How to Stop Hospitals From Killing Us

[MachineGhost]

When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.

The world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.

http://online.wsj.com/article/SB1000087 ... lenews_wsj

[BearBones]

But these mistakes go largely unnoticed by the world at large, and the medical community rarely learns from them. The same preventable mistakes are made over and over again, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers.[/i]

Although the system is not perfect by any means (nor is it for air traffic control), it is not true that the systems are not meant to learn. There are layer and layers of protocols and oversight built around learning from and trying to prevent medical errors. For surgeries, for instance, there are elaborate procedures in place to reduce wrong site procedures. Many of these procedures were not in place 5-10 years ago, and the protocols are constantly evolving. Same for administering IV medications.

[MachineGhost]

Although the system is not perfect by any means (nor is it for air traffic control), it is not true that the systems are not meant to learn. There are layer and layers of protocols and oversight built around learning from and trying to prevent medical errors. For surgeries, for instance, there are elaborate procedures in place to reduce wrong site procedures. Many of these procedures were not in place 5-10 years ago, and the protocols are constantly evolving. Same for administering IV medications.

Very encouraging, but it does none of us any good until there is transparency so that consumers can avoid supporting hospitals that should fall victim to Creative Destruction.

[BearBones]

Very encouraging, but it does none of us any good until there is transparency so that consumers can avoid supporting hospitals that should fall victim to Creative Destruction.

I'm in the medical profession, so it is tempting to disagree. But I don't. Unfortunately, transparency to consumers is a very tricky concept, both for doctors as well as hospitals. Outcomes depend so much on the population being served, just as it is with teachers. So how do you compare results of a hospital (or school) serving indigent inner city population with that serving an affluent suburb. Then there are the legal ramifications, which are HUGE. If the legal barriers to transparency of medical errors were removed, the systems would likely improve much more readily, IMO.

[Reub]

How to keep them from killing us? Stay away!

[MachineGhost]

I'm in the medical profession, so it is tempting to disagree. But I don't. Unfortunately, transparency to consumers is a very tricky concept, both for doctors as well as hospitals. Outcomes depend so much on the population being served, just as it is with teachers. So how do you compare results of a hospital (or school) serving indigent inner city population with that serving an affluent suburb. Then there are the legal ramifications, which are HUGE. If the legal barriers to transparency of medical errors were removed, the systems would likely improve much more readily, IMO.

To those of us not in the medical profession, all we see is cryonism in supporting incompetent surgeons, doctors, nurses, procedures, etc. that harm and kill people and bureaucrats, politicians and institutions using legal terrorism to harbor and defend this anarchronistic, narcissistic, hubris-spewing collective.  So its not like "legal barriers" were ever in place for reasons of justice or economic efficiency for consumers.  Transparency would be a huge step in reform.

I am unclear if those doctor and hospital rating sites, like HealthGrades, popping up quite do the job or not?  I certainly use Yelp and whatever else review site I can find before I choose a physician.  I don't want to wind up paying precious non-insurance money to some egotistical, drug-pushing asshole that is closed minded to the wonderful wide world of alternative medicine.  So in that respect, review transparency has been beneficial for me, but clearly from what I observe, the system has a hell of a long ways to go before being anywhere near consumer-driven.

[stone]

Machine Ghost,

closed minded to the wonderful wide world of alternative medicine

Am I being naive in understanding that as soon as something has been shown to work then, by definition, it becomes conventional medicine rather than alternative medicine?

[l82start]

Machine Ghost,

closed minded to the wonderful wide world of alternative medicine

Am I being naive in understanding that as soon as something has been shown to work then, by definition, it becomes conventional medicine rather than alternative medicine?

  probably true if it is profitable to the makers of medicine and medical supply's, not so guaranteed if it involves food, vitamins, plants or treatment that they cant make a buck off of,

[Benko]

Am I being naive in understanding that as soon as something has been shown to work then, by definition, it becomes conventional medicine rather than alternative medicine?

It can become conventional medicine only if it works via a paradigm/model that conventional western medicine is comfortable with.  FOr example testing patients for vit D levels is becoming routine,and lipoic acid  (a nutritional supplement) is being prescribed for diabetes.  Other modalities or really unconventional approaches are another story and nobel prize winner max plank's comments still apply:

A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.
Max Planck

[stone]

Am I being naive in understanding that as soon as something has been shown to work then, by definition, it becomes conventional medicine rather than alternative medicine?

It can become conventional medicine only if it works via a paradigm/model that conventional western medicine is comfortable with.  FOr example testing patients for vit D levels is becoming routine,and lipoic acid  (a nutritional supplement) is being prescribed for diabetes.  Other modalities or really unconventional approaches are another story and nobel prize winner max plank's comments still apply:
A scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it.
Max Planck

If something is shown to work then doesn't it get adopted regardless of whether theory can explain why it works? If you know of an example of some treatment that does work but is regected because it is unknown how it works, then I'd be fascinated to hear about it.
Scientists often are attracted to the unexplained like moths to a flame. That Max Planck quote is fascinating though. I guess he had a tough time convincing people of his data/theories. He was able to convince the up and coming generation though by the sound of it.

[Benko]

Stone you have no idea how unwilling most docs are to accept anything new.  Look at the history of the cause of ulcers.  Forget the guys name but he had really good data showing that a certain bacteria causes ulcers.  No one believed him till he drank the bacteria infecting himself and then they started to believe him.  If I recall correctly it was decades after they discovered what could prevent scurvy (talking about ancient history now) before it was implemented.  NDs (naturopaths) are very open to trying new treatments, MDs,not so much.  MDs are not early adopters even of new conventional treatments even when there is a well designed article in prestigious journal.  Certainly some doctors will change their practice, but many will not.  The mayo clinic on vitamin D:


he new recommended daily allowance (RDA), as set in 2010, is based on age, as follows: for those 1-70 years of age, 600 IU daily;
http://www.mayoclinic.com/health/vitami ... ION=dosing

So the mayo clinic recommends archaic levels of vitamin D a topic which there is A LOT of data on (to put it really mildly).  What hope is there that anything even mildly controversial gets looked it?  Hint see Max Plank quote above.

[MachineGhost]

If something is shown to work then doesn't it get adopted regardless of whether theory can explain why it works? If you know of an example of some treatment that does work but is regected because it is unknown how it works, then I'd be fascinated to hear about it.

I think you're laboring under the false assumption that medicine is evidence-based and not profit-based or ego-based.  Remember, we have a relatively higher death-grip of crony capitalism in our health care system compared to NHS's socialized medicine.  Profits and reputation triumphs everything else.  All of the college curriculum's and research grants are controlled by the pharmacuetical industry and there is a revolving door syndrome and huge conflicts of interest with the numerous alphabet soup agencies responsible for "overseeing" everything.

There's tons of neglected treatments that work.  One off the top of my head, mostly because the pharmaceutical industry rejected it as too threatening to their profits after researching it, is graviola eradicating cancer.  Heck, even lowly garlic cures cancer.

There's also an amazing lag of 10 years between publication of scientific research and the application of it at the clinical/doctor level.

[stone]

Benko, I've actually been startled by how doctors on occasions have actually been too ready to be early adopters of novel therapies without sufficient evidence. A classic example is the chemotherapy regime for non-Hodgkin's lymphoma. The first effective treatment was the CHOP regime introduced in the 1970s. It cured about 35% of patients which was great but obviously left plenty of room for improvement.  Over the next couple of decades the chemotherapy regimes used "evolved" to become ever more complex and hazardous. The people who originally developed CHOP then tested the "third generation" regimes versus the old school CHOP regime in a large randomized trial. They showed that CHOP was actually superior.
I think humans have a frailty for wanting to tinker and also for projecting bogus patterns out of statistical noise. I think it is vital to properly scrutinize everything.

[stone]

Machine Ghost, you have the FDA to thank for a lot of the massive costs and delays. I've got the impression that big pharma actually loves the FDA because the FDA creates a wide moat that prevents smaller companies from entering the market. My better half actually worked on getting a molecular diagnostic from the lab to being FDA approved. It was ten years of massive struggle.

[MachineGhost]

Machine Ghost, you have the FDA to thank for a lot of the massive costs and delays. I've got the impression that big pharma actually loves the FDA because the FDA creates a wide moat that prevents smaller companies from entering the market. My better half actually worked on getting a molecular diagnostic from the lab to being FDA approved. It was ten years of massive struggle.

That only applies to drugs (synthetic single molecules) medical devices and soon biologics.  Anything that is not doesn't have to be approved by the FDA, but at the same time companies cannot make any claims that it mitigates or cure diseases or even cite scientific evidence, though the FDA is gradually losing the latter battle on free speech grounds.

Compared to the rest of the world, we are really damn lucky the DSHEA was passed in 1994 that told the FDA to fuck off out of the dietary supplement market after decades of relentless, heavy handed suppression; the EU and UK are currently going in the wrong direction (backwards).  Before DSHEA, it was quite hazardous to be in the "health foods" store business, nevermind practicing alternative medicine; you were liable to be raided and imprisoned by jack-booted, armed FDA thugs at any time.  There's still tons of old horror stories that have yet to be told or movies made out of.

The flimsy health freedom we enjoy today is all due to those handful of brave souls that didn't kowtow to the blundering, murderous FDA for decades upon decades.  Whether that be through nonviolent resistance or litigation.

[BearBones]

I think you're laboring under the false assumption that medicine is evidence-based and not profit-based or ego-based.  Remember, we have a relatively higher death-grip of crony capitalism in our health care system compared to NHS's socialized medicine.  Profits and reputation triumphs everything else.  All of the college curriculum's and research grants are controlled by the pharmacuetical industry and there is a revolving door syndrome and huge conflicts of interest with the numerous alphabet soup agencies responsible for "overseeing" everything.

There's tons of neglected treatments that work.  One off the top of my head, mostly because the pharmaceutical industry rejected it as too threatening to their profits after researching it, is graviola eradicating cancer.

Not challenging you, but curious. If indeed medicine ignores evidence based medicine in favor of profit and ego, can you provide some examples of treatments with level I (or even USPSTF II1) evidence that doctors are ignoring?

[MachineGhost]

Not challenging you, but curious. If indeed medicine ignores evidence based medicine in favor of profit and ego, can you provide some examples of treatments with level I (or even USPSTF II1) evidence that doctors are ignoring?

I think that's a tricky question because "standard of care" and "evidence based medicine" have slowly evolved over time to become more synonymous as the influence of post-DSHEA scientific research and expert algorithms have forced institutions and the underlying practitioners to "own up".  But just off the top of my head, I can't pull up some "standard of care" that has substandard medical evidence other than antibiotics for common colds or polypharmacy, though I've certainly read about many times in the past.  I think cancer oncology is probably the single worst example as it is very resistant and reluctant to any change for true increases in outcomes (nevermind actual curing) because it is such a huge profit center to hospitals ($100K+ in revenues per patient per year) and oncologists also tend to have huge super-egos buttressed by slick salesmen controlling their "education".  Very little real research filters down to oncology at the practical/applicable level.

One thing that really concerns me about algorithms and bots replacing more and more technicians and eventually doctors themselves is that the software might be a rigid "standard of care" controlled by the pharmaceutical industry who directly or indirectly provide the updates and medical data.  Unless it is "open source" like Wikipedia or something like that, medicine in the future may wind up being an even worse case of crony tyranny than at present.

[stone]

Machine Ghost, I'm personally thankful for the conventional oncology treatment I received (the CHOP chemotherapy I mentioned before). It was a 30year-old, off patent, treatment and saved my life. The oncologist I had was an angel.

I realize that things are a bit of a minefield now with many very expensive new cancer therapies that barely work. I wonder whether the whole pricing structure for drugs is dysfunctional. Perhaps having upfront prizes for developing effective drugs would be better than patents as a way of paying for drug development. Basically once a drug is developed it would make sense to me to provide it at cost of manufacture and use instead prize money to pay for drug invention.

[BearBones]

I think you're laboring under the false assumption that medicine is evidence-based and not profit-based or ego-based.

Not challenging you, but curious. If indeed medicine ignores evidence based medicine in favor of profit and ego, can you provide some examples of treatments with level I (or even USPSTF II1) evidence that doctors are ignoring?

I think that's a tricky question because "standard of care" and "evidence based medicine" have slowly evolved over time to become more synonymous as the influence of post-DSHEA scientific research and expert algorithms have forced institutions and the underlying practitioners to "own up".  But just off the top of my head, I can't pull up some "standard of care" that has substandard medical evidence other than antibiotics for common colds or polypharmacy, though I've certainly read about many times in the past....

Your first post asserts that modern medicine ignores good evidence, and your answer does not really support that. It is about something different entirely. All of us realize that many things in medicine are not on firm scientific footing, especially when nothing better exists. But to say that good evidence is ignored in favor of ego or profit, could be perceived as a rather inflammatory and flippant remark if it is unsubstantiated.

[Reub]

It is much more than medical mistakes alone that can kill you in a hospital. There are antibiotic resistant microbes of many kinds lurking within their walls. MRSA and clostridium difficile are just 2 that come to mind. They are prevalent in hospitals.

[MachineGhost]

Your first post asserts that modern medicine ignores good evidence, and your answer does not really support that. It is about something different entirely. All of us realize that many things in medicine are not on firm scientific footing, especially when nothing better exists. But to say that good evidence is ignored in favor of ego or profit, could be perceived as a rather inflammatory and flippant remark if it is unsubstantiated.

I don't recall using the term "ignore", so I would not put it that way.  I would put it that the institutional [dis]incentives cause health authorities to choose in their own self-interest over that of the patient.  This is basic game theory.  The catch is they're hardly aware that they are doing so to patients and would likely become emotionally indignant if anyone accused them of such.  In fact, most humans are not aware of their cognitive biases or environmental influences on their actions.

Certainly, I aim to be inflammatory because people must be shocked out of their comfort zone for them to question their premises (anger is a strong motivator), but I was not being flippant.  The evidence is out there if anyone really cares enough to hunt it down.  If I come across anything again in the future, I will post it to this thread.

[BearBones]

Your first post asserts that modern medicine ignores good evidence, and your answer does not really support that. It is about something different entirely. All of us realize that many things in medicine are not on firm scientific footing, especially when nothing better exists. But to say that good evidence is ignored in favor of ego or profit, could be perceived as a rather inflammatory and flippant remark if it is unsubstantiated.

I don't recall using the term "ignore", so I would not put it that way.  I would put it that the institutional [dis]incentives cause health authorities to choose in their own self-interest over that of the patient.  This is basic game theory.  The catch is they're hardly aware that they are doing so to patients and would likely become emotionally indignant if anyone accused them of such.  In fact, most humans are not aware of their cognitive biases or environmental influences on their actions.

Certainly, I aim to be inflammatory because people must be shocked out of their comfort zone for them to question their premises (anger is a strong motivator), but I was not being flippant.  The evidence is out there if anyone really cares enough to hunt it down.  If I come across anything again in the future, I will post it to this thread.

That it is being ignored seems implied by your statement.

Agree that there are incentives and disincentives in most everything, including medicine, and this can have negative impact on otherwise appropriate decisions. But that is a far reach from a blanket statement that medicine is "profit based or ego-based." Very few physicians will ignore treatments with well-supported evidence for efficacy just for profit or ego, IMO. But believe what you will.

As for the evidence, shouldn't you be the one to hunt it down? You are the one that made the statement, so it is your credibility on the line. I hope you are not a doctor.

[MachineGhost]

As for the evidence, shouldn't you be the one to hunt it down? You are the one that made the statement, so it is your credibility on the line. I hope you are not a doctor.

True, but I believe more in the philosophy of teaching a man how to fish, not giving him a fish.  Considering I'm just a layperson with no ego or pecuniary interest to protect and that I don't get paid for hunting down proof, I just don't have the interest to do so if I don't have it at hand already.  But here's a good start.  A new book Bad Pharma has just been published.  From the intro:

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in its life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all. These are ongoing problems, and although people have claimed to fix many of them, for the most part, they have failed; so all these problems persist, but worse than ever, because now people can pretend that everything is fine after all.

The "whole book is about meticulously defending every assertion in the paragraph" above.

http://www.amazon.co.uk/dp/0007350740/

[Gumby]

One example that comes to mind is Gum Disease.

In June, I went in for my normal dental checkup and my dentist decided that my gum recession had worsened to the point that he referred me to a periodontist. He said "once your gums recede, they never grow back" and he said the periodontist would likely recommend grafting surgery to replace the gum line on three or four of my teeth.

Well, I wasn't particularly happy with the idea of surgery so I went home and looked for an "alternative" treatment.

My research turned up an interesting story...

It turns out that during the 1960s a periodontist by the name of Dr. Joseph Phillips discovered that most gum disease was caused by conventional tooth brushing — which tends to be too vigorous, merely moves plaque around the mouth and mostly deposits it under the gum line (much like sweeping dirt under a carpet).

So, a few decades ago, Dr. Phillips designed a simple and very inexpensive toothbrush that could remove plaque from the mouth and re-grow a person's gums if used in certain way. His new toothbrush had very soft bristles, rounded ends, and a cap that maintains its shape. Then he devised a very specific brushing technique to maximizes the capillary action of the new brush. No toothpaste is used (otherwise, it would clog the capillary action). If you wish to use toothpaste, brush your teeth lightly with your normal tooth brush and then you follow up with the "Phillips Blotting Brush and Technique".

You can find blotting brushes online for about $3/brush.

When used properly, the Phillips Blotting Brush & Technique can restore and grow gums — provided the recession isn't severe.

Here's an old video of Dr. Phillips demonstrating his technique on a patient.

Well, I tried it out — seeing I had very little to lose (other than more of my gums). And guess what... It's only been eight weeks and my gums have almost completely grown back.

I'm certain that if I had visited the periodontist, I'd have had unnecessary gum surgery by now. It's far more profitable for a periodontist to charge me hundreds of dollars for gum surgery rather than $12 for a pack of blotting brushes.

Of course, when the Phillips Blotting Technique was first discovered, you couldn't just watch the instructional video on YouTube and order the brushes online like you can today. You had to actually go to a dentist or periodontist that learned the technique somehow and happened to have the brushes on hand. As you might imagine, most dentists and periodontists probably didn't see the point of such an inexpensive solution that would have undermined their revenue so much. So, over time, the technique has mostly been lost and ignored by dentists and periodontists as well as the ADA.

[Reub]

Gumby you might want to look into that Emmi-Dent ultrasound toothbrush that Machine Ghost recommended a while ago. I bought one and there is little movement of the toothbrush at all to cause gum loss. You just leave the toothbrush in place and then move it to the next group of teeth every five seconds or so allowing the ultrasound to do the work. It feels as if you went for a professional cleaning every time that you use it. The only downside is that you need a little more patience when brushing.

http://www.emmi-dent.com/