http://www.madinamerica.com/2015/11/study-329-big-risk/
He refers to Study 329: https://en.wikipedia.org/wiki/Study_329
In 1990 at the start of the Big Pharma era, you and your doctor lived in a world where medical issues were found in journals, textbooks and a small number of popular books. Today there is likely to be a health story on the front page of the newspaper, with an entire section inside devoted to health. The amount of health related material on the Web is second only to pornography and even pornography is grist to the medical grind.
The political has become personal in an extraordinary fashion.
Unlike any time in medicine hitherto, when you go to a doctor today you will have to take your place in a queue of people, many of whom have been summoned to a consultation by a clinic screening for a wide range of things none of which bother the people who have been summoned. They will come to the clinic unaware of any problem but will leave with diagnoses and on medication. The doctors call them in not out of concern for them but because the doctors have targets to meet in order to get reimbursed – targets set by Big Risk.
Big Pharma play on this pitch but it’s Big Risk that draws the lines and sets up the goalposts.
When you do get in to see the doctor, you’ll find someone who adheres to Guidelines. She will do so in good faith, figuring this the way to bring the best evidence to bear on your case. She will not recognize she is being guided to see problems in certain ways and to deliver on patent treatments.
Big Pharma Big Risk
Re: Big Pharma Big Risk
I am not entirely sure what point you are trying to get across...
Prevention is very fashionable these days, largely because 1) it saves money 2) it is better for the patient. This is when done correctly.
For example Hypertension. Which is most usefully defined as the blood pressure at wish it is better to start treatment than to leave it for a given population. This varies on various risk factors.
Study 329 is an example of where pharma has deliberately mislead doctors. Same for older examples like thalidomide. If you want a good book on it I suggest Bad Pharma by Ben Goldacre. Brilliant.
Now as for guidelines. They are not perfect. Most doctors know this. They get followed broadly but sometimes large numbers of people will ignore them and the guidline is changed (NICE guidance on statins rings to mind as a recent example). But by a large a good 'starting point' for the non expert doctor on a given condition. This is most General practitioners/Family doctors. They cannot know all the conditions they start treating in complete expert detail.
As for comments on 'but it sin't tailored to ME'. It can't be perfectly. The data is from large pools. This should them be used as well as possible in a given situation.
As for the comment RCTs can't show anything unless you understand the biology. Bollocks. We know acetaminophen/paracetamol is an analgesic. We still don't know HOW it works, really. Same for most anaesthetic gases and many others. Should we stop using them?
Prevention is very fashionable these days, largely because 1) it saves money 2) it is better for the patient. This is when done correctly.
For example Hypertension. Which is most usefully defined as the blood pressure at wish it is better to start treatment than to leave it for a given population. This varies on various risk factors.
Study 329 is an example of where pharma has deliberately mislead doctors. Same for older examples like thalidomide. If you want a good book on it I suggest Bad Pharma by Ben Goldacre. Brilliant.
Now as for guidelines. They are not perfect. Most doctors know this. They get followed broadly but sometimes large numbers of people will ignore them and the guidline is changed (NICE guidance on statins rings to mind as a recent example). But by a large a good 'starting point' for the non expert doctor on a given condition. This is most General practitioners/Family doctors. They cannot know all the conditions they start treating in complete expert detail.
As for comments on 'but it sin't tailored to ME'. It can't be perfectly. The data is from large pools. This should them be used as well as possible in a given situation.
As for the comment RCTs can't show anything unless you understand the biology. Bollocks. We know acetaminophen/paracetamol is an analgesic. We still don't know HOW it works, really. Same for most anaesthetic gases and many others. Should we stop using them?
Re: Big Pharma Big Risk
In the US, many of us are trying to navigate a chaotic system that is responsible for the vast majority of bankruptcies while simultaneously causing as many iatrogenic problems as it solves. The realities of our system forces medical professionals to practice defensive medicine.
My point? When dealing with critical aspects of my life I like to have a basic understanding of the motivations of the people with whom I am dealing. The article gave me hints of insight that may be obvious to most on the inside of the system, which I assume you are.
For instance, years ago one of my doctors told me he had detected a heart murmur (it seems to have disappeared
). I foolishly checked the heart murmur box when filling out the new patient form at the dentist and he insisted I take a massive dose of antibiotics before filling a cavity. Of course, I refused to play the defensive medicine game and lied, saying I had taken the pills when I hadn't. A few years later they determined that this practice of prescribing antibiotics for those with heart murmurs does more harm than good. Rather than adding a treatment to see how it works out, I prefer the precautionary principle.
https://en.wikipedia.org/wiki/Precautionary_principle
I thought this was a good article because it shows how pharma and insurance seem to be colluding to rape the system.
Your use of the word bollocks hints that you might not be American. That word may well apply to our whole system.
FWIW, a good friend recently opened a concierge medical practice. If I ever need a physician, I'll be seeing her.
My point? When dealing with critical aspects of my life I like to have a basic understanding of the motivations of the people with whom I am dealing. The article gave me hints of insight that may be obvious to most on the inside of the system, which I assume you are.
For instance, years ago one of my doctors told me he had detected a heart murmur (it seems to have disappeared
). I foolishly checked the heart murmur box when filling out the new patient form at the dentist and he insisted I take a massive dose of antibiotics before filling a cavity. Of course, I refused to play the defensive medicine game and lied, saying I had taken the pills when I hadn't. A few years later they determined that this practice of prescribing antibiotics for those with heart murmurs does more harm than good. Rather than adding a treatment to see how it works out, I prefer the precautionary principle.https://en.wikipedia.org/wiki/Precautionary_principle
I thought this was a good article because it shows how pharma and insurance seem to be colluding to rape the system.
Your use of the word bollocks hints that you might not be American. That word may well apply to our whole system.
FWIW, a good friend recently opened a concierge medical practice. If I ever need a physician, I'll be seeing her.
Re: Big Pharma Big Risk
Ah yes, I am an insider from across the pond.
For clarity I am a (junior) doctor practicing in the UK. So I do operate in a different system and I agree the US system has aspects bordering on insanity. PSA usage and biopsy spring to mind from the outset.
As for heart murmurs, entirely possible. But as doctor 'hearing a murmur' with a stethoscope unless they do an Echocardiogram won't give you any idea of what sort of murmur it is and if anything needs doing (murmurs can indicate anything from innocent flow murmur to something that needs surgery). Which at least as tests go has no radiation so it is safe.
As for what the dentist said, it used to be the advice here too. The reasoning being murmur = imperfect valves > increased risk of endocarditis > dental work can increase risk of endocarditis > if both then prophylactic abx. The evidence then showed it didn't make any difference, so we stopped doing it.
The precautionary principle is how people should be practicing (for a given level of consensus). Defensive medicine has to exist sadly due to litigation risks etc. Although the UK did have the number of doctors sued drop last year for the first time in forever.
I am glad you feel you have a doctor you can trust. But remember that close emotional bonds can also colour medical decision making. Such that here we can lose our licence if we treat friends/family (in non emergency/isolated/etc situations).
I still can't get my head round how some of the US system works. But then I don't more money for doing an extra test. I get scolded for wasting resources when I book an unnecessary test. There is a least a vogue here of 'do not test unless it will change management'.
In addition most lifestyle diseases you can have more effect with self modification than pills, without the downside. But people seem to like a pill over changing habits.
For clarity I am a (junior) doctor practicing in the UK. So I do operate in a different system and I agree the US system has aspects bordering on insanity. PSA usage and biopsy spring to mind from the outset.
As for heart murmurs, entirely possible. But as doctor 'hearing a murmur' with a stethoscope unless they do an Echocardiogram won't give you any idea of what sort of murmur it is and if anything needs doing (murmurs can indicate anything from innocent flow murmur to something that needs surgery). Which at least as tests go has no radiation so it is safe.
As for what the dentist said, it used to be the advice here too. The reasoning being murmur = imperfect valves > increased risk of endocarditis > dental work can increase risk of endocarditis > if both then prophylactic abx. The evidence then showed it didn't make any difference, so we stopped doing it.
The precautionary principle is how people should be practicing (for a given level of consensus). Defensive medicine has to exist sadly due to litigation risks etc. Although the UK did have the number of doctors sued drop last year for the first time in forever.
I am glad you feel you have a doctor you can trust. But remember that close emotional bonds can also colour medical decision making. Such that here we can lose our licence if we treat friends/family (in non emergency/isolated/etc situations).
I still can't get my head round how some of the US system works. But then I don't more money for doing an extra test. I get scolded for wasting resources when I book an unnecessary test. There is a least a vogue here of 'do not test unless it will change management'.
In addition most lifestyle diseases you can have more effect with self modification than pills, without the downside. But people seem to like a pill over changing habits.