Many medical treatments don't work

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Friday, February 24. 2017

Many medical treatments don't work

Many medical treatments do not work, or do not provide the benefits desired. This is not because of deliberate quackery. It is more because of convention and the slowness of medical practice to change. Furthermore, marginal study results frequently have validity, but so marginally that there is no important clinical use. Try explaining that in court.

One example might be the treatment of borderline hypertension, which is dubious but in the US if a doc doesn't address it he'd be looked at askance because the current consensus is to treat. Next year, it might be the opposite. Another example is coronary artery stents.

The topic discussed here: When Evidence Says No, But Doctors Say Yes - Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.

Posted by Dr. Joy Bliss in Medical, Psychology, and Dr. Bliss at 14:53 | Comments (9) | Trackbacks (0)

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I used to do a lot of statistical work in R&D and materials and I'm very dubious of the type of "meta-analysis" done by the bio-med community. It's really easy to turn this into anything you want to say. Unlike machines or materials you can't test humans to destruction and you also don't start with brand-new healthy specimens. Thus the analysis methods are cloudy at best and rarely are there astounding differences in outcomes. This is really easy to use to falsely support dropping newer therapies. Teasing out what works and under what circumstances is an art that is best left to the practitioner. Guidelines are helpful, but in a litigious environment they become law. In addition, this discussion misses the underlying problem of accurate diagnosis and characterization of the state of the disease. The current tools are better than in the past, but still lack precision.

Better to try some things and have some agreements that potential harm is not excessive than to not try at all. Ban all metastudies and use the time and effort to do properly designed and executed primary studies.

#1 DirtyJobsGuy on 2017-02-24 15:31 (Reply)

Diet and nutrition. There western medical convention is absolutely spot on every single time. Science!

#2 Ten on 2017-02-24 16:01 (Reply)

Sport on every time they entirely change their recommendations every five or ten years.

#2.1 bd on 2017-02-24 16:03 (Reply)

Which perfectly inform preconceived biases roughly every other time. Butter!

#2.1.1 Ten on 2017-02-24 18:24 (Reply)

The two biggies actually have been #1 stop drinking sewage, and #2 get immunized against communicable diseases.

#2.2 Another guy named Dan on 2017-02-24 17:56 (Reply)

Don't be obese or smoke, eat real food occasionally, and get some exercise, would be the modern additions.

#2.2.1 Texan99 on 2017-02-25 10:57 (Reply)

It's a variation of the 80/20 rule. We fixed 80% of the health problems in the last 80 years or so with antibiotics, immunizations, etc. The tough health problems are... well tough.

#3 IdahoBob on 2017-02-24 19:51 (Reply)

I got interested in what was, and might still be, called "Outcomes research" and spent a year at Dartmouth learning techniques and methods. I had retired from surgical practice after a long back surgery. I then went out into the world and offered my new skills at analyzing medical quality. There I discovered that nobody, except a few doctors, was interested in medical quality. I eventually gave that up and taught medical students for the next 20 years. There were job offers from insurance companies that wanted to rent my medical degree but none interested in what I was interested.

#4 Mike-K (Link) on 2017-02-25 08:46 (Reply)

Well, I'm interested, and although I can't hire you, I'd sure buy another of your books if you'd write one! I can't remember when I've enjoyed a book so much.

#4.1 Texan99 on 2017-02-25 10:59 (Reply)

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Friday, February 24. 2017

Many medical treatments don't work