The new BMJ (i.e., British Medical Journal), which unfortunately gives the commoners only limited access to the stuff they are probably least inclined to read, has several items of interest to us colonists as we yell and scream about rationing and bureaucrats. The tea slurping decolonization monkeys think about these things rather differently than we do; their pinko doctors offer an instructive perspective.
- Katy Bell et al find that routine monitoring of bone density in the first three years after post-menopausal women start on the anti-osteoporosis drug bisphosonate is useless and even misleading. Save money, don't do it.
- CC Butler and a multitude find that there are big regional variations around Europe in the likelihood that adults with coughs will be prescribed antibiotics, but there is no association with better outcomes. Overprescribing of antitbiotics, as our faithful readers know, wastes money, causes adverse effects (for one thing, it can wipe out the endosymbionts in our throats and intestines, causing opportunistic infections), and of course promotes antibiotic resistance in pathogens. In Europe, of course, there tend to be bureaucrats who could get doctors to stop doing this. They should consider restricting people's personal freedom to waste money, harm themselves, and risk the doom of humanity.
- According to SG Thompson and colleagues, routinely screening men age 65-74 for abdominal aortic aneurysm reduces the 10 year risk of death from .87% to .46%, so according to my calculations you could save a life by screening 243 men. They figure this will cost about 7 600 pounds sterling per avoided death, which they deem worth it. Of course, these guys are already getting on so they may not have long to go even if they avoid the aneurysm, but still. Of course, this doesn't save money, it costs money, but we still might want to do it. Rescreening the guys who were negative ten years later, however, is probably not worth it.
- Joanna Moncrief and David Cohen argue -- entirely correctly as far as ol' Les is concerned -- that psychiatric drugs, specifically "antipsychotics" and "antidepressants" -- don't really target specific underlying disease processes. No, depression is not a serotonin deficiency and psychosis is not a disorder of dopamine processing. We don't really know what the heck they are. These drugs produce altered mental states which may just happen to make some people feel better, e.g. by suppressing affect they make people with psychosis calmer. That doesn't mean they are treating the disease, however. If patients understood this -- which would first require the drug companies to stop lying about it, although they don't mention that -- they would probably consume less of these drugs, save money, and avoid side effects.
- New results in the Archive of Internal Medicine show that people with chronic kidney disease do just fine on lower doses of drugs that increase the red blood cell count. The manufacturers, by the way, have pushed for higher doses. Natch.
- Iona Heath is a physician who declines her own doctor's recommendation that she have screening mammograms. She writes that "for every 2000 women invited to screening for 10 years one death from breast cancer will be avoided but that 10 healthy women will be "overdiagnosed" with cancer. This overdiagnosis is estimated to result in six extra tumorectomies and four extra mastectomies and in 200 women risking significant psychological harm relating to the anxiety triggered by the further investigation of mammographic abnormalities. The percentage of women surviving 10 years if they are not screened is 90.2%; it is 90.25% if they are screened. Is this enough of a difference to risk the possibility of significant harm? For me, it is not." If more women were given this information -- which is entirely accurate, by the way -- fewer might choose to be screened.
So we Americans need to clearly understand that meaningful choice requires accurate information. The freedom to choose to waste money and harm yourself out of ignorance is the opposite of freedom, as far as I'm concerned. People need to stop degrading and abusing the word freedom: it doesn't pertain exclusively to rapacious capitalists, it needs to be our common possession.