Why Almost Everything You Hear About Medicine Is Wrong

MMiz

MMiz

I put the M in EMTLife
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Why Almost Everything You Hear About Medicine Is Wrong

If you follow the news about health research, you risk whiplash. First garlic lowers bad cholesterol, then—after more study—it doesn’t. Hormone replacement reduces the risk of heart disease in postmenopausal women, until a huge study finds that it doesn’t (and that it raises the risk of breast cancer to boot).

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Quite depressing. This isn't exactly a revelation, particularly with the big pharm industry, but at least someone in a public position is giving it attention.

Some may argue against evidence based insurance reimbursements, but it would do a great deal to put these into check.
 
A word from Rip Van Winkle!

I fell asleep in 1985, I was kind of bowling with these midgets and got drunk and you know how THAT goes! Anyhow, when I awoke, all the evidence showed it was 2010!

What WAS in that drink, anyway, and where can I get more?

Okay, so I'm HERE now and I just gotta accept that EVERYTHING has changed. But you know what blows my mind? Almost EVERY drug or therapy or procedure I used to save lives when I was a paramedic in 1980 has been de-bunked, if not banned altogether!

You think I'm kidding? They even took "A" and "B" out of the "ABC'S of CPR"!!! Man, what an eye-opener! In ONE generation, everything that made me what I was got overturned; go figure! This freaked me out even more than learning my wife has been dead for ten years!

But I made myself feel better, you know how? I checked out the newest advances and guess what they're saying right now? They're saying that aggressive treatment to defeat sudden death is OUT and helping the victims attain a state of suspended animation either through cooling or drug administration as close to the time of the incident as possible is the way to go!

That tells me, 25 years from today, all the stuff you do now will have been declared obsolete as well. If all this is true then, and the painful part is, statistically, we've really not made that much of a dent on our adversary any way we've done it since our inception in the late 1960's -- I have to ask:

If we are administers of drugs and therapies that are likely to be proven ineffective in the future, would it make sense for us to take more responsibility to both choose AND monitor the drugs we DO use?

Right now, we just give what they tell us. We learn what they tell us. They never say, "This is unlikley to provide a favorable long-term result for your patients." Do they?

What if we empowered an investigative body to compile a list of drugs and interventions that provide the highest rate of success with the least amount of side-effects? What if they make the decision if a drug is still in an "experimental" or "Proven" stage and then make recommendations for the appropriate sequence of interventions for each emergency.

Yes, it's a form of standardization, but as it stands, we're STILL administering far too many therapies that are still speculative than may be good for our patients.
 
Part of the problem with that perception is this:

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But yes there are more than a few problems with the way research is conducted and published.

All the more reason why EMS needs more providers who can interpret research, and conduct it themselves in order to drive our profession forward.
 
This doesn't look like news.

It has been known for some time that there is a bunch of questionable research.

Books have been written on unconscious bias in doing all scientific research.

But lack of education goes a long way. Let me talk about vitamin D.

Do you think that the vitamin D you can buy at the store works?

Answer: nope, it doesn't.

Long and short you know why?

Answer: because to get active vitamin D you need a prescription, because it can really mess you up.

B12? Even in underdeveloped nations you have a 9-11 year supply in your body unless you have some profound disease with some very overt symptoms.

The list goes on.


But here is the real rub with "evidence based medicine." Practice guidlines are usually given in the form of a Bell curve to make it easy to understand. Well, when you make it easy to understand, you lose a lot of accuracy.

Most medications prescribed will help some people some time. Effective medicine, that which improves lives and outcomes, doesn't come from industrialized application of it. If the pre bell curve study shows a drug works for 10% of the people it is administered to, how do you decide that is not enogh to pay for it?

What is the cutoff? 1% of the world population is 600,000,000 people.

If you decide that your only paying for treatment that helps most people, what happens to some people? Too bad, so sad?

I especially like the part about surgical procedures not being scrutinized. With the exception perhaps of cosmetic surgeons, most surgeons I know see surgery as a treatment of desperation.

What abot palliative surgery? You know it won't cure, you do it to make things better for a short while.

The big problem with "evidence based" medicine is our over reliance on it. It is a tool. One of many in the box.

If you really want to know where you stand on the health scale, go see you doctor and have a health screen. A real one, with tests. Not just a brief physical. Ask to find out what things like your hba1c is today.

Of course that could cost you a few $1000 because your "health insurance" doesn't pay to prevent you from getting sick. They just palliate you after you do. Sometimes...

Medicine is very complex. It is too complex today for people to understand enough about it to make their own decisions. Where do they get most of their information? "I saw it on TV as a sound byte." Excellent.

ok off to go take a test.
 
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