When Evidence Says No, But Doctors Say Yes ProPublica
David Epstein – with audio podcast
“In a 2013 study, a dozen doctors from around the country examined all 363 articles published in The New England Journal of Medicine over a decade — 2001 through 2010 — that tested a current clinical practice, from the use of antibiotics to treat people with persistent Lyme disease symptoms (didn’t help) to the use of specialized sponges for preventing infections in patients having colorectal surgery (caused more infections). Their results, published in the Mayo Clinic Proceedings, found 146 studies that proved or strongly suggested that a current standard practice either had no benefit at all or was inferior to the practice it replaced; 138 articles supported the efficacy of an existing practice, and the remaining 79 were deemed inconclusive.”
“Intensive medication to keep blood pressure very low in diabetic patients caused more side effects and was no better at preventing heart attacks or death than more mild treatments that allowed for a somewhat higher blood pressure.”
“. . use of a genetic test to determine if a popular blood thinner is right for a particular patient — but gaining in popularity despite mounting contrary evidence.”
“CPR is no more effective with rescue breathing than if chest compressions are used alone”
“. . breast-cancer survivors who are told not to lift weights with swollen limbs actually should lift weights, because it improves their symptoms”
“Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all”
And, the situation will probably get worse
“The 21st Century Cures Act — a rare bipartisan bill, pushed by more than 1,400 lobbyists and signed into law in December — lowers evidentiary standards for new uses of drugs and for marketing and approval of some medical devices.”
“. . medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof.”
“ . . postmenopausal patients to go on hormone therapy for heart health - a treatment that at the millennium accounted for 90 million annual prescriptions - only to then see a well-designed trial show no heart benefit and perhaps even a risk of harm.””
Recently . . 1,600 hospitals across the country concluded that about half of all stent placements in stable patients were either definitely or possibly inappropriate.”
. . “removing financial incentives can also help change behavior. “I have a dozen or so cardiologists, and they get the exact same salary whether they put in a stent or don’t,” Nissen says, “and I think that’s made a difference and kept our rates of unnecessary procedures low.”
“The study authors concluded that cardiologists were being influenced by the “availability heuristic,” a term coined by Nobel laureate psychologists Amos Tversky and Daniel Kahneman for the human instinct to base an important decision on an easily recalled, dramatic example, even if that example is irrelevant or incredibly rare.”
“Stenting is what scientists call “bio-plausible” — intuition suggests it should work”
“. . study, which compared atenolol [ a beta-blocker] with sugar pills. It found that atenolol didn’t prevent heart attacks or extend life at all; it just lowered blood pressure”
Hospitals, doctors, pharmacies, big pharma, etc. each have negative incentives to use Vitamin D – doing so would decrease their income
“It is, of course, hard to get people in any profession to do the right thing when they’re paid to do the wrong thing.”
“There is some evidence that atenolol [a beta-blocker] might reduce the risk of stroke in young patients, but there is also evidence that it increases the risk of stroke in older patients - and it is older patients who are getting it en masse.”
“ . . in 2014, atenolol was prescribed to more than 2.6 million Medicare beneficiaries,. . “
Use of atenolol is finally decreasing : , ,” If that rate holds, atenolol will stop being prescribed in just under two decades. . “
Meniscus surgery was found to be no better than sham surgery.at 1 year, yet meniscus surgery continues to be “. . one of the most popular surgical procedures in the hemisphere”
Deep brain stimulation of 7 Parkinson’s patients seemed to help their spatial memory. The trial was replicated a few years later with 49 Parkinson/s patients – it found that deep brain stimulation actually impaired spatial memory in their study.
“Antibiotics for a sinus infection will resolve symptoms faster in one of 15 people who get them, while one in eight will experience side effects”
“A meta-analysis of sleep-aid drugs in older adults found that for every 13 people who took a sedative, like Ambien, one had improved sleep — about 25 minutes per night on average — while one in six experienced a negative side effect, with the most serious being increased risk for car accidents.”
Referenced the website The Number Needed to Treat
- Blood Pressure Medicines for Five Years to Prevent Death, Heart Attacks, and Strokes
- Benefits: 1 in 125 were helped (prevented death). 1 in 67 were helped (prevented stroke). 1 in 100 were helped (prevented heart attack*)
- Harms: 1 in 10 were harmed (medication side effects, stopping the drug)
- Aspirin to Prevent Cardiovascular Disease in Patients with Known Heart Disease or Strokes
- Benefits: 1 in 50 were helped (cardiovascular problem prevented), 1 in 333 were helped (prevented death), 1 in 77 were helped (prevented non-fatal heart attack), 1 in 200 were helped (prevented non-fatal stroke)
- Harms: 1 in 400 were harmed (major bleeding event*)
- Aspirin to Prevent a First Heart Attack or Stroke
- Benefits 1 in 1667 were helped (cardiovascular problem prevented), None were helped (prevented death), 1 in 2000 were helped (prevented non-fatal heart attack), 1 in 3000 were helped (prevented non-fatal stroke)
- Harms: 1 in 3333 were harmed (major bleeding event*)
I later found that as far back as 1982 that there was no benefit in doing so.
In the past decade there have been many meta-studies, Cochraine reports, etc.
At age 71 this was my first time in an hospital.
I had taken too much highly bioavailable Curcumin every 4 days for 2 weeks.
I later found that Curcumin has Oxalte which makes Calcium Oxalate stones in the Kidney