Sunday, July 24, 2011

Why experts keep failing us--and how to know when not to trust them
Traditional Chinese Medicine and HIV/AIDS

-author David H. Freedman makes the case for what his editors called New Age medicine in the July/August issue of The Atlantic.

The article is kind of all over the place--with perhaps an undue amount of ink devoted to the mysteries of the placebo effect--but there are some juicy bits here and there and more than a few (unreferenced) factoids that, at least to my mind, merit chasing down.

Among them:

  • "Last year, 75% of the $2.6 trillion the U.S. spent on health care was for treating chronic diseases that, to a large degree, can be prevented or reversed through lifestyle change." -Dean Ornish, founded of the Preventive Medicine Research Institute and physician-researcher at UCSF

  • "Studies have shown that angioplasty and stents don't prolong life in patents with heart disease." -Dean Ornish

Ornish argues that a focus on diet, exercise and stress reduction (I would only include managing one's response to stresses) can do a better job of preventing, slowing and even reversing heart disease than most drugs and surgical procedures.

  • "Studies have shown that lifestyle changes work better than drugs in preventing the complications of diabetes." -Dean Ornish

The following studies were cited as evidence of the power of the placebo effect:

A 2002 study found that sham knee surgery involving only an incision but nothing else did as much to relieve arthritis pain as the standard real procedure.

A 2009 study found that the same was true of a common back operation for osteoporosis.

A 2008 study in the British Medical Journal showed that patients receiving sham treatment for irritable bowel syndrome (which is one of the 10 disorders that most frequently bring patients to doctors and which has been estimated to cost the U.S. up to $30 billion a year) did as well as patients typically do [sic] on the standard drug [which is?] for the disorder.

A 2001 study showed that in patients suffering from Parkinson's disease, a placebo treatment caused dopamine production to surge.

German Medical Association (which has, over the years, designed, conducted and published some really high quality research!) study this year found that 59% of patients with stomach discomfort were helped by sham treatments.

A 2008 survey found that "about half" of U.S. physicians admit they routinely prescribe treatments they don't think are likely to be of direct physical benefit.

Tapping the skin in random places with a metal tube can "reliably produce" results "identical to" those of acupuncture needles inserted into [classically described] acupuncture points of the system's energy meridians.

Then there is the litany (to which we can surely add less recent fiascos) of FDA approved drugs that later failed to work against the disease for which they were licensed or (and/or) came with horrific side effects:

  • Avastin for cancer: increased risk of blood clots, heart attacks

  • Avandia for diabetes: increased risk of heart attacks

  • torcetrapib for heart disease and hypercholesterolemia: increased risk of death

Freedman adds to this list the (accurate) observation that even the cholesterol lowering statins are now regarded to be of questionable benefit in lowering the risk of a first heart attack, and notes sardonically, "the use for which they are most widely prescribed."

Also: "Recent studies have shown heart-bypass surgery and the emplacement of stents to prop open arteries to be of surprisingly little help in extending the lives of most patients."


Among the more 'macro' thinking observations in the article, none is probably more on the nose than that of UCSF biologist and Nobel Laureate Elizabeth Blackburn. She observes:

"Modern medicine was formed around success in fighting infections disease. ... To a large degree, the medical infrastructure we have today was designed with infectious agents in mind. Physician training and practices, hospitals, the pharmaceutical industry, and health insurance all were built around the model of running tests on sick patients to determine which drug or surgical procedure would best deal with some discrete offending agent. ... We face an entirely different set of medical challenges today (heart disease, prostate cancer, breast cancer, diabetes, obesity and other chronic disease now account for three-quarters of health care spending), but we haven't rethought the way we fight illness. The medical establishment still waits for us to develop some sign of one of these illnesses then seeks to treat us with drugs and surgery."

And as if to illustrate Blackburn's point, Freedman includes, a couple of pages later, the case of Mary Pinkard, a 54-year old woman with a long history of extreme fatigue, sinus discomfort, and other symptoms which under the care of conventional physicians resulted in three operations on her sinuses and a hysterectomy, as well as long, intense courses of antibiotics--none of it very helpful. After she began seeing an osteopath who was also trained in acupuncture and other alternative approaches, she says the improvements have been dramatic: hasn't been sick in five months and hasn't had to take any drugs. She says it was well worth the $2,500 she has had to pay out of pocket.

I would like to add one final section on how medical students 'lose their healer mindset,' but that will have to wait until this weekend.

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