Don't Assume Your Doctor Practices Evidence-Based Medicine
I talk regularly with an epidemiologist who emphasizes what the headline of this post says, so I'm especially sensitive to this notion -- that maybe your doctor isn't acting in your (evidence-based) best interest.
I learned to look closely at the risks and potential benefits of a particular procedure, which is why I don't get knee surgery (not that I could afford it now with how Obamacare has ruined my healthcare). Instead, I do isometric exercises and I take glucosamine/chondroitin/MSM (per a Cochrane report), as well as krill oil, and curcumin to (I hope) help my knee.
In getting medical care, I think it's also important to remember that all drugs have side-effects and any procedure can go wrong -- or even dead wrong. The name for that is "iatrogenesis."
Despite being aware of all of this, I still found some of the stories shockingly upsetting in this (excellent) long read via Propublica and The Atlantic by David Epstein:
Not long after helping the executive, Brown and his colleagues were asked to consult on the case of a 51-year-old man from a tiny Missouri town. This man had successfully recovered from Hodgkin's lymphoma, but radiation and six cycles of chemotherapy had left him with progressive scarring creeping over his lungs. He was suffocating inside his own body. The man was transferred to Barnes Jewish Hospital, where Brown works, for a life-saving lung transplant. But when the man arrived in St. Louis, the lung-transplant team could not operate on him.Four months earlier, the man had been admitted to another hospital because he was having trouble breathing. There, despite the man's history of lymphoma treatment, which can cause scarring, a cardiologist wondered whether the shortness of breath might be due to a blocked artery. As with the executive, the cardiologist recommended a catheter. Unlike the executive, however, this man, like most patients, agreed to the procedure. It revealed a partial blockage of one coronary artery. So, doctors implanted a stent, even though there was no clear evidence that the blockage was responsible for the man's shortness of breath--which was, in fact, caused by the lung scarring. Finally, the man was put on standard post-implantation medications to make sure he would not develop a blood clot at the site of the stent. But those medications made surgery potentially lethal, putting the man at an extremely high risk of bleeding to death during the transplant. The operation had to be delayed.
Meanwhile, the man's lung tissue continued to harden and scar, like molten lava that cools and hardens into gray stone. Until one day, he couldn't suck in another breath. The man had survived advanced-stage lymphoma only to die in the hospital, waiting until he could go off needed medication for an unneeded stent.
What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you're prescribed or the surgery you'll undergo wouldn't be so common if it didn't work, right?
For all the truly wondrous developments of modern medicine--imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few--it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven't kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it's profitable--or even because they're popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
I'm lucky, in that I spend my days looking stuff up. Psych studies but studies nonetheless. So when I have something amiss with me, I look up papers on it and look at what the evidence says. That's -- of course -- no guarantee, because while there's been a replication crisis in psychology, what's more serious is the publication bias (shelving studies that don't come up with the desired effect) and other abuses and simply bad stat work in medicine.
At least some of the time, you'd better just hope you aren't being led astray by your doctor and at least ask questions and get a few opinions.
Here's a wonderful excerpt from Michael Lewis' The Undoing Project on a Toronto doctor who was influenced by Daniel Kahneman and Amos Tversky in his work to help trauma surgeons avoid errors in judgment when life and death are on the line.
Amy, Such a good topic! We have to be our own advocates. Pick good doctors, and do the research on procedures and drugs. And of course, weed out the mercola type garbage.
I ended up taking many of the same supplements you take for a different ailment. There are new drugs out there for IBS, but the side effects scared me. So I dug into the science. Tried a dozen things until I found something that had a noticeable effect. Turmeric.
Haven't found anything better than curcumin for inflammation. I've been taking a supplement of turmeric with black pepper (studies say it helps absorption, so why not) 3 times a day for about a year. When I get lazy or forget and skip a day, it's evident.
I run my dog in agility, she's only 2 but even she (and her buddy, the very old cat) both get glucosamine/chondroitin/MSM a few times a week.
We treat our pets better than we treat ourselves sometimes.
Starla at February 23, 2017 10:24 PM
Wondering if you've seen/heard/evaluated Dr. Wallach's Pig Pack and its fellows. Years ago I heard his radio ads, and they sounded reasonable...
Maybe they turn your hair red. I dunno.
Radwaste at February 23, 2017 11:46 PM
remember that cancer doc that was running that huge scam for years and was actually giving chemo/surgery to healthy people? he collected something like 20 million bucks from medicare and only got caught because 1 foreign newbie doc was suspicious. IIRC correctly that scammer doc was considered a hero for the entirety of his career--well yeah he was "curing" non cancer sufferers of cancer
That other doc raping women in his office and then using other patients blood to not get caught also scared the shit out of me.
Ppen at February 24, 2017 12:24 AM
As the saying goes, "The patient is the new expert."
Lastango at February 24, 2017 12:39 AM
I didn't look too closely at this Pig Pack but I sure wouldn't take all these vitamins. I take only the ones for my knee, vitamin D, and magnesium malate, and MK7 (vitamin K). I eat a low-carb diet and have the blood pressure of an Olympic athlete.
It's so disgusting that these supposed miracle cure doctors prey on patients who are desperate to believe.
And no, the patient isn't the new expert. That's dangerous, too. People are quick to read some quack site on the Internet and believe.
Amy Alkon at February 24, 2017 4:54 AM
This is a typical sneer about any who dare criticize those with medical degrees. This is referencing the meticulous research of Nina Teicholz, whom I had on my podcast, and whose book, Big Fat Surprise, is evidence-based, while the way doctors have told us to eat for decades is not.
https://twitter.com/BJSM_BMJ/status/834980134226550785/photo/1
Amy Alkon at February 24, 2017 4:58 AM
More on Teicholz, Gary Taubes, and how doctors have had us eating in THE most unhealthy, non-evidence-based ways:
http://observer.com/2017/02/health-recommendations-wrong-saturated-fat-sodium-intake/
Amy Alkon at February 24, 2017 5:01 AM
2 oral surgeons refused to treat my Mom because she was on Fosamax for bone density. There may be tests now to show if it's a problem for oral surgery but ...
"But osteonecrosis of the jaw has also been reported in women who had teeth pulled while taking the widely prescribed osteoporosis pill Fosamax ..."
http://www.webmd.com/a-to-z-guides/news/20051003/drug-for-bone-disease-linked-to-jaw-death#1
Bob in Texas at February 24, 2017 5:39 AM
I'm dealing with a knee issue too (arthritis). What has helped me so far has been the joint lubrication injections. I tried glucosamine and it didn't seem to help much. Maybe I need to try curcumin; I have not heard of that one. I've been taking Naproxin for a few months, but I'm going off of this week to see if it makes any difference.
The joint injections make me functional; they don't give me back the full range of motion that I had, but it's a lot better than nothing. The doc has told me that scoping my knee would be the next step, but at this point, I don't think it's necessary. And I'm facing some insurance issues too -- we're on an ultra-high-deductible plan at work now.
Cousin Dave at February 24, 2017 6:26 AM
I diagnosed and cured my ulcer with help from an overseas pharmacy and self diagnosed an instance of DVT. When I went in for treatment of the DVT, the doc was snarky about my efforts to take care of my own health. Feh!
No one cares more about my health than I do. Unfortunately i need new hips and I can't do that myself!
BlogDog at February 24, 2017 8:38 AM
I take Glucosamine/Chondroitin for my knees but my doctor also recommended Type II collagen AKA Knox Gelatin for my joints, several double-blind studies have shown significant improvement in joint function with it.
As far as doctors, as a kidney stone sufferer (over 100 in the past 20 years) I have dealt with the problem of doctors not operating from the best information. I have had them recently order calcium restricted diets even though the JAMA among other medical publications have shown that such diets caused persistently elevated levels of urinary calcium output and recommended INCREASING dietary calcium intake as it caused a temporary increase and dropped again because it didn't cause your body to leach the calcium out of your bones to fill your requirements. Likewise I can no longer have a script for pain meds in case of an attack because of the DEA, even though I had one script of like 10 tablets last almost 3 years, cause, you know, I might be a junkie. Now I have to go to the ER if I have an attack that Motrin won't handle.
warhawke223 at February 24, 2017 8:53 AM
Note to self: drink plenty of water.
I R A Darth Aggie at February 24, 2017 9:44 AM
The other problem with *evidence based* medicine is almost all the evidence of treatment efficacy is statistical in nature.
That doesn't always work out well for the individual patient.
Isab at February 24, 2017 9:50 AM
Isab: "The other problem with *evidence based* medicine is almost all the evidence of treatment efficacy is statistical in nature. That doesn't always work out well for the individual patient."
Oh, I so agree! Too many times I've had to tell a doctor, yea, that may be true for other people but, it isn't so in my case.
Some, but not most, actually listen to me. Most just dismiss me as some sort of nut case.
And THAT is what is good about our medical system - I do NOT have to stick to the doctor the government tells me to. I can switch to another doctor who will listen to me.
charles at February 24, 2017 6:29 PM
http://www.bbc.com/news/science-environment-39054778?SThisFB
Isab at February 24, 2017 6:56 PM
I remember my dermatologist dismissing my assertions that the minocycline that I was taking for acne was irritating my eyes. But fortunately, we agreed to switch to doxycycline (non-irritating, but less effective).
mpetrie98 at February 24, 2017 7:40 PM
Amy,
I am and RN who works in a cardiac cath lab. Our Interventional docs ask patients who are undergoing elective stent procedures if they have any surgeries planned in the next 12 months before a device is implanted. The decision is ultimately left up to the patient.
Keep in mind that shortness breath is seen with blockages and can also be caused by valve disease. It is unknown if the patient mentioned in the article also had a right heart cath done to assess this.
Christine at February 25, 2017 6:57 AM
You want your doctors to use "evidence based medicine," but on the other hand, you use glucosamine, a supplement where the evidence for its benefit is inconclusive, and not all that great.
But testing shows that it is safe, regardless. And it may be of some benefit.
It's certainly better than doing nothing. And nothing is pretty much what the medical industry can do about arthritis. As someone who's only a couple of years younger than you, Amy, I use it, too.
And I am a firm believer in supplementation. I believe in the body's ability to recover if you just feed it right.
Patrick at February 25, 2017 8:53 AM
Good old "Doctor" John Brinkley and his miracle goat gland therapy were apparently quite popular back in the day.
All men needed the Brinkley operation, he declared, but the procedure was most suited to the intelligent and least suited to the *stupid type*."
Marketing 101.
Gog_Magog_Carpet_Reclaimers at February 25, 2017 8:53 AM
The hillbilly town I live in proudly calls itself "The City of Medicine" (Duke University is here). Meanwhile I have not encountered a single competent doctor in the area. (One real good dentist, though, from Long Island.)
And, at least half of the alleged doctors I have encountered are money-grubbers who will keep you sick until you run out of money. If I ever get really sick I'm moving back North where they have real doctors.
I am not making this up. You want stories? I got stories.
Alan at February 26, 2017 10:46 PM
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