In the era of so-called “evidence-based medicine,” it’s astounding how much evidence goes against so many treatments that doctors continue to blithely prescribe and perform. (Generally paid for by you, the taxpayer.) And the more common the medical condition, the more inappropriate the procedures.
For example, cardiologists give stent implants with invasive cardiac catheterization to men and women who have even the slightest indication of coronary heart disease. But what does the evidence show? Are these popular procedures useful? Do they extend lives?
Dr. David L. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. Louis, recently examined every clinical trial since 2012 comparing stent implantation with conservative treatments such as diet, moderate exercise, and stress reduction.
He found that stents for patients with stable heart disease didn’t prevent heart attacks or extend lives. He also concluded that patients not actually in the process of having a heart attack shouldn’t ever get stents.
Nonetheless, cardiologists give stents to hundreds of thousands of patients with stable heart disease every year. And two percent will suffer serious complications or die as a result.
As a resident in the operating room, I often heard “don’t just stand there, do something.” But these doctors would be well-advised to “don’t just do something, stand there.” Since, “they also serve who only stand and wait.”
Ignorance isn’t an excuse
Clearly, sometimes doctors simply don’t keep up with the science. In fact, in 1999, a senior executive at the American Medical Association told me about their unpublished survey results that showed only nine percent of practicing physicians based changes in their medical practice on published medical literature.
Other times, doctors know the state of the science perfectly well. But they continue to deliver these treatments because they’re profitable — or even because they remain popular and patients expect them.
Even if the procedure has been studied recently, you have to be careful. Your doctor may say you need a stent, claiming it’s been studied in thousands of patients and shown to help.
But it may not work for you because everyone is an individual. Plus, as I reported in the March 2017 issue of my Insiders’ Cures newsletter, the entire practice of cardiology is based on studies done on younger, healthier volunteers. And doctors have no idea if many heart treatments are really safe and effective in the older people with heart disease. (You can read the full article by visiting my website, www.drmicozzi.com and logging in to the Subscriber section with your username and password. And if you aren’t already a subscriber, now is the perfect time to get started.)
And cardiology isn’t the only problem area that ignores current research…
A 2012 study by the Australian Department of Health and Aging identified 156 standard medical treatments that are ineffective and/or unsafe. For example:
–Orthopedic surgeons perform thousands of procedures to repair torn meniscuses each year. But studies show physical therapy is just as effective.
–Studies also show that CPR is no more effective when given with assisted breathing than when chest compressions are used alone.
–Women with swollen arms following breast cancer surgery are told not to exercise their arms. But evidence shows moderate exercise actually reduces swelling.
Plus, as I previously reported, a review of 48 studies found that experts underestimate the harms of cancer screenings and overestimate their benefits.
It’s the same sad story with drugs
In 2013, U.S. doctors examined all 363 studies on antibiotics published in the New England Journal of Medicine between 2001 and 2010. They found the standard practice of prescribing antibiotics to treat persistent Lyme disease did nothing to help. Yet prescribing these antibiotics remains the first line of treatment in many practices.
In another investigative study, researchers looked at a drug used to dramatically lower blood pressure in diabetic patients. The drug caused more side effects and was no more effective at preventing heart attacks or deaths than milder treatments that allowed for somewhat higher blood pressure.
You may wonder, as I do, why the medical establishment claims to worry about the evidence so much, since they just ignore it when it suits them. And they consistently try to use this argument against the safe, effective natural approaches that do work.
Well, brace yourself, because things are about to get worse…
21st Century Cures Act
Last December, Congress rushed through the 21st Century Cures Act. And former President Obama signed it after the election and before President Trump took office.
This disastrous, new law lowers standards of evidence required for the approval of new uses of drugs and medical devices. It is a model of crony capitalism, pushed by more than 1,400 Washington lobbyists.
Fortunately, some physicians are trying to do something to stop it. The Right Care Alliance represents a collaboration of healthcare professionals and community groups seeking to counter the trend of increasing medical costs with decreasing patient benefits. Right Care says it is “bringing medicine back into balance, where everybody gets the treatment they need, and nobody gets treatment they don’t need.”
Ask if your doctor is a partner in Right Care. If he or she isn’t, it could tell you a lot. In the meantime, follow the dictum that less is more. Especially when it comes to modern medical care.
As my mentor, U.S. Surgeon General C. Everett Koop (1917 – 2013) always quoted, “the least medicine that works, is the best medicine.” That approach is the only real solution to so-called “healthcare reform,” despite all the nonsense with Obamacare, “Repeal and Replace,” the newly proposed rewrite by the Democratic Caucus (now that they have had a chance to finally read and witness it), or anything else, designed by the crony capitalist healthcare system and their government minions.
“When Evidence Says No, but Doctors Say Yes,” The Atlantic (www.theatlantic.com) 2/22/2017