Map of life expectancy at birth from Global Education Project.

Friday, October 04, 2013

Doctor Doofus

There's nothing I can do, and nothing original I can say about the collapse of our republic, I'll just outsource to Timothy Egan then move on to my regular blogging agenda. Or rather, I will say this. It is really depressing to think that there are horrid communities in this country, full of racist, ignorant, cruel and repulsive people who would actually vote for the malignant clowns who run the Republican party. I will make sure never to visit such places.

Now, on to Stayin' Alive. In spite of 20 years or more of serious efforts to improve the quality of medical care and to rein in overdiagnosis, overtreatment and just plain wrong treatment, all sorts of news today that shows we are failing. First, I believe I have written before about low back pain. Most of the time it resolves on its own after a while; there is no benefit to commonly performed surgical procedures, nor to ordering MRI or other imaging procedures on routine presentation, and definitely more harm than benefit to prescribing narcotics. Ordinary over-the-counter pain relievers, maybe physical therapy, and just waiting are the right course unless there are other symptoms indicating a possible serious problem.

Well, Mafi et al in JAMA Internal Medicine (I think you'll get stopped at the abstract, but I have the magic cookie) find that from 1999 to 2010, mistreatment of low back pain increased in the U.S.

Nonsteroidal anti-inflammatory drug or acetaminophen use per visit decreased from 36.9%in 1999-2000 to 24.5%in 2009-2010 (unadjusted P < .001). In contrast, narcotic use increased from 19.3%to 29.1% (P < .001). Although physical therapy referrals remained unchanged at approximately 20%, physician referrals increased from 6.8%to 14.0%(P < .001). The number of radiographs remained stable at approximately 17%, whereas the number of computed tomograms or magnetic resonance images increased from 7.2%to 11.3%during the study period (P < .001).

Meanwhile, futile treatment of critically ill patients continues more or less unabated; doctors continue to prescribe antibiotics for upper respiratory tract infections which is a) generally useless and b) actually harmful to patients and c) harmful to all of society; and, in BMJ, we learn that most trials of cancer screening don't even bother to assess harms, which says a lot about the underlying psychology of physicians and clinical researchers. Obviously, if you only study potential benefits and ignore potential harms, you'll end up doing a lot of stuff you shouldn't do.

I almost despair, at times. Patients also think that more is necessarily better, and of course this fundamental misunderstanding contaminates our politics as well. No, efforts to reduce overdiagnosis and overtreatment are not "death panels." They are life panels. Reducing waste and harm in medical care is the only way to make the whole enterprise sustainable, affordable, and available to everybody and at the same time, it means better outcomes and healthier people.

And to hell with Republicans.


robin andrea said...

I have been diagnosed with degenerative arthritis in my cervical and lumbar spine. In addition to facet joint blah blah and spondylosis with hypertrophic something or other. Fortunately my doctor hasn't prescribed any medication for me, but did send a referral to a physical therapist last Friday (I'm still waiting for them to call me for an appt). I couldn't imagine taking a narcotic for the pain I feel. Well, I do enjoy a glass of w(h)ine when I think about Republicans.

Cervantes said...

Aha, you have something more than ordinary low back pain which is usually self limiting. But your definitely right, narcotics are not the way to go. Getting older has its downside, to be sure, but it's mostly tolerable.

Don Quixote said...

It is true that Obama never should have tried to compromise with mutant Republicans over the prospect of single payer, universal, comprehensive health coverage. He treated them as rational people and we now know they are anything but. Having lived in the South for years, I can see that racism is the #1 force behind the opposition to Obama's policies, but as Katrina vanden Heuvel points out in this month's Nation magazine (, there is a long history of rich American shitheads opposing universal health care.

Cervantes said...

That included the American Medical Association for most of its history, BTW. They only changed their position in the '90s. They were opposed to Medicare.

Anonymous said...

Last year I was told by an osteopath that I had "grumpy biceps". He said he could give me various medical terms that were all essentially meaningless but he preferred "grumpy". Told me definitely not to take any drugs. Sounds like your kind of doctor.