Thursday, February 3, 2011

is anybody else reading this stuff?

it's funny when i set my mind on something, in this case looking for things for the 'duh' files or looking for things that disagree with the prevailing thoughts on medicine/healthcare, that something just jumps up at me from a sort of unlikely source. in this case it's newsweek magazine - the january 31, 2011, issue. under 'scope, health matters, science+: why almost everything you hear about medicine is wrong.
that's the headline of the article. so, of course i read it.
seems that 'the very framework of medical investigation may be off-kilter, leading time and again to findings that are at least unproved and at worst dangerously wrong'.
we used to think (or, let's say i used to think, as i had been trained to think, with most of my western medicine trained colleagues) that medical trials were rigorously controlled and that the outcomes couldn't be compromised by the authors or the companies paying for the studies of whatever drug or treatment or test was being studied. it was only 'those nonmedical, no fda-approved, non double blind placebo controlled studies' that were suspect. how stupid was that? apparently pretty stupid. i don't know whether to believe the ones i wasn't supposed to believe or just disbelieve the ones that were supposedly done right.
the effect on the practice of medicine in the western world, where drugs cost everybody so much, could be tremendous. tremendous in a good way, as far as i'm concerned. yes, pediatrics is 'safe' in many ways from the statins and the diabetes drugs and the antidepressants and psa tests, etc., but they are still used. and then, after all, pediatricians are people, too, and some are of an age where these medicines and tests are being recommended to us.
what if, instead of overhauling healthcare the way it is, it's overhauled pretty much from the inside out? cut about a trillion (a trillion is a million million, just for you math folks) in drug cost from the national healthcare bill and wow, it's not so bad! instead of figuring out how to pay for all those 'necessary' meds and treatments that studies show are good and safe and effective, and that we now know may not be any of those things, we just pay for the stuff that's really helpful. that should be easy to figure out...not. who's going to do the study to prove which treatments and drugs and tests are really needed? but at least it's not now in a rationing of care sense so much as in a safe/effective sense. until now (and maybe past now if i'm the only person who reads newsweek) it's been counted on that there will be somebody somewhere whose case requires drug A or treatment B and for some reason theirs is unique and therefore the drug or treatment should be available to everyone regardless of whether they meet the same criteria, because this is the u.s. of a and by golly we should be free to get treated in any way we want whether it makes sense of not, and by the way, our insurance should be forced to pay for it.
so now it can be said that nobody needs this medicine or this treatment. that the only effect that the antidepressant that so famously worked by fixing a chemical imbalance (i lost count of how many people wanted a chemistry test done to see if they were out of balance...there is no such test, though i guess i should have faked one and sold it and made a mint before this deal came out!) was a placebo effect. and now, God is so good in the order that He revealed these things to my tiny little mind, since we know that the placebo effect works even though we know it's a placebo, we can cut down our drug costs and side effects tremendously!
quick, someone open a drug company specializing in placebos...oh, wait, there are several, but they thought they were making real drugs!
so, a few quotes and i'll finish this parcel of radical thought.
from a guy who questions the doctor who is calling all this research into question: he worries that the 'most-research-is-wrong claim "could promote an unhealthy skepticism about medical research, which is being used to fuel anti-science fervor'". and on how statistical flukes affect studies: "when you do thousands of tests, statistics says you'll have some false winners(or, even a blind hog finds an acorn every once in a while - my words)...drug companies make a mint on such dicey testing an approved drug for other uses, they get hits by chance, and 'doctors use that as the basis to prescribe the drug for this new use. i think that's wrong.'"
the caveat: the last paragraph. "of course, not all conventional health wisdom is wrong. smoking kills, being morbidly obese or severely underweight makes you more likely to die before your time, processed meat raises the risk of some cancers, and controlling blood pressure reduces the risk of stroke. the upshot for consumers: medical wisdom that has stood the test of time - and large, randomized, controlled trials - is more likely to be right than the latest news flash about a single food or drug.'
ok. nuff said. so, what are all those internal medicine/family medicine docs going to do with all those medicare patients on all those drugs? and what are we going to do about this information? be skeptical of medical research? look at the emperor's clothing real closely, he may need viagra.