Many Common Treatments Aren’t Helpful

by birtanpublished on September 19, 2020

Evidence-based medicine has made progress since doctors infamous bloodletting of George Washington but less than you might think why do doctors still offer treatments that may not be helpful that's the topic of this week's healthcare triage special thanks to

Austin frack rooms up calm this episode was a depth when your doctor gives you health advice and your insurer pays for the recommended treatment you probably presume it's based on solid evidence but a great deal of clinical practice that's

Covered by private insurers and public programs isn't the British Medical Journal sifted through the evidence for thousands of medical treatments to assess which are beneficial and which aren't according to the analysis there's

Evidence of some benefit for just over 40% of them only 3% are ineffective or harmful a further six percent are unlikely to be helpful but a whopping 50 percent are of unknown effectiveness we just haven't done the study sometimes

Uncertain and experimental treatments are warranted patients may even welcome them when there is no known cure for a fatal or severely debilitating health condition trying something uncertain as evidence is gathered is a reasonable

Approach provided the patient is informed and consents the gathered evidence should then be analyzed so we know what works and what doesn't in the future in many cases routinely delivered

Treatments aren't rigorously tested for years benefits are assumed harms ignored this kind of thinking may have killed George Washington it's 67 years old and a few months shy of three years after his presidency Washington reportedly

Awoke short of breath with a sore throat and soon developed a fever over the next 12 hours doctors drained 40% of his blood among other questionable treatments then he died Washington surely had a serious disease theories

Include croup diphtheria pneumonia and acute bacterial epiglottitis whatever it was bloodletting did a little but cause additional misery and most likely hastened his death though the procedure was common at the time for

A variety of ailments its benefits were based on theory not rigorous evidence in the ear of modern medicine this may strike some is primitive ignorant hundreds of years later the same thing still happens though

Fortunately not with bloodletting in the late 1970s some doctors thought they'd found a way to treat breast cancer patients with what would otherwise be lethal doses of chemotherapy the approach involved harvesting bone marrow

Stem cells from the patient's before treatment and reintroducing them afterward fueled by encouraging comments from doctors the 1980s news media reported higher chemotherapy doses as the means to survival yet there was no

Compelling evidence that bone-marrow transplants protected patients but told they would many patients fought insurers in court to get them under pressure from Congress in 1994 all health plans for federal workers were acquired to cover

The treatment yet not a single randomized trial had been done finally in 1995 the first randomized trial was published with impressive results half of women who received bone marrow transplants had no subsequent evidence

Of a tumor compared with just 4% of the control group but these results didn't hold up with for subsequent clinical trials contradicting them the approach was recognized for what it was ineffective at best lethal at worst

Wishful thinking that runs ahead of war goes against research finding is behind today's opioid epidemic – despite a lack of solid evidence for years many believe that modern opioid medications were not addictive it's now abundantly clear they

Are but the damage is done there are countless other examples of common treatments and medical advice provided without good evidence magnesium supplements for leg cramps oxygen therapy for acute myocardial infarction

IV saline for certain kidney disease patients the avoidance of peanuts to prevent allergies and children many knee and spine operations type blood sugar control and critically ill patients clear liquid diets before

Colonoscopies bed rest to prevent preterm birth and the prescribing of unnecessary medications to list just a few some of these cases there's even evidence of harm it is not uncommon for newer evidence to contradict what has

Been standard practice a study examined 363 articles in the New England Journal of Medicine starting from 2001 to 2010 that addressed an existing medical practice 40% the articles found the existing practice

To be ineffective or harmful some of these reversals are well-known for example three articles contradicted hormone replacement therapy for postmenopausal women another three reported increased risk of heart attacks

And strokes from the painkiller Vioxx looked at one way medical reversals like these represent a failure we didn't gather enough evidence before a practice became commonplace but in another way they were at least a partial

Success science eventually caught up with practice that doesn't always happen this is all part of a growing movement to identify harmful and wasteful care and purge it from health care systems the American Board of Internal Medicine

Is choosing wisely campaign identifies five practices in each of dozens of clinical specialties that lack evidence cause harm or for which better approaches exist the organization that assess the value of treatments in

England has identified more than 800 practices that officials there feel should not be delivered it's an uphill battle even when we learn something doesn't make us better it's hard to get the system to stop doing it it takes

Years or even decades to reverse medical convention some practitioners cling to weak evidence of effectiveness even when strong evidence of lack of effectiveness exists this is not unique to clinical medicine

It exists in health policy too much of what we do lacks evidence and even when evidence mounts that a policy is ineffective our political system often caters to invested stakeholders who benefit from it an honest assessment of

The state of science behind clinical practice and health policy is humbling though many things we do and pay for are effective there's a lot we don't know that's inevitable what is it inevitable where the real problems lie is assuming

Without evidence that something works Haeju enjoy this episode you might enjoy this other episode where we focus on how hard it is to get doctors to stop doing stuff once they've started we'd also like to start getting you to support the

Show at patreon.com slash healthcare triage where like our research associate Joe sevens or our surgeon Emeril Sam you can support the show and help us make it better

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