Active Low-Carber Forums - View Single Post - Doctors and Patients: stuck in a rut

The title says it all:

Quote:

When Evidence Says No, but Doctors Say Yes

Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments.

Sounds familiar to all of us, I am sure. From "you aren't eating enough carbs" from a diabetes "educator" to pushing statins on everyone who walks through the door, we are in a situation where knowledge is accumulating faster than the medical profession can properly absorb it.

Quote:

While he was waiting in the emergency department, the executive took out his phone and searched “treatment of coronary artery disease.” He immediately found information from medical journals that said medications, like aspirin and blood-pressure-lowering drugs, should be the first line of treatment. The man was an unusually self-possessed patient, so he asked the cardiologist about what he had found. The cardiologist was dismissive and told the man to “do more research.” Unsatisfied, the man declined to have the angiogram and consulted his primary-care doctor.

The Internet strikes again!

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And so the executive sought yet another opinion. That’s when he found Dr. David L. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. Louis. The executive told Brown that he’d felt pressured by the previous doctors and wanted more information. He was willing to try all manner of noninvasive treatments—from a strict diet to retiring from his stressful job—before having a stent implanted.

The executive had been very smart to seek more information, and now, by coming to Brown, he was very lucky, too. Brown is part of the RightCare Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits. As Brown put it, RightCare is “bringing medicine back into balance, where everybody gets the treatment they need, and nobody gets the treatment they don’t need.” And the stent procedure was a classic example of the latter.

Despite all the stenting that is still going on:

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In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure.

That's the big issue: such a procedure usually has a 2-5% chance of complications, right up to death. That's a big risk for zero payoff.

Read the whole thing: it includes one of the major downsides of this kind of outdated thinking.

And it's not like this situation is improving, either:

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... The 21st Century Cures Act—a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December—lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices. Furthermore, last month President Donald Trump scolded the FDA for what he characterized as withholding drugs from dying patients. He promised to slash regulations “big league. … It could even be up to 80 percent” of current FDA regulations, he said. To that end, one of the president’s top candidates to head the FDA, tech investor Jim O’Neill, has openly advocated for drugs to be approved before they’re shown to work. “Let people start using them at their own risk,” O’Neill has argued.

That's my bold and my italics because &(#*$&)#(*$&)#(~ the heck! I don't think they are motivated by helping their fellow humans, is all I'm saying. When it already takes about ten years for an outdated, disproved, treatment to stop being given to patients.

What makes the current pharmaceutical situation even more of a gamble is the mounting evidence that there is a much greater range of genetic diversity than we ever dreamed of. Which means that miracle drug for Patient X could turn out disastrous for Patient Y.

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According to Vinay Prasad, an oncologist and one of the authors of the Mayo Clinic Proceedings paper, medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof.

And that's just basic brain wiring: we see something "work" and then it's "pry it out of our hands."

Was pro-survival at one time. Now... not so much

Getting the book referenced in the article: Ending Medical Reversal.