When Evidence Says No, But Doctors Say Yes

[StarchHEFP]

https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

Fresh off the press:

When Evidence Says No, But Doctors Say Yes
Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.

by David Epstein, ProPublica
February 22, 2017

[bbq]

http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2071976/pdf/bmj-335-7627-ltr-0951a.pdf

Big Pharma Plays Hide-the-Ball With Data - Newsweek
http://www.newsweek.com/2014/11/21/medical-science-has-data-problem-284066.html

How Scientific Is Modern Medicine Really?
http://www.huffingtonpost.com/dana-ullman/how-scientific-is-modern_b_543158.html

Regarding Ignorance and Shamelessness in the US Medical Industry … plus more
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684106/

One turns on a comment from Steven D. Shapiro, md, chief medical and scientific officer for the University of Pittsburgh Medical Center (UPMC) at the largest, international, interprofessional health meeting. In a plenary panel with his fellow health system leaders from Mayo and University of Minnesota, Shapiro stated bluntly, “Only about a quarter of what we do has strong evidence and we only do that about half the time.” The comment was tossed off in a matter-of-fact way, unchallenged by his colleagues. He was merely sharing an accepted reality. UPMC is that city’s largest employer.

Behind the Curtain With Dr. Oz
http://www.huffingtonpost.com/dr-dean-ornish/behind-the-curtain-with-d_b_6608128.html

Recently, an article in the British Medical Journal concluded that evidence supported only 46 percent of the recommendations made on the Dr. Oz show. Headlines proclaimed, “More than half of Dr. Oz’s advice is baseless or wrong!”

What this study didn’t mention is that less than half of conventional medical care — what your doctor tells you — is based on randomized controlled trials and strong scientific evidence. Much less.

For example, the joint cardiovascular practice guidelines of the American College of Cardiology (ACC) and the American Heart Association (AHA) have become important documents for guiding cardiology practice and establishing benchmarks for quality of care. An article in the Journal of the American Medical Association reviewed these guidelines and concluded that only 11 percent of the 2,711 guidelines met the A-level of evidence (i.e., strong evidence from randomized controlled trials) and 48 percent met the C-level of evidence (i.e., based on the personal opinions of experts in the field).

Not so different than the Dr. Oz level of evidence.

[pundit999]

In 2012, Brown had coauthored a paper that examined every randomized clinical trial that compared stent implantation with more conservative forms of treatment, and he found that stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure.

“Nobody that’s not having a heart attack needs a stent,” says David Brown, cardiologist and professor at the Washington University School of Medicine. (Whitney Curtis for ProPublica)
Brown explained to the executive that his blockage was one part of a broader, more diffuse condition that would be unaffected by opening a single pipe. The cardiovascular system, it turns out, is more complicated than a kitchen sink. The executive started medication and improved his diet. Three months later, his cholesterol had improved markedly, he had lost 15 pounds, and the chest pain never returned.

Great article. Thanks for posting. This was published in the Atlantic also. So hopefully this is getting good coverage.

I was minutes away from getting a stent much like the executive in the article. I did my own research and quickly found enormous evidence that stents do not work for stable patients like me. I also then declined the procedure and instead changed my life style.

When I asked the cardiologist if getting a stent would mean that I would not have a heart attack in the future, the guy actually said with a straight face that yes, it would. I ran!

Be very afraid approaching a cardiologist or for that matter, any doctor.

[Skip]

Be very afraid approaching a cardiologist or for that matter, any doctor.

Totally agree with this sentiment.....without any symptoms it doesn't make sense.

I like the following quoted (concept) from the article which is true for doctors and patients:

The rationalizations in each focus group followed four themes: (1) Cardiologists recalled stories of people dying suddenly — including the highly publicized case of jogging guru Jim Fixx — and feared they would regret it if a patient did not get a stent and then dropped dead. 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.

[brec]

A bit over four years ago I was strongly advised to have a double bypass. Based on my own research, which included, but was not limited to, Dr. Esselstyn's results, I decided to continue with my recently-adopted dietary changes. I think my cardiologist had my best interests at heart [cough], but so far I'm happy with my decision.

[StarchHEFP]

Be very afraid approaching a cardiologist or for that matter, any doctor.

Totally agree with this sentiment.....without any symptoms it doesn't make sense.

I like the following quoted (concept) from the article which is true for doctors and patients:

The rationalizations in each focus group followed four themes: (1) Cardiologists recalled stories of people dying suddenly — including the highly publicized case of jogging guru Jim Fixx — and feared they would regret it if a patient did not get a stent and then dropped dead. 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.

What an awesome article. Here are #2, 3, 4. The lawsuit issue is definitely an issue. Bias is rampant in the lawsuit culture. There is something called "proximate cause" that the lawyers use. The last possible step prior to the patient dying that involves medical decisionmaking, must be the cause of death. It's easy to convince a jury that a doctor "denied the stent" to the patient when it "would have saved his/her life". You have no idea what nasty, nasty people those attorneys are. They keep us docs up at night, worried sick. This can't be quantified. That's why plant-based docs are derided and feared, that perhaps a patient will be told to do "natural" treatment, be halfheartedly compliant, and get a heart attack because we "failed to act". I see this (figuratively) EVERY SINGLE DAY where a patient just as the examples, with stable angina, who was half-ass about my recommendations, eventually went to a cardiologist and they stuck a couple stents in his arteries. (This may or may not be based on an actual case and may be factual or fictitious, I can't say)

Same as a doctor who is sued by a smoker's family because we "didn't do enough" to stop them from smoking. Believe it or not folks, this actually happens! Understand the quit smoking statistic is 5% or 1 in 20 smokers, actually quit. The deck is stacked. (Again, I am speaking hypothetically and not necessarily from any experience whatsoever).

Any suggestions from any legal minds on how to deal with the bad guys? (Talk to your OWN doctor for medical advice, don't take my medical advice. I may or may not be a licensed doctor. I'm just an anonymous kind of guy posting this info for discussion and education only. Don't take this as medical advice. Do not treat yourself. Any decision you make against medical advice might or might not kill you. Any decision you make after being given medical advice also may or may not kill or injure you. Always ask about the risks, benefits, and limitations of treatment with YOUR OWN doctor or doctors) -> true story (or maybe not a true story), I was advised to give a disclaimer like this by an attorney (again, I may or may not have been given this advice, I can't say).

(2) Cardiologists believed that a stent would relieve patient anxiety. (3) Cardiologists felt they could better defend themselves in a lawsuit if a patient did get a stent and then died, rather than if they didn’t get a stent and died. “In California,” one said, “if this person had an event within two years, the doctor who didn’t intervene would be successfully sued.” And there was one more powerful and ubiquitous reason: (4) Despite the data, cardiologists couldn’t believe that stents did not help: Stenting just made so much sense. A patient has chest pain, a doctor sees a blockage, how can opening the blockage not make a difference?

[Skip]

You have no idea what nasty, nasty people those attorneys are. They keep us docs up at night, worried sick. This can't be quantified.

However, if you are sued by one of these nasty people, your livelihood might rest in the hands of a competent defense lawyer to help you. It's akin to finding that plant based doctor that might really help someone vs a doc who will do any pill/procedure to make a buck.

[StarchHEFP]

You have no idea what nasty, nasty people those attorneys are. They keep us docs up at night, worried sick. This can't be quantified.

However, if you are sued by one of these nasty people, your livelihood might rest in the hands of a competent defense lawyer to help you. It's akin to finding that plant based doctor that might really help someone vs a doc who will do any pill/procedure to make a buck.

It's all about informing the patient. It's all about what you tell them, and write down as much as possible. This is the best defense. Including some information from clinical studies is also useful. There are 3 counties in Illinois, Madison, St. Clair and Cook County, where they are called the "Judicial Hellholes" of America. This is for a reason. Remember, the defense lawyers aren't paid that much, however the plaintiffs lawyers play a lottery every day. The difference between a doctor and a lawyer, is that we have an ethical code that we are at least supposed to follow. In a lawyer's world, ethics often goes out the window. Have you seen Jim Carrey's movie Liar Liar? It's like that.

Again, the above may or may not convey that I am or am not a licensed physician. The above was purely a hypothetical discussion and any bearing on any real events is purely hypothetical and fictional. This discussion may cause hair loss and graying of the hair. Please talk to your doctor before reading this passage. If you are a lawyer, please refrain from reading the passage, as it may cause feelings of shame and guilt.

Addendum: I had no idea but someone actually created this website: http://www.judicialhellholes.org/
Posting the above website does not constitute endorsement. The opinions of the website are not shared necessarily by me or Dr. McDougall. Visit at your own risk.

[bbq]

Well, we've gotta understand what they're doing on their side to make a living:

http://lanierlawfirm.com/attorneys/w_mark_lanier.htm
https://www.justice.org/event/putting-trial-beginning-end-featuring-mark-lanier



That's how they (both parents are lawyers) afford to raise 5 kids. Going on a family vacation for 2 weeks to cruise the Greek islands and coming back a week before the trial, packing 5 books about PowerPoint after ordering them off Amazon, feeding 4 of them to the fish before reading the only one that's engaging:

http://www.nytimes.com/2005/08/22/business/vioxx-verdict-raises-profile-of-texas-lawyer.html
http://lanierlawfirm.com/legal_practice_areas/pharmaceutical_liability/vioxx.htm

Then he called his colleague and asked her to get in touch with Cliff Atkinson who wrote that book Beyond Bullet Points:

http://lanierlawfirm.com/attorneys/dara-hegar.htm

Getting home Sunday night and then that author was in his office Monday morning:

https://www.amazon.com/Cliff-Atkinson/e/B001I9RREY

For that Collectabilitiy leg, why wouldn't they focus on pursuing the health care / sickness care industry since plenty of Benjamins could easily flow from one pocket to another?



US Spending on Personal Health Care and Public Health, 1996-2013
http://jamanetwork.com/journals/jama/fullarticle/2594716

http://jamanetwork.com/journals/jama/article-abstract/2594697

In 2015, the United States spent roughly $3.2 trillion on health care. That is a staggering, almost unimaginable amount. Indeed, this level of spending makes the US health care system the fifth largest economy in the world, behind only the US, Chinese, Japanese, and German national economies.

[Skip]

Remember, the defense lawyers aren't paid that much, however the plaintiffs lawyers play a lottery every day.

I have personal relationships with a doctor whose reputation was at stake in a big $$ case and a medical malpractice lawyer who defends doctors. Both agree on the importance that the defense lawyer has. Both sides of the case brought in their "medical" experts to prove their case and the skill of the attorney to present a case to a jury was critical. Defense lawyers can make a very comfortable living.

[brec]

...There is something called "proximate cause" that the lawyers use. The last possible step prior to the patient dying that involves medical decisionmaking, must be the cause of death. ...

Despite the ordinary meaning of the word "proximate," this is not what "proximate cause" means in law. In "proximate cause," "proximate" denotes logical or legal proximity, not chronological.

Proximate cause ... is not necessarily the closest cause in time or space nor the first event that sets in motion a sequence of events leading to an injury.

--http://legal-dictionary.thefreedictionary.com/proximate+cause

(This has almost nothing to do with the topic.)

--brec, law school class of 2020

[patty]

Be very afraid approaching a cardiologist or for that matter, any doctor.

Totally agree with this sentiment.....without any symptoms it doesn't make sense.

I like the following quoted (concept) from the article which is true for doctors and patients:

The rationalizations in each focus group followed four themes: (1) Cardiologists recalled stories of people dying suddenly — including the highly publicized case of jogging guru Jim Fixx — and feared they would regret it if a patient did not get a stent and then dropped dead. 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.

I liked this too.

Aloha, patty

[bbq]

Speaking of the lack of evidence, many "health" summits these days are making a killing while whatever they're advocating might not be always (unless they're reputable researchers or professionals etc.) backed by or grounded in anything whatsoever:

http://affiliates.foodrevolution.org/leaderboard/
http://affiliates.foodrevolution.org/faq/

Some affiliates have earned more than $250,000 for their organizations, promoting our past summits. Online courses have also generated significant revenues.

http://healthtalksonline.com/summit-model-dead/

Mega-Summits: +60k in attendance and several hundred thousand in gross revenue.

Let's pick this one as an example since he's appearing in plenty of "health" summits all the time:

http://thesciencepost.com/naturopath-gets-in-over-his-head-when-pilot-asks-if-anyone-on-board-is-a-doctor/

PHOENIX, AZ – On a recent flight from Washington to Phoenix, naturopath Josh Axe jumped out of his seat when the captain asked if anyone on board was a doctor. A passenger near the rear of the plan had begun seizing and was unconscious on the floor. The passenger also had a deep laceration on her forehead after hitting it on the seat while falling down.

According to reports, Mr. Axe laid the patient, 30-year old Genna Hill, on her back and asked someone to get him his carry-on bag. He apparently tried applying several different essential oils to the patient with no success. It was at this point that Axe declared the patient’s chakras were completely out of sync and he needed healing crystals stat.

“No one really knew what he was talking about,” said one passenger. “He kept asking for healing rocks and muttering about subluxations or something.”

Eventually one of the other passengers, a medical receptionist, mentioned to Mr. Axe that maybe he should apply some pressure to her head wound to help stop the bleeding. She also told Axe that he shouldn’t move her neck around so much and perhaps move her onto her side. It was at this point that Axe sank back onto his heels and declared “I think we lost her.”

Moments later the woman came to and slowly sat up with help from the medical receptionist, who was holding a towel on her head wound.

According to witnesses, Axe then rushed in and helped the woman to her seat, explaining that he had probably just saved her life.

Typical SAD eaters have been poisoning themselves with toxic food choices from cradle to death and pretty much any kinda lifestyle changes could lead to a certain degree of improvements. Ain't it too easy to take advantage of such low-hanging fruit when the bar is set so low?

[StarchHEFP]

Well, we've gotta understand what they're doing on their side to make a living:

http://lanierlawfirm.com/attorneys/w_mark_lanier.htm
https://www.justice.org/event/putting-trial-beginning-end-featuring-mark-lanier



That's how they (both parents are lawyers) afford to raise 5 kids. Going on a family vacation for 2 weeks to cruise the Greek islands and coming back a week before the trial, packing 5 books about PowerPoint after ordering them off Amazon, feeding 4 of them to the fish before reading the only one that's engaging:

http://www.nytimes.com/2005/08/22/business/vioxx-verdict-raises-profile-of-texas-lawyer.html
http://lanierlawfirm.com/legal_practice_areas/pharmaceutical_liability/vioxx.htm

Then he called his colleague and asked her to get in touch with Cliff Atkinson who wrote that book Beyond Bullet Points:

http://lanierlawfirm.com/attorneys/dara-hegar.htm

Getting home Sunday night and then that author was in his office Monday morning:

https://www.amazon.com/Cliff-Atkinson/e/B001I9RREY

For that Collectabilitiy leg, why wouldn't they focus on pursuing the health care / sickness care industry since plenty of Benjamins could easily flow from one pocket to another?



US Spending on Personal Health Care and Public Health, 1996-2013
http://jamanetwork.com/journals/jama/fullarticle/2594716

http://jamanetwork.com/journals/jama/article-abstract/2594697

In 2015, the United States spent roughly $3.2 trillion on health care. That is a staggering, almost unimaginable amount. Indeed, this level of spending makes the US health care system the fifth largest economy in the world, behind only the US, Chinese, Japanese, and German national economies.

Thank you so much for that very astute and detailed analysis! You sure know your stuff! I am quite impressed. In Chicago we have something called "Sutton's law" which means Willie Sutton was a bank robber, and when they asked him why he robbed banks he simply answered "because that's where the money is".

[StarchHEFP]

Speaking of the lack of evidence, many "health" summits these days are making a killing while whatever they're advocating might not be always (unless they're reputable researchers or professionals etc.) backed by or grounded in anything whatsoever:

http://affiliates.foodrevolution.org/leaderboard/
http://affiliates.foodrevolution.org/faq/

Some affiliates have earned more than $250,000 for their organizations, promoting our past summits. Online courses have also generated significant revenues.

http://healthtalksonline.com/summit-model-dead/

Mega-Summits: +60k in attendance and several hundred thousand in gross revenue.

Let's pick this one as an example since he's appearing in plenty of "health" summits all the time:

http://thesciencepost.com/naturopath-gets-in-over-his-head-when-pilot-asks-if-anyone-on-board-is-a-doctor/

PHOENIX, AZ – On a recent flight from Washington to Phoenix, naturopath Josh Axe jumped out of his seat when the captain asked if anyone on board was a doctor. A passenger near the rear of the plan had begun seizing and was unconscious on the floor. The passenger also had a deep laceration on her forehead after hitting it on the seat while falling down.

According to reports, Mr. Axe laid the patient, 30-year old Genna Hill, on her back and asked someone to get him his carry-on bag. He apparently tried applying several different essential oils to the patient with no success. It was at this point that Axe declared the patient’s chakras were completely out of sync and he needed healing crystals stat.

“No one really knew what he was talking about,” said one passenger. “He kept asking for healing rocks and muttering about subluxations or something.”

Eventually one of the other passengers, a medical receptionist, mentioned to Mr. Axe that maybe he should apply some pressure to her head wound to help stop the bleeding. She also told Axe that he shouldn’t move her neck around so much and perhaps move her onto her side. It was at this point that Axe sank back onto his heels and declared “I think we lost her.”

Moments later the woman came to and slowly sat up with help from the medical receptionist, who was holding a towel on her head wound.

According to witnesses, Axe then rushed in and helped the woman to her seat, explaining that he had probably just saved her life.

Typical SAD eaters have been poisoning themselves with toxic food choices from cradle to death and pretty much any kinda lifestyle changes could lead to a certain degree of improvements. Ain't it too easy to take advantage of such low-hanging fruit when the bar is set so low?

Wow, just wow. I can't believe that's a true story. And this certainly explains why my inbox is flooded with invites for "health summits" every few weeks! They are quite out of hand. Any one of these practitioners is free to put their talks out there on YouTube such as Dr. McDougall does, but now I understand they want you to pay a couple hundred, and split the money with the presenters.