Thursday, June 01, 2006

Medical guesswork--no evidence required?

The cover of BusinessWeek magazine's May 29th issue was a bit of a surprise to see: Medical Guesswork: From heart surgery to prostate care, the medical industry knows little about which treatments really work. The article, by John Carey, highlights a lot of work done by Dr. David Eddy--a medical doctor turned researcher/mathematician who has challenged the medical profession by proving that the practice of medicine is more guesswork than science. Doctors acknowledge that the "portion of medicine that has been proven effective is still outrageously low--in the range of 20 to 25%. We don't have the evidence [that treatments work] and we are not investing very much in getting the evidence." says Dr. Stephen C. Schoenbaum.

In other words, what they're saying is that medicine isn't 'evidence-based' is instead "based largely on rules and traditions, not scientific evidence." And the result? Poor health care, unnecessary treatments, and millions of dollars spent that may be totally unnecessary. The article highlights a change in diabetes care whereby Dr. Eddy proved that the conventional treatment did little to prevent heart attacks and strokes (complications of diabetes) but replacing the conventional protocol with aspirin and generic drugs for blood pressure and cholesterol reduced these complications dramatically. And in the process saved millions while improving life.

Common treatments like angioplasty, ear tubes and spinal surgery were not helpful yet they were the 'gold standard' that patients thought they must have! Last year over 400,000 heart by-pass surgeries and 1 million angioplasties were performed yet the data shows that except for the 3% of most extreme cases, these patients would have had just as good a result with drug treatment. Think of the implications of this....the money spent, the risk of dying during these surgeries as well as the recovery time and this is an alarming situation.

I share this information and challenge you to think about your own health care. Realize that this article shows you MUST become involved and informed vs. just depending on your doctor to pick out a solution for you. This is a key component of Life Puzzle-making--self-responsiblity. When working with medical professionals ask yourself..."Is this doctor just guessing? Does he/she have evidence that this would be the best?" When presented with an option, I recommend you thank him/her and then say, "I want to think about this and check it out a bit more, but I'll get back to you".....and then go do your own research. It may save you lots of time and money.

I had my own experience with this guesswork. I had a dark spot mole on the ball of my foot. It was flat and gave me no problems--it was discovered through a routine check-up. The doctor says, "You might want to have that removed" and sent me off to a surgeon. I met with him and he said, "We don't really know why, but its a belief amongst us that moles on the foot become problematic, so we generally take them off as a preventive measure." I told him I would think about it--because the surgery was expensive and I would need to be off my foot for at least 6 weeks which would make life quite difficult, I wasn't looking forward to this. When I thought about it at home, it made less and less sense to me....and then I called a doctor friend of mine and told her what was happening--and said, "I think this is overblown--and it just doesn't make sense to me to perform surgery on something that's not giving me any problems--what do you think"?

I'll never forget her answer! She said, "Ann, can you see your foot?" I said. yes, I could. She went on and said "Then I suggest you look at it once a month and see if anything changes with that mole--end of treatment for now!" We then started laughing! And even now it makes me chuckle (and the spot went away on its own!), but I also know that for many people--they would have had that surgery! Because the doctor said I should.....

Now more than ever it is important that you understand that so many of the systems that we trust and thereby we assume they know what they're doing....DON'T! That's hard to swallow isn't it? We believe our government is on top of it, but Katrina proved otherwise. We believe our doctors/medical system knows what its doing and why--but this article clearly shows that much of the medical treatment used in this country is not based on good, sound, scientific evidence. With that said, you have to stand tall in your doctor's office and be a partner in your health care and make rational choices amongst this guesswork!