that one case of breast cancer is caused by the radiation.
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 Having mammograms was of no benefit at all.
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 Women were alive and surviving at the same rate whether they had been assigned to receive mammograms or not.
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finding cancer earlier may not always be the answer. In the case of breast cancer a large proportion of cancerous lumps, perhaps 25 percent or more, are slow-growing and may therefore never lead

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In the case of breast cancer a large proportion of cancerous lumps, perhaps 25 percent or more, are slow-growing and may therefore never lead to serious danger.

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That regular breast exams are a better screening tool than mammograms is a suggestion that has been made before, convincingly.

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In summary:

mammograms do not appear from the research to have any benefit

regular breast exams are a better screening tool

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Medical Myth #3: ACLS

According to Newman in Hippocrates’ Shadow, Advanced Cardiac Life Support (A.C.L.S.) doesn’t work.  This has been my experience as well (there are always those very rare exceptions).  As the discussion of ‘fixing’ healthcare looms, one place to cut costs would be at the end of life.  I am continually amazed by the number of very elderly who do not have Do Not Resuscitate (D.N.R.) orders who arrive to the Emergency Department dead, and we have to try and resuscitate a dead person.  The cost of these end of life measures is astounding.  

“The ACLS method is used on more than a million people every year in the United States, and for millions more around the world.* This is notable in light of a vast body of evidence that all leads to the same conclusion: it doesn’t work.”-Hippocrates’ Shadow

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Medical Myth #2: Antibiotics & Bronchitis

I can’t tell you how many patients that I have seen that have had cold and cough symptoms for 1-3 days and come to see me for antibiotics. They rarely seem satisfied when I try and educate them that they have a viral upper respiratory tract infection that must run its course and that antibiotics won’t help and may make matters worse.

“Many studies and large reviews have compared antibiotics to placebos for acute bronchitis and concluded that antibiotics are unnecessary and offer no significant benefit. In addition, antibiotics have a significant downside: they produce common side effects such as diarrhea, allergic reactions, rashes, and yeast infections, as well as rarer side effects such as fatal or nearly fatal allergic reactions, liver problems, and severe skin reactions. Their extremely frequent administration has also bred an ongoing international crisis of antibiotic resistance. This means that in the aggregate, antibiotics are harmful both in the short and in the long term (when there’s well-documented risk and little-to-no benefit, the risk/benefit ratio is an easy calculation-it equals harm).”-Hippocrates’ Shadow

“People often visit their physician between roughly three and seven days from the beginning of their symptoms, and the average viral illness lasts approximately seven to ten days. In most cases, then, the illness is about to abate regardless of whether or not antibiotics are taken. But patient belief in the power of antibiotics is reinforced by the coincidence of their feeling better just days, or even hours, after the first antibiotic dose.”-Hippocrates’ Shadow

“There are roughly twenty-four thousand life-threatening allergic reactions each year from the unnecessary antibiotics. Giving antibiotics for viral disease is essentially a large-scale game of Russian roulette, and there are thousands of losers.”-Hippocrates’ Shadow

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Medical Myth #1: Back Pain

We will be starting a series titled: Medical Myths.  It has been sparked by a great book about medicine: Hippocrates’ Shadow by ER doctor David Newman.

back_pain

Myth #1: Back Pain.  Back pain is no myth, but its treatment is.  Back pain is one of the most common complaints seen by doctors.  Thankfully, it is usually self limiting (gets better on its own).  

The myth is that we know what causes it.  We don’t, or at least, it is not clear.  Many people with back pain seem to want an answer ASAP.  They request xray’s which are not helpful, or now many patients want an MRI as soon as they get their first bout of pain.  

“But there’s a secret about MRIs and back pain: the most common problems physicians see on MRI and attribute to back pain herniated, ruptured, and bulging discs are seen almost as commonly on MRIs of healthy people without back pain. This means that herniated and bulging discs, and most of the other findings that radiologists report seeing on MRIs of the back, usually have nothing to do with back pain.”-Dr. Newman, Hippocrates’ Shadow

Besides “I want an MRI” requests, the other request is: surgery.  But surgery doesn’t seem to work.  The only time you want anyone taking a knife to your back is if you have a neurologic deficit i.e. weakness.  

“Surgery to fix or remove a disc is usually performed in the hope that a herniated disc is compressing a nerve and causing the pain, but it carries a poor overall success rate. Even after the nerve is decompressed, or freed, by removing the disc surgically, half of the time the patient’s low back pain is unrelieved.”-Dr. Newman, Hippocrates’ Shadow

We will ALL suffer from back pain in our lives.  The best treatment? no one knows.  Prevention is important: Don’t do things that are going to put you at risk for injury. 

The good news–most of the time back pain will get better in time.