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Why Doctors Hate Science

kdawson posted more than 5 years ago | from the comparative-effectiveness-research dept.

Medicine 1064

theodp writes "A 2004 study found some 10 million women lacking a cervix were still getting Pap tests. Only problem is, a Pap test screens for cervical cancer — no cervix, no cancer. With this tale, Newsweek's Sharon Begley makes her case for comparative-effectiveness research (CER), which is receiving $1 billion under the stimulus bill for studies to determine which treatments, including drugs, are more medically sound and cost-effective than others for a given ailment. Physicians, Begley says, must stop treatments that are rooted more in local medical culture than in medical science, embrace practices that have been shown scientifically to be superior to others, and ignore critics who paint CER as government control of doctors' decision-making."

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Global warming is a lie (-1, Offtopic)

Luke727 (547923) | more than 5 years ago | (#27035953)

Also, Linux is for fags.

Re:Global warming is a lie (-1, Troll)

Bruce Penises (1489821) | more than 5 years ago | (#27036021)

Also, Linux is for fags.

Correction: Linux is for fags that can't afford a Mac.

Evidence-based medicine (5, Interesting)

gravos (912628) | more than 5 years ago | (#27036025)

Evidence-based medicine is not the norm in the US, but you can't necessarily blame the doctors for failing to consider it: the whole system is the problem. Consider the case of Dr. Daniel Merenstein, a family-medicine physician trained in evidence-based practice.

In 1999 Merenstein examined a healthy 53-year-old man who showed no signs of prostate cancer. As he had been taught, Merenstein explained ... there is little evidence that early detection makes a difference in whether treatment could save your life. As a result, the patient did not get a PSA test. Unfortunately, several years later, the patient was found to have a very aggressive and incurable prostate cancer. He sued Merenstein for not ordering a PSA test, and a jury agreed--despite the lack of evidence that it would have made a difference. Most doctors in the plaintiff's state, the lawyers showed, would have ignored the debate and simply ordered the test. Although Merenstein was found not liable, the residency program that trained him in evidence-based practice was--to the tune of $1 million.

Re:Evidence-based medicine (2, Insightful)

tuxgeek (872962) | more than 5 years ago | (#27036191)

I'm 53 and my physician makes a regular practice of PSA tests for men my age, actually I started having them @ 50. Also just had my first colonoscopy recently and good thing as I had one tumor removed that was pre-cancer.

This is rule of thumb, and Dr. Merenstein should have known this.

Re:Evidence-based medicine (5, Insightful)

Anonymous Coward | more than 5 years ago | (#27036249)

Data is not the plural of anecdote.

Re:Evidence-based medicine (4, Insightful)

Zironic (1112127) | more than 5 years ago | (#27036301)

The relevant question is not how common the test is.

The relevant question is, would it have made any difference?

WHY NIGGERS HATE ASPIRIN: (-1, Troll)

Anonymous Coward | more than 5 years ago | (#27036351)

1. It's white.
2. It works.
3. They're too proud to pick the cotton out of the bottle.

Re:Evidence-based medicine (5, Informative)

neoshmengi (466784) | more than 5 years ago | (#27036317)

I'm 53 and my physician makes a regular practice of PSA tests for men my age, actually I started having them @ 50. Also just had my first colonoscopy recently and good thing as I had one tumor removed that was pre-cancer.

This is rule of thumb, and Dr. Merenstein should have known this.

Actually the previous poster is right. Population based studies suggest that more harm than good is done by screening for prostate cancer.

The evidence goes like this. Once you have an elevated PSA, you see the urologist who orders a biopsy. Biopsies and treatments for prostate cancer carry risks like bleeding and infection, urinary incontinence and impotence. Now most prostate cancers will not kill you or cause problems in your lifetime. So investigations and treatments for prostate cancer cause more harm to people than the cancer does. This makes sense in a population, but not to the guy who got a bad cancer.

The current guidelines do not suggest PSA's in all men over fifty, but rather that you discuss the risks and benefits of screening, plus potential harm of further workup of a positive screen vs. the harm of developing prostate cancer. In practice, there is no patient who can actually understand enough of this to truly make an informed decision. Many docs haven't heard of the 'new' evidence and continue screening. The ones who do know of that evidence often ignore it because it's hard to explain, and patients will love you for finding an early cancer, even if it would never have affected them.

As far as your colon cancer screening comment, what you describe is standard of care.

The other thing to consider is that medicine in the US is HUGELY biased by the litiginousness of US culture. US emergency medicine guidelines, for example, are extremely aggressive and notorious for over investigating. The priority is protecting practitioners from litigation rather than appropriately treating the patient. A lot of those investigations are not recommended in socialized health care systems because they are not cost effective, nor do the benefits outweigh the disadvantages.

Re:Evidence-based medicine (2, Interesting)

Anonymous Coward | more than 5 years ago | (#27036333)

By the time a cancerous growth is detectable, 4 billion cancerous cells have been produced. Based on the average rate of cancer cell mitosis, the patient has lived with cancer for 10 years by the time an early-detection test proves positive. Therefore, in cases where precancerous growths are not detectable without invasive surgery (yours is an exception), such a result makes little difference in the remaining lifespan of the patient. Thus "early" detection should really be called "late" detection, and such tests aren't always warranted if no symptoms occur.

exactly the point: rules of thumb are not science (1)

Trepidity (597) | more than 5 years ago | (#27036427)

There is no scientific evidence at all that "a regular practice of PSA tests" is useful in any respect, or that it even does more good than harm. It's a medical custom that has no empirical basis.

Evidence-based medicine is in your hands. (-1, Troll)

Anonymous Coward | more than 5 years ago | (#27036229)

What you want done, you give that evidence to who you choose to be your doctor. There truly aren't many doctors anymore because they are all bought and payed-for by Abbot Laboratories, Pfizer, and Merck. It was just the other day that I heard on the radio about all the "black needle" incidents where licensed "doctors" would kill a patient if the insurance company exposed litigation or the treatment cost the doctor from his liability. I'm aware of people getting rid of cancer homeopathically and therapeutically, yet are killed in good health by the court-ordered radiation therapy they were coerced into continuing.

It's absolutely nuts, like Slashdot moderation as to why I wouldn't login just for this to be modded-down.

Re:Evidence-based medicine is in your hands. (1)

jmitchel!jmitchel.co (254506) | more than 5 years ago | (#27036315)

????

Re:Evidence-based medicine is in your hands. (0, Troll)

MindlessAutomata (1282944) | more than 5 years ago | (#27036325)

"I'm aware of people getting rid of cancer homeopathically and therapeutically, yet are killed in good health by the court-ordered radiation therapy they were coerced into continuing."

Because we are talking about EVIDENCE-based medicine, not eye-of-newt, toe of frog nonsense and tinfoil hat paranoia. Let me guess, this is all orchestrated by the Jewish Illuminati Freemasons?

I bet that radio show was something like Alex Jones', which is why you didn't care to mention what radio show you heard it on. Some people will believe any form of bullshit--you are one of them.

Re:Evidence-based medicine (5, Insightful)

girlintraining (1395911) | more than 5 years ago | (#27036341)

The problem is when you introduce two separate institutions that were never really meant to interoperate. There is a perception by the general public that doctors should be like House, or Scrubs, or a dozen other TV shows out there where everyone is a genius, and the cure can be found in a 1 hour episode with just a few tests, a quick flip through a book, and some snarky commentary. It's the same with criminal investigations -- the so-called "CSI effect". Juries now want "DNA evidence" to prove someone was at a scene (or not), something that's both impractical and often unnecessary, and cases have been lost simply because the evidence was "too boring".

The truth is doctors aren't geniuses. They sat next to you in high school. Some of them copied your answers on the math test. They are average everyday people that have been trained (hopefully well) to do a specific job. When the justice system (and the general public's expectations) meet the medical establishment, it's not pretty. Evidence is poorly understood, and when people don't understand something intellectually they fall back on their gut feelings, their emotions. As horrible as that sounds (and sometimes is), what can we really expect from Joe Average? A carefully-weighed judgment, with full knowledge and understanding of the evidence? Please.

Here's a hard truth to swallow: All that stuff about a "jury of your peers", and being judged by people who are well versed in the law (but not necessarily the material issue at hand), doesn't work in modern society. Our method of voting and elections are horribly outdated as well, and there are dozens of systems which (at least statistically) would provide "better" results. But we as individuals want to believe we understand things well enough. We want to believe that we are righteous, and just, and overall good people. And we very well may be, but that means exactly dick in the larger equation. Just as we have specialists in medicine, technology, and elsewhere, we need a justice system, a political system, and other institutions to mirror society in it's specializations -- judges who have IT training, or medicine, etc. Politicians who make decisions about, say, telecommunications who have worked in the industry. Because society has become too complicated for us to have just judges, or just lawyers, or outdated concepts like a "jury of our peers"... Who's only qualifications were that they registered to vote in your county.

If you want change, start by choosing the right people for the job, because contrary to popular belief in this country, not just anyone can do these things.

Re:Evidence-based medicine (2, Interesting)

Anonymous Coward | more than 5 years ago | (#27036343)

This is precisely the point - no doctor hates science, and the medical profession as a whole are champions of scientific thinking when most other professions have yet to be introduced to the concept.

Unfortunately this is severely mitigated by two groups - lawyers and patients.

The original article could equally be titled 'why lawyers hate science' - as the parent says, many judgements against doctors are based on whether something could have been done, not whether there was evidence to support doing it, or even whether it would have been effective.

Patients come to doctors with the expectation that something will be done, and a significant part of medicine is allaying the fears and anxieties of the patient.

The cover-your-ass imperative imposed by lawyers and the demands of anxious patients significantly skew treatment away from the scientific ideal - the desire to make money (while also significant) is a distant third, and largely reflects that monetary incentives in private medicine do not match well with the interests of the patient (i.e. a systemic funding problem).

But the title of the original article - implying that doctors hate science - is utter crap.

Re:Evidence-based medicine (2, Interesting)

rev_sanchez (691443) | more than 5 years ago | (#27036389)

Following a recognized best practices protocol could provide some legal defense in cases like this while providing better care at a lower cost. In practice it certainly won't be that easy. It does tend to turn the practice of medicine into a game of 21 questions to start identifying the problem and a checklist to treat it but a fill-in-the-blank style of treatment could make their paperwork go faster too.

Smart move (4, Insightful)

mc1138 (718275) | more than 5 years ago | (#27035959)

While I am all for people being able to make their own calls and decisions, this sort of research could very well help to streamline more basic medical procedures and help bring to light both new medicines and treatments that might not be able to afford the same advertising as the crap that gets shoved in front of consumers every ten minutes on tv, radio and internet.

Re:Smart move (5, Insightful)

Chonnawonga (1025364) | more than 5 years ago | (#27036121)

Even worse is the advertising that gets shoved in the faces of the doctors! There was another study recently (I'd link to it, but I'm too lazy to go search for it) that found that doctors were making a lot of choices about which drugs to prescribe based on all the advertising and free samples they're regularly bombarded with. Then there was another study that found that drug companies were spending twice as much on marketing as on research. Sadly, family physicians just don't have a whole lot of extra time to be reading up fully on every drug that hits the market. Having a way to distil research and make it more accessible to doctors could go a long way to countering that.

It isn't the doctors in many cases... (4, Insightful)

cayenne8 (626475) | more than 5 years ago | (#27036423)

Hell, it isn't so much the Dr's making the decisions now...for the past decades, we've had the beancounters in HMO's and like dictating what tx the physicians, clinics and hospitals can give.

Couple that with having to do unnecessary tests many times just to CYA to fight off bloodsucking lawyers and malpractice cases....well, that explains a lot of it away.

Re:Smart move (5, Insightful)

fuzzyfuzzyfungus (1223518) | more than 5 years ago | (#27036165)

In addition, the dreaded "rationing" of healthcare is already here, brought to you by the private sector. I work, I have insurance, I pay my premiums; but the insurance company, obviously, makes more money when they deny a claim than when they pay it. A system where procedures are paid or denied based on their expected benefit, as established by actual research, would be a considerable improvement.

In reality, "choice" in medicine is already an illusion for virtually everybody. Unless you can absorb arbitrarily high out-of-pocket expenses, or have extraordinarily generous insurance coverage, your medical choices are already circumscribed by what you can afford, or convince your insurer to pay for. Better data would, hopefully, more closely align people's options with what is actually effective, and increase overall quality.

Re:Smart move (5, Insightful)

wellingj (1030460) | more than 5 years ago | (#27036255)

I see where you are coming from, but I still can't agree that people should eat food and drive cars that they can't afford. I don't to see how health care should be any different.

I think the whole problem there stems from how health insurance morphed to health care. If you want to go see a doctor every year, pay for it. If you get run over by a truck, that's what insurance is for. Insurance is for the unforseable, not the routine. The problem is the line that has to be drawn, and it becomes a pretty grey area, so it's ended up that the insurance company is expected to pay for everything, which of course drives up the cost.

Wondered off on a tangent there... oops.

Re:Smart move (2, Insightful)

IamGarageGuy 2 (687655) | more than 5 years ago | (#27036309)

I don't think you wandered off topic, I think you are directly ontarget.

Re:Smart move (0)

Anonymous Coward | more than 5 years ago | (#27036391)

Insurance companies would *rather* pay for you to get an annual checkup and catch problems early, because practically everything is cheaper to treat if caught early.

Re:Smart move (5, Insightful)

causality (777677) | more than 5 years ago | (#27036409)

I see where you are coming from, but I still can't agree that people should eat food and drive cars that they can't afford. I don't to see how health care should be any different. I think the whole problem there stems from how health insurance morphed to health care. If you want to go see a doctor every year, pay for it. If you get run over by a truck, that's what insurance is for. Insurance is for the unforseable, not the routine. The problem is the line that has to be drawn, and it becomes a pretty grey area, so it's ended up that the insurance company is expected to pay for everything, which of course drives up the cost. Wondered off on a tangent there... oops.

Indeed. I can't remember where I heard this, but this is an explanation I've heard: if car insurance worked like health insurance, then every time you put gas in your tank or get an oil change or replace the tires you would file a new claim.

Re:Smart move (1)

tepples (727027) | more than 5 years ago | (#27036463)

If you want to go see a doctor every year, pay for it. If you get run over by a truck, that's what insurance is for. Insurance is for the unforseable, not the routine.

First a question to sharpen a big chunk of the gray area: If I come down with a chronic condition that needs expensive prescription drugs to control it, is that "unforeseeable" or "routine"?

Re:Smart move (1)

xenocide2 (231786) | more than 5 years ago | (#27036469)

What angers people though is the routine denials of claims. I don't think its right to reject ambulance fees when you're injured with a compound fracture (this happened to my little brother); did they expect him to walk to the emergency room?

Insurance and free markets serve society best when the contracts are simple and clear. As you point out, what's covered is a massive gray area, and it's far worse than you mention. Ever read a hospital bill?

Re:Smart move (1)

cayenne8 (626475) | more than 5 years ago | (#27036481)

I agree largely. I've been doing the indie contracting thing, and have been happy with my healthcare I provide myself. I have a high deductible ($1200) insurance policy, that I use AS insurance against catastrophic emergencies. Otherwise, I sock away the max each year in a Health Savings Account, which I can earn money on, and is not like the use it or lose it things w2 employees get.

I pay for my office vists and tests out of the HSA with pre-tax dollars. When I tell the clinic I am paying, I generally get an immediate 15% discount off what they'd pay insurance companies.

I figured that saving for medical care, is much like anything else when it comes to living within your means.

And,with the HSA's....in the long run, I can save more money that you do paying deductibles and co pays for everything....

I wish they'd expand this type of thing...make much higher limits to HSA's annually...etc.

Wha huh? (0)

Anonymous Coward | more than 5 years ago | (#27036509)

I work, I have insurance, I pay my premiums; but the insurance company, obviously, makes more money when they deny a claim than when they pay it

If you're not spending your own money on the actual health care, it's not the free market. It doesn't matter much whether the government or a giant faceless corporation is the payer, neither one really shares your interests.

The whole reason we even have health benefits "provided" by employers is because of government price controls. Wartime price controls on labour. Benefits were a way to entice workers where salaries were capped.

If you're going to bitch about free market failings, it might be a good idea to make sure the effect you're complaining about is the result of free market principles actually being applied.

Re:Smart move (1, Insightful)

Anonymous Coward | more than 5 years ago | (#27036173)

You should also consider that "research" of this type is what HMOs and nationalized health care systems use to deny or delay individual treatment. Almost anything can be used for good or ill; there are no universal panaceas.

paps with no cervixes (5, Funny)

UltimApe (991552) | more than 5 years ago | (#27035977)

I bet next they give mandatory prostate exams to women too!

Re:paps with no cervixes (2, Funny)

MrNaz (730548) | more than 5 years ago | (#27036135)

Next I bet you'll tell me that mamograms for men are useless. I'd counter by saying that you haven't seen many Slashdotters with their tops off.

Re:paps with no cervixes (4, Informative)

fuzzyfuzzyfungus (1223518) | more than 5 years ago | (#27036201)

Substantially less useful; but not entirely useless. Breast Cancer in males is uncommon; but not unheard of [cancer.org] .

Re:paps with no cervixes (1)

UltimApe (991552) | more than 5 years ago | (#27036435)

this just in, all men should get breast exams on the off chance they have cancer. Better to be safe than sorry right?

Re:paps with no cervixes (0)

Anonymous Coward | more than 5 years ago | (#27036171)

Skene's gland [wikipedia.org] (poosibly NSFW) exams, maybe?

But CER is government control (1, Flamebait)

tjstork (137384) | more than 5 years ago | (#27035979)

Of course, its Newsweek, the famous liberal rag, and yes, the intent here is trying to persuade doctors that foolishly supported Obama into believing that they will somehow gain in the new regime. They won't.

Re:But CER is government control (1)

narcberry (1328009) | more than 5 years ago | (#27036009)

But but, this will stimulate the economy by...
well by...

anyone?

Re:But CER is government control (0)

Anonymous Coward | more than 5 years ago | (#27036193)

The economy is dead, nothing can stimulate societies whom depend on war as a source of revenue. As for doctors, the doctors i've had the chance to visit for the most part are the quickest human beings to diagnose anything...especially in an ER! They will give you any disease/aliment just to give one to YOU! Paper work / pay are the only, let me repeat ONLY motivators for this system

So yes throwing money into it will stimulate the economy, have you forgotten how much money is spent in this INDUSTRY?!

An entire federal department works just with these drugs! $$$$$$$$$$$$$$$$$

Re:But CER is government control (1)

MrNaz (730548) | more than 5 years ago | (#27036207)

The idea is that it will increase the total level of research and development that gets done, making up for some of the loss in the lead that America had over the rest of the world for the majority of the second half of the twentieth century.

However, personally, I believe that the US's comparative advantage in this area was due to the enormous talent tapped by draining Germany after the second world war, and other countries as well due to the far higher per-capita income available in the US as well as the "American Image" that was so shiny and desirable.

Now, however, those German scientists are old and dying, and the US no longer offers the same image it once did. Professionals and intellectuals are realizing that the up and coming economies of China and India can offer as good opportunities, if you're positioned to take advantage of them, and many are also realizing that the abrasive, raw capitalist society that America has become is no longer conducive to comfortable and stable lifestyles.

The result? The "brain drain" that the US is now suffering. Sure, we can blame Chinese technological advances on their willingness to steal from US research bodies, but let's be honest here; post WWII US science and technology is pretty much all thanks to the German scientists that were whisked away in the post war reorganization. You think any of the brilliant minds ended up on the Nuremberg gallows? No, they ended up heading US DoD projects.

Err... sorry for rambling.

Re:But CER is government control (1)

ghetto2ivy (1228580) | more than 5 years ago | (#27036053)

You could choose not to accept government funded healthcare. How is that gov't control? Many doctors don't take any insurance. Insurance companies reject procedures and medicine all the time, but based on budgets not on science and stats.

Re:But CER is government control (1)

wellingj (1030460) | more than 5 years ago | (#27036401)

Not accept health care, yet I'm forced to pay for it? You are right! that's not government control so much as plain old thievery.

Re:But CER is government control (2, Insightful)

Anonymous Coward | more than 5 years ago | (#27036107)

Yeah, those damn liberals. Here they come, trying to screw up the impeccable record the Republicans have accrued over the years... ... wait, nevermind. I was delusional for minute.

Still bitter about the election? Good. I can't tell you how rewarding it feels as an American to demoralize and frustrate the idiots on the right.

Re:But CER is government control (4, Insightful)

ColdWetDog (752185) | more than 5 years ago | (#27036117)

Yeah, it's Newsweak, and this is a pretty lame piece. For one, the title "Doctors Hate Science". Just a wee bit of overreach, worthy of kdawson (maybe that's why he put it up).

Next up:

If bureaucrats were in charge, physicians might have to prescribe the newest hypertension drugs as a first-line therapy, do MRIs to diagnose back pain and give regular Pap tests to women who have had total hysterectomies.

Which conflates the argument that doctors sometimes do those (and other) stupid things. They don't have to....

And another gem:

It's hard not to scream when you see how many physicians, pharmaceutical companies, medical-device makers and, lately, hysterical conservatives seem to hate science, or at best ignore it. These days the science that inspires fear and loathing is "comparative-effectiveness research"

What the fuck is wrong with this woman? Did somebody do a prostate exam on her? Yep, there is a problem - doctors don't necessarily do what sometimes iffy research describes as best practices. And there is the big issue of why medical practice varies so much from region to region. And doctors very definitely tend to do things that pay them money (i.e., procedures) when perhaps they are better off not doing so.

But this 'article' is just an idiotic rant. There are fairly large and well funded groups that find it in their best interest not to go along with this idea, but to paint everybody with the same brush and to dismiss detractors of CER is just immature. Unfortunately, for the vast majority of patients, we really don't know what is the best combination of treatment or not treatment. Most of the studies have been done for fairly short periods of time and on rather homogeneous populations. It's hard to know how those studies apply to the real world patient in your office.

Let's take the little issue of pap smears after hysterectomies. If you had a hysterectomy for actual cervical cancer, then you ARE supposed to keep getting pap smears (at some unknown frequency). That's because cancerous tissue doesn't necessarily stop growing the moment it wanders off it's initial tissue base. That's why it's a cancer.

Way to go Newsweek. Take an important, complicated issue and create a brain dead sound bite.

Roll up your sleeve and bend over.

Re:But CER is government control (1)

linzeal (197905) | more than 5 years ago | (#27036149)

Doctors have been over-prescribing drugs for commission, doing unnecessary surgery for profit and killing people through brazen ineptitude for too long. The party is over and doctors are going to be treated like naughty children because they are acting like it.

Already? (0)

Anonymous Coward | more than 5 years ago | (#27035983)

Obama's ppl are writing news for Slashdot already???

because patient hates science (1, Insightful)

Anonymous Coward | more than 5 years ago | (#27035989)

There are a lot of evidence-base guidelines already. The question to ask is why patient hates science and ask for hi-tech test (MRI, CT) and latest pills.

The assumption here (4, Insightful)

popo (107611) | more than 5 years ago | (#27036013)

the assumption here is that wasteful procedures are due to the profit motives of physicians.

anyone who knows anything about health-care will tell you that the primary cause of most non-cost-effective procedures is fear of legal consequences.

want cheaper healthcare? reform the legal system and get the hmo's out of the game.

Re:The assumption here (0, Troll)

Zironic (1112127) | more than 5 years ago | (#27036047)

The thing is, you can't completely absolve doctors of legal responsibility, what would stop them from killing and maiming people at will o.O?

Re:The assumption here (4, Insightful)

davolfman (1245316) | more than 5 years ago | (#27036109)

The criminal justice system?

Re:The assumption here (2, Insightful)

wellingj (1030460) | more than 5 years ago | (#27036349)

Don't forget the Hippocratic Oath [wikipedia.org] .

Re:The assumption here (1)

phantomcircuit (938963) | more than 5 years ago | (#27036167)

Guilt and not wanting to kill or maim people

Seriously how many doctors do you think there are that want to kill or main patients?

Re:The assumption here (1)

Zironic (1112127) | more than 5 years ago | (#27036213)

More then zero?

Doing rather sick things to people in the name of "Science" has been reasonably common.

Re:The assumption here (1)

IP_Troll (1097511) | more than 5 years ago | (#27036231)

want cheaper healthcare? reform the legal system and get the hmo's out of the game.

Where did GPP suggest that doctors should be absolved of legal responsibility? To reform a legal system that causes doctors to perform unnecessary cover-your-ass procedures does not mean remove responsibility.

Re:The assumption here (1)

Zironic (1112127) | more than 5 years ago | (#27036371)

The problem is I think defining the law in such a way that doctors do not get punished for things out of their control but do get punished for incompetence/malice.

Re:The assumption here (1)

frieko (855745) | more than 5 years ago | (#27036233)

Dude goes in for a sore throat, doctor accidentally amputates his leg. Which of these makes you feel safer?
a) Dude gets a big check. The doctor's malpractice insurance goes up a little and he keeps on "practicing".
b) Doctor is fired for being an idiot, gets a new job as a plumber.

Re:The assumption here (1)

Zironic (1112127) | more than 5 years ago | (#27036323)

Personally I'd like
C)Doctor goes in jail for Aggravated assault.

Re:The assumption here (1)

frieko (855745) | more than 5 years ago | (#27036467)

Or that, whatever. The main point being that our current scheme, (a), is absolutely idiotic.

Re:The assumption here (1)

gravos (912628) | more than 5 years ago | (#27036189)

This is correct, of course. See my comment above about Dr. Daniel Merenstein.

Re:The assumption here (0)

Anonymous Coward | more than 5 years ago | (#27036211)

And those who want the most extreme reform (liberals) are those who fight to keep the doctor's liability as high as possible.

Re:The assumption here (3, Insightful)

db32 (862117) | more than 5 years ago | (#27036257)

This isn't entirely true, but it isn't exactly off the mark either. There are simply a stupid number of factors involved here that allow nonsense like this to happen. Insurance companies will frequently pull garbage like "we won't pay for X unless Y has already been done". So then doctors are forced into doing Y before doing X so that the patient doesn't get saddled with an insane bill. Also, before anyone here goes "well the doctor could just not charge" I will point out that these things are RARELY interelated. Doctors don't generally do any of the work themselves. You go to the family doctor for joint pain for example. He says go get an X-ray. Typically only specialists will have their own x-ray equipment (podiatrist/orthopedics/etc). So...either you get refered to a hospital or specialist and go get your x-ray. Bill #2 is now generated. So then that x-ray gets sent off to a radiologist who reads the x-ray into a dictation machine. Bill #3 is generated. Now, as an expense somewhere in bill #2 or #3 is going to be the cost of some transcriptionist group taking that dictation and typing it up. THEN! If you have to fix that joint surgically you go to a hospital...now you are paying an anesthesiologist (who is typically his own practice rather than a hospital employee), you are paying the hospital for your time in their OR and Recovery and supplies used, you are paying a surgeon (who may or may not be working for whoever did your x-rays). Now, at each stage of this process the insurance company gets to dictate terms of what will and won't be paid for. You are still dealing with the profit motivation of the various doctors in that chain (hey, not all of them are good docs, most are, but there are always assholes in every field) and you are dealing with the stupid lawsuits. People have managed to turn honest mistakes into malpractice which I think is fucking insane. Doctors should be held to high standards, but when you say they can't make a mistake without losing their ass the costs of healthcare goes through the f'ing roof. If they remove a lung when you were supposed to be getting a kidney removed...malpractice. If you come out with brain damage after a brain surgery...unless they were just running around with a blender in your head this is just one of the risks of having brain surgery....not fucking malpractice.

All of this doesn't even begin to cover all of the lobbying that the insurance companies and pharma companies do to rig the game in their favor. Everyone bitches about these evil "socalists" trying to screw up medical services, but the real issue is that the die hard capitalists have already fucked it all the hell up in their favor and they are scared to death of losing the kickbacks. (Disclaimer: Go talk to someone in the military about that whole free government provided healthcare...you get what you pay for...)

Re:The assumption here (1)

Firethorn (177587) | more than 5 years ago | (#27036277)

the assumption here is that wasteful procedures are due to the profit motives of physicians.

Not necessarily, a lot of it's probably from non-scientific collations of knowledge and anecdotes.

IE 'in their personal experience' procedure A is better than B, when in reality it's not, they never gave B a proper chance.

Along those lines, why do you blame HMOs? They tried to do the same thing the government is now pushing - figuring out the most cost effective procedures and methodologies to save costs. Remember - a Patient that isn't cured/fixed is going to keep seeking medical care, so an ineffective procedure is worse than nothing.

On lines of the legal system, I read somewhere that something like 3% of doctors are responsible for 90% of the malpractice suits. - Well, I exaggerate apparently. 5% responsible for 50% [tradewatch.org] , 1.7% for 27.5%. Still, getting rid of the worst 2% of doctors would be the trick(those who can't, teach? Maybe). But who would replace them? We have something of a doctor shortage to begin with.

Back on the topic of lawsuits for malpractice, well, honest studies would help in lawsuits: Why didn't you do X? Because CER's study showed that X is ineffective for situation Y, that's why.

Re:The assumption here (1)

timeOday (582209) | more than 5 years ago | (#27036381)

This book [amazon.com] has a chapter on how non science-based medicine actually is. For instance, when you go in and get a checkup and they listen to your heart with a stethoscope, guess what that's for? Nothing. But everybody does it. Malcolm Gladwell's "Blink" also has a chapter about how an extremely small decision tree (with about 4 nodes) diagnoses heart attacks more accurately than physicians can do it subjectively.

Re:The assumption here (1)

Zironic (1112127) | more than 5 years ago | (#27036505)

I don't know about your doctor, but mine does it to listen to my lungs.

Re:The assumption here (1)

Breakfast Pants (323698) | more than 5 years ago | (#27036475)

What was the sum of money across all malpractice judgments last year? I couldn't find it via Google. I'd like to see how big of a percentage it is compared to the total money spent on healthcare.

While a bit alarmist... (5, Insightful)

blahplusplus (757119) | more than 5 years ago | (#27036071)

... as the title of this entry suggest. Not all doctors are created equal, and lets get this straight - all human beings, no matter how educated are very fallible and human.

I had one young doctor think I should have my moles checked out that "looked cancerous" and another doctor whom I'm also freinds with that tells me "that doctor is full of shit". I also had my GP (general practitioner) suggest I had a part of my foot cut off after a series of infections after many an ingrown nail, needless to say I rejected his suggestion and did the work on the foot myself and still have everything all intact and normal as ever.

Just because someone suggests something who is in a position of recognized credentialed authority, does not mean it is a license to take their judgments and advice without scrutiny and a grain of salt.

Knowing how to do this and when is the hard part, but this is something that only people who've lived long enough and have the wherewithal to gain by experience - mankind is extremely fallible. Therefore critical skepticism must be employed when decisions can have significant consequences.

It's easy for experts to suggest something to someone else when they don't have to bear the risk and consequences of going through with it.

Re:While a bit alarmist... (0)

Anonymous Coward | more than 5 years ago | (#27036269)

Moral of your story: Always get a second opinion when you don't feel things are right.

After all, it's called practicing medicine for a reason.

Re:While a bit alarmist... (1)

techno-vampire (666512) | more than 5 years ago | (#27036487)

I had one young doctor think I should have my moles checked out that "looked cancerous"

I remember, about thirty years ago or so, having my doctor of the time remove a mole from my back after a physical. Officially, it was because it looked cancerous. Actually, as he explained, if he didn't find anything wrong, I'd have to pay for everything, but this way, he could bill my insurance and they'd pay it without batting an eye. I've no idea how things work now (Currently, I get all my medical care through the VA.) but I wonder how many harmless procedures are done simply to avoid having the patient pay.

I'm torn on this (3, Insightful)

DesScorp (410532) | more than 5 years ago | (#27036125)

While I like the idea of reinforcing what works and discouraging what doesn't, the fact is, this is a federal study, and likely the well-intentioned results will be some government panel or body controlling what doctors can and cannot do, regardless of the patient's circumstances, all in the name of "science" and "efficiency". They may well make some things better. But they'll inevitably make more things worse.

I want to aid in better treatments, but I can also easily see some overreaching federal agency micromanaging physicians. Sorry, but find me one federal agency that never tried to expand their power exponentially, often in the name of "the public good".

Re:I'm torn on this (2, Funny)

SecurityGuy (217807) | more than 5 years ago | (#27036243)

find me one federal agency that never tried to expand their power exponentially, often in the name of "the public good".

The IRS. At least, they don't claim it's for the public good. :P

Random quote (1, Insightful)

LingNoi (1066278) | more than 5 years ago | (#27036139)

Remedies has been around of thousands of years, we tested it all and the stuff which works was called "medicine"

The point I'm trying to make here is that these people that believe modern science is some how inferior to their new age hocus pocus need to be hit with the clue stick.

This goes especially for those idiots that believe in Homoeopathy [randi.org] .

Re:Random quote (1)

wizardforce (1005805) | more than 5 years ago | (#27036197)

indeed, that "clue stick" is high medical costs, sickness and death. The feds can suggest the best course of treatment sure, but do you really want them making your medical decisions rather than yourself and your doctor? What could possibly go wrong?

Re:Random quote (5, Interesting)

rthille (8526) | more than 5 years ago | (#27036425)

The quote I like best is: "What do you call 'Alternative Medicine' that works?" "Medicine"

Mis-education courtesy of Big Pharma (2, Insightful)

macraig (621737) | more than 5 years ago | (#27036159)

Why do you folks think Big Pharma is so successful? One of the prongs of their attack on medical knowledge (and ultimately research also) is mis-education and indoctrination of physicians themselves, through both subtle whispering in their ears as well as brute-force constant bombardment. The knowledge of physicians is pretty much under attack from the day they toss that cap in the air, if not sooner.

BTW, I've heard from a family member who is a Kaiser HMO patient that Kaiser does not allow Big Pharma reps direct access to its staff phyicians, and instead funnels them to some sort of departmental liaison; if that's true, that is certainly one good thing that an HMO is doing.

Re:Mis-education courtesy of Big Pharma (1)

wizardforce (1005805) | more than 5 years ago | (#27036219)

It is ultimately up to the patient being treated to make the decision about their own health. Not "big pharma" nor the federal government, it's your decision. I can not for the life of me understand why people are so intent on putting the responsibility for their health on to others when it is their life in danger... you would think that their own life would mean enough to do at least some basic research on the matter...

Re:Mis-education courtesy of Big Pharma (1)

epee1221 (873140) | more than 5 years ago | (#27036449)

While the decision is yours to make, those who deliberately misinform you about that decision do you wrong.

Evidence based medicine is extremely frustrating (4, Insightful)

neoshmengi (466784) | more than 5 years ago | (#27036183)

I practice evidence based medicine as much as possible. The trouble is that patients have a very hard time understanding it, let alone appreciating it.

I don't give antibiotics for colds, but those patients often go see other doctors to get their antibiotics. When they get their inappropriate prescription, ironically I come across as a bad doctor for not prescribing it in the first place.

When people bring their kids in to get some gravol for their viral gastroenteritis, I tell them that it has been shown to be no better than placebo, so I don't offer it. Parents hate that.

I have a cranky baby at home. My friends asked me why I don't use Oval. I told them that there is evidence that it doesn't work. They stared at me like I had three heads. After all, they tried it and it worked for them!

People come in with back pain. My job is to rule out the dangerous causes, and once that's done give them some analgesia and tell them to weight a few weeks for it to improve. Any serious pathology will reveal itself over time if there are no red flags during the initial history and physical. Patients hate that. They want the xray. So they go to their chiropractor who orders a bunch of xrays (placebo 'tests' are very therapeutic to patients actually). "Well, your xray looks fine!"

EBM is hard on the practitioners. The old school of medicine is to say, "This is what you have and this is what you need to do to fix it."

Now we say, "It's likely that you have this, although I can't say for certain. Here are the pros and cons of the treatments. Now what would you like to do?"
Very dissatisfying to a lot of patients.

Everyone wants all the scans and tests even when it doesn't make sense, because they all know the guy who was told that his problem wasn't serious and it turned out to be cancer etc.

The previous party line was that all diabetics should be on aspirin to decrease their chances of having a heart attack. A recent study came out showing very little evidence for primary prevention of heart attacks with aspirin. What to do now? How to integrate every little bit of often conflicting evidence into clinical practice? It's very hard to stay up to date, let alone sift the wheat from the chaffe.

EBM is the gold standard of how we should practice medicine. Yet it is immensely frustrating to put into actual practice.

Re:Evidence based medicine is extremely frustratin (3, Interesting)

KeithJM (1024071) | more than 5 years ago | (#27036307)

When people bring their kids in to get some gravol for their viral gastroenteritis, I tell them that it has been shown to be no better than placebo, so I don't offer it.

Have you considered that, although it's no better than placebo, it might be better than nothing? Saying it's no better than placebo doesn't actually mean that they won't see a difference if you don't prescribe anything. It's why they use placebos in trials.

Re:Evidence based medicine is extremely frustratin (4, Insightful)

neoshmengi (466784) | more than 5 years ago | (#27036383)

When people bring their kids in to get some gravol for their viral gastroenteritis, I tell them that it has been shown to be no better than placebo, so I don't offer it.

Have you considered that, although it's no better than placebo, it might be better than nothing? Saying it's no better than placebo doesn't actually mean that they won't see a difference if you don't prescribe anything. It's why they use placebos in trials.

I have considered it. I also consider the fact that every medicine I prescribe carries risks, even if those risks are low. If I don't know whether the risk outweigh the benefits, I don't prescribe, particularly for 'nuisance' illnesses.

I know many physicians who prescribe placebo treatments and tests. I have trouble doing this even though patients find it very satisfying. What I sometimes do instead is tell people what the evidence is and let them decide. I struggle with the ethics of prescribing a placebo.

Re:Evidence based medicine is extremely frustratin (2, Insightful)

UltimApe (991552) | more than 5 years ago | (#27036413)

While there is merit in placebo... For patients that don't have health-care plans, or those on fixed income, spending shit tons of money on what amounts to snake oil is quite a good reason to prescribe bullshit.

Re:Evidence based medicine is extremely frustratin (1)

UltimApe (991552) | more than 5 years ago | (#27036313)

You bring to light a lot of good points and examples. Patients are belligerent. But I suppose thats to be expected in a country where a good portion of its populace are believing things that might as well amount to superstition.

Re:Evidence based medicine is extremely frustratin (1)

gravos (912628) | more than 5 years ago | (#27036385)

I feel for you, I really do. I couldn't handle being in your profession, it would be way too frustrating for me.

is there some way to find EBM doctors? (1)

Trepidity (597) | more than 5 years ago | (#27036489)

Say I'm a scientist, but not in the medical profession. So I can't treat myself, but I would like to be treated by someone who I have confidence is basing their decisions on solid evidence. That is, going to them should get me results that have better expected outcomes than doing my own damn PubMed searches and self-treating. It seems this often isn't the case; a lot of treatment is "rule of thumb" or "I don't like the look of that", and as you point out the patients are probably at least as responsible as the doctors in this.

But if I really do want a physician who's going to give me an honest summary of current scientific evidence, how do I find someone? Do people openly advertise as doing evidence-based medicine? I can see that a lot of people simply don't want EBM--- they want the old-fashioned village doctor who has a folk remedy and answer for everything. But it seems there ought to be some way to connect people who do with doctors who're willing to provide it.

This is right out of Tom Daschle's book (2, Insightful)

ducomputergeek (595742) | more than 5 years ago | (#27036203)

http://www.amazon.com/Critical-What-About-Health-Care-Crisis/dp/0312383010/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1235966206&sr=8-1 [amazon.com]

And modeled on the UK system where a review board develops a formula the determines if the cost-benefit is worth it or not.

Sounds all good and all, but basically this is what HMO's try to do now.

Only difference I can tell is that the government will be the ones telling you what treatments you can/cannot get instead of the HMO's.

Hopefully... (0)

Anonymous Coward | more than 5 years ago | (#27036205)

I hope the procedures investigated and shown to be useless, if not harmful, once and for all, is male circumcision, especially when it involves non-consenting infants.

Won't work (0)

Anonymous Coward | more than 5 years ago | (#27036215)

This will completely flummox the fraction of doctors that aren't good physicians to begin with. For the rest, this will just impede their judgement.

kdawson (2, Insightful)

timmarhy (659436) | more than 5 years ago | (#27036217)

please stop with the media whore titles. it only makes you look stupid.

Re:kdawson (0)

Anonymous Coward | more than 5 years ago | (#27036265)

please stop with the media whore titles. it only makes you look stupid.

Why do you hate science?

Re:kdawson (1)

Benzido (959767) | more than 5 years ago | (#27036421)

He's having a tough time, since kjoey and kpacey started dating and spent the summer together on a yacht. Boy did that make him look stupid!

More Art than Science (1)

eekygeeky (777557) | more than 5 years ago | (#27036251)

Medicine is currently more or less based on science, but that only because science has taken such a large role in our brave new society.

Medicine has always been more art than science, famously so; a doctor is not a scientist, even if he researchs and publishes, he's a different animal from a clinical researcher.

Doctors make, and have always made, and will always make, medical decisions on far less verity than any scientist would accept, for obvious reasons. Thanks to modern science, you can almost count on him(or her- new times indeed) not to kill you with the treatment. Our modern doctor has a vast arsenal of sceince based medicine at his disposal, but you may trust that every decision he makes is grounded in nothing more or less than his own hubris, and if you're lucky, his brains and experience and his expertise. Nothing whatsoever to do with science. In point of fact, our medical educational system is mostly designed to weed out the unintelligent, the fools and the irresponsible- aside from basic scientific literacy, that is your guarantee that your doctor won't fuck you up even worse- a general merit system. Works pretty well, actually! Science? Nothing to do with it.

Thanks to, again, modern science, and medical institutions, he is right more often than not, or has the tools to attack a problem he may not be right about, but he is not a scientist. He is an artist.

Picasso has more in common with a doctor than Neil Bohrs by a large margin. Sleep on that before your next checkup, o my brothers.

US Doctors are fucked (0, Interesting)

Anonymous Coward | more than 5 years ago | (#27036275)

The next decade of 'change' in the US will reduce doctors to government functionaries. Too bad you sunk $150k into that education... you will soon be making the equivalent of 4 year engineer wages, and you'll have less discretion while earning it.

You deserve it. All of my life I've listened as the grabbers made their claims; US infant mortality is higher than the socialists, US lifespan is short because of free market medicine. Claims that the majority of US doctors would prefer a collectivized system. It all went unanswered by you. It was fear of offending your international colleagues. Fear of revealing the truth about canukistan's medicine, for instance. It's hard to defend a free market system while arguing for more government *-cade dollars, isn't it?

You kept your mouth shut because controversy is unpleasant, and now the barbarians are at the door. Enjoy your ass raping. That's what CER is all about; determining the precise technique and quatity of lubrication necessary to fuck the doctors and hospitals right up the tailpipe.

And if you educrats out there think Uncle Sam is going to pay full retail to make higher education 'free' in this country... LOL.

Subject (1)

z-j-y (1056250) | more than 5 years ago | (#27036281)

the funny thing is, medical studies changes their conclusions all the time. one day low temperature won't worsen your cold, the next day it does. one says coffee will save your life, another says it will kill you.

glad that finally we'll have a single authority to give us one definitive answer for any question.

Misleading Title (4, Insightful)

LightPhoenix7 (1070028) | more than 5 years ago | (#27036297)

While I understand the need to have a catchy title, it's grossly mis-representative of the problem. Doctors don't hate science - doctors hate the misapplication of science and the failure to apply common sense. Hence, pap smears for patients without a cervix.

Re:Misleading Title (1)

rthille (8526) | more than 5 years ago | (#27036457)

Well, there are quite a few doctors who deny the fact of evolution...

depends on the doctor (1)

Trepidity (597) | more than 5 years ago | (#27036507)

There is quite a lot of resistance in the medical community to evidence-based medicine, especially among older doctors. The "everything requires subjective judgment of the practitioner, damn what your numbers say" strain of doctoring didn't really die out in the 19th century. Most doctors, actually, probably operate more based on folk knowledge and rules of thumb than any solid empirical evidence, except in specialized areas.

What about the 10,000,000 women? (0)

Anonymous Coward | more than 5 years ago | (#27036311)

Why didn't they speak up about the Pap test? Is it possible that the test still has a purpose even if you don't have cervix?

Why Doctors Hate Science (0)

Anonymous Coward | more than 5 years ago | (#27036327)

The title is quite sensationalist. If this were an article on the iPhone it would garner a rebuttal 5 times the original article's length.

Constraining decisions isn't bad... (1)

greg_barton (5551) | more than 5 years ago | (#27036373)

...when they're constrained by reality.

Theodoric the Barber (1)

flaming error (1041742) | more than 5 years ago | (#27036375)

Six minute video, [nbc.com] don't need to watch it all, but be sure to catch the last 45 seconds.

Doctors Hate Science? (1)

Orion Blastar (457579) | more than 5 years ago | (#27036377)

This sounds like the kind of old country doctor that Dr. McCoy would be on the USS Enterprise and argue against Mr. Spock's Science and Logic, all the while Dr. McCoy uses science in his medical bay to treat patients.

One can reason that the cervical cancer tests would reveal other sorts of cancer as well. It is like a woman who had hear breasts removed, died of breast cancer later anyway as the cancer came back after the breasts were surgically removed.

Why can't we just have one general "cancer test" developed for all kinds of cancer that exist, be it cervical, breast, lung, kidney, colon, etc? Our technology is as advanced as it can get for this day and age.

Instead of Dr. McCoy, we now have Dr. House who gets a patient with a "mystery illness" as many diseases and cancers, etc share symptoms. Then they have to run dozens of tests until they find the right one via logic and deduction and process of elimination. Until the heathcare insurance company or the government gets the bill for the dozens of tests run to solve the illness the patient had, and then treat it.

If a person's life is at stake, how many tests a doctor is allowed to make, could mean the difference between life and death.

Well Mr. Smith we'd like to run a series of tests to see what illness you have, but Obama and Congress passed a healthcare bill that limits us to run just one test. We ran it for lupis, but it came back negative, and since we ran one test, we cannot run another. I'm afraid we'll have to just release you from the hospital and write it up as "the flu" and give you a prescription for antibiotics. Sure hope it isn't cancer, AIDS, or even something that might kill you. Best of luck, Mr. Smith, we got other patients to help out now, they pile up a lot and we are really busy after that Universal healthcare bill got passed.

If we're gonna have a medicine flamewar... (2, Insightful)

The Master Control P (655590) | more than 5 years ago | (#27036515)

I figure I might as well throw in my two cents:

Last summer, I hurt one of my shoulders bad. It was somehow dislocated before it slipped back into place. I'm well aware that this does a good job fucking up the joint. For the first week, it was a dull ache that got acute when I moved my right side at all. I couldn't swing my arm backwards past straight out, to say nothing of doing any pushups. It's been about 4 months now and I can finally just about lay down on my back arms-straight-up without any nagging pain.

We can't afford health insurance so I never even considered seeing a doctor. Why risk getting raped for half a semester's tuition just so they can either say "you'll get better" or recommend more things we can't afford?

Now go ahead, tell me it's my fault for not working hard enough to have insurance or that I'd have to wait in line in England. At least there someone will eventually take a look at it.

Child abuse (1, Insightful)

TechwoIf (1004763) | more than 5 years ago | (#27036517)

Will this help hospitals stop cutting the penis of babies? I know a few folks that want there foreskin back.
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