HEATSTROKE

Everyone is at risk for Heatstroke in times of extreme heat, those who are exerting themselves, but also those sitting quietly in the sun. Heat stroke is defined as a core body temperature in excess of 40.5ºC (105ºF) with associated central nervous system dysfunction in the setting of a large environmental heat load that cannot be dissipated

The truth is, you can develop heat stroke while sitting perfectly still, if you have certain risk factors like chronic medical conditions or use certain medications.
Hyperthermia is defined as elevation of core body temperature above the normal range of body temperature. Body temperature is maintained within a narrow range by balancing heat load with heat dissipation. The body's heat load results from both metabolic processes and absorption of heat from the environment. As core temperature rises, the the autonomic nervous system is stimulated to produce sweating and cutaneous vasodilation.

Evaporation is the principal mechanism of heat loss in a hot environment, but this becomes ineffective above a relative humidity of 75 percent. The other major methods of heat dissipation — radiation (emission of infrared electromagnetic energy), conduction (direct transfer of heat to an adjacent, cooler object), and convection (direct transfer of heat to convective air currents) — cannot efficiently transfer heat when environmental temperature exceeds skin temperature.

In other words when it gets hot and needs to pump faster, hearts weakened by heart disease may be unable to get the body cooled fast enough. People with high blood pressure or hypertension also experience greater stress on the heart, and hypertension sufferers often follow low-salt diets. Not having enough salt in your system can lower the threshold for heat stroke. People with diabetes can also easily become dehydrated, which keeps the body from sweating normally, and obesity not only puts extra pressure on the heart, but it also must work even harder to cool down a larger person.

Medications like diuretics (water pills) reduce the amount of fluid in the body and lead to easier dehydration. Beta blockers, often used to treat heart problems, can also prevent the heart from beating faster, thus inhibiting the body's cooling system. Older people are especially at risk for these factors affecting how your body reacts to the heat. Untreated heat exhaustion can lead to heat stroke, which is signified by a rapid heartbeat, confusion or even delirium, a fever of greater than 104 degrees, severe headaches and seizures or muscle twitching. The skin of a heat stroke victim will be warm and dry, because the body is no longer able to perspire.

The reason is --Your body must maintain its normal temperature to work well. When it gets hot, your body begins to cool itself by sweating. Your body cools as the perspiration evaporates. In order to get more blood to the skin's surface and aid sweating, the heart will beat faster. This occurs even if you're sitting still in the sun.If your body is unable to rid itself of excess heat, your organs can begin to overheat and stop working. This is called heat stroke, and can result in confusion, seizures, permanent disabilities, multiorgan system failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation, renal, hepatic failure, hypoglycemia, rhabdomyolysis, seizures and death.

Physical findings in heat stroke may include cutaneous vasodilation, tachypnea, rales due to noncardiogenic pulmonary edema, excessive bleeding due to disseminated intravascular coagulation, and evidence of neurologic dysfunction such as altered mentation or seizures. The skin may be moist or dry, depending upon underlying medical conditions, the speed with which the heat stroke developed, and hydration status. Not all victims of heat stroke should be assumed to be volume-depleted. Laboratory studies may reveal coagulopathy, acute renal failure, acute hepatic necrosis, respiratory alkalosis, and a leukocytosis as high as 30,000 to 40,000/mm3.

Warning signs for heat stroke or exhaustion are dizziness or fainting, excessive sweating, muscle cramps, cold or clammy skin, headaches, rapid heartbeat or nausea. If you experience any of these, get out of the heat right away, drink water, juice or sports drinks and seek medical attention.

PRECAUTIONS
The risk of serious consequences can be reduced with a few simple precautions. If you have A chronic medical conditions discussed, try to get out of the sun sooner than others, and avoid outdoor activities during the hottest times of day. Wear loose fitting clothes and unless otherwise directed, get plenty of extra fluids (like water, but avoid alcoholic or caffeinated beverages).

TREATMENT
Cooling measures — Augmentation of evaporative cooling is considered the treatment modality of choice because it is effective, noninvasive, and easily performed. The naked patient is sprayed with a mist of lukewarm water while air is circulated with large fans. Shivering may be suppressed with intravenous benzodiazepines such as diazepam (5 mg IV) or lorazepam (1-2 mg IV) or, if NMS is not suspected, with chlorpromazine (25 to 50 mg IV).

Other effective cooling methods are less commonly utilized. Immersing the patient in ice water is the most effective method of rapid cooling. Immersing the patient in ice water results in rapid cooling but complicates monitoring and access. Applying ice packs to the axillae, neck, and groin is effective, but is poorly tolerated in the awake patient.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

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“SUN ALLERGY”---DRUG-INDUCED PHOTOSENSITIVITY IS PRIMARILY DUE TO UVA RAYS.

Advise patients taking photosensitizing drugs to use a broad-spectrum sunscreen.

A list of the usual culprits (isotretinoin, thiazides, etc)...include also ones that are often forgotten such as benzodiazepines and NSAIDs. This table summarizes drugs which have been associated with photosensitivity. It is important to note that many of the drugs listed were included based on case reports. However, patients taking these drugs should be counseled to minimize sun exposure and to use broad-spectrum (UVA and UVB) sunscreens when sun exposure cannot be avoided.

Drug-induced photosensitivity may present in a variety of ways. Most reactions are either phototoxic or photoallergic. Photoallergy is a rare, immunological response, which is not dose-related and occurs after continuous exposure. Photoallergy occurs when light causes a drug to act as a hapten, triggering a hypersensitivity response which often manifests as pruritic and eczematous rash.Phototoxic reactions are chemically-induced reactions which occur when the drug absorbs UVA light and causes cellular damage. This reaction can be seen with initial exposure to a drug, may be dose-related, and doesn't demonstrate cross-sensitivity. It usually has rapid onset and manifests as an exaggerated sunburn. This reaction will be seen only on skin areas exposed to the sun.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for information on Heatstroke

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WHAT KIND OF SPF SUNSCREENS TO USE

SPF is often misunderstood says the Prescriber’s Newsletter.

SPF applies only to UVB...not UVA. UVB causes the familiar sunburn. SPF is an estimate of how long a person can stay in the sun without obvious sunburn.

For example, if a person would burn in 10 minutes with NO protection, then an SPF 15 sunscreen will protect 15 times longer or 150 minutes...and an SPF 30 would protect 30 times longer or 300 minutes.There's no proof that an SPF over 50 gives any measurable added benefit.

UVB ratings get the most attention, but are only part of the story.
UVA ratings will appear on some sunscreens. You'll see 1, 2, 3, or 4 stars indicating low, medium, high, or highest protection.
UVA causes skin aging and skin cancer...not visual sunburn.

Recommend sunscreens labeled broad-spectrum. These contain UVA blockers such as avobenzone, zinc oxide, and/or titanium.

You'll now see Mexoryl SX (ecamsule) in some Anthelios sunscreens. Mexoryl SX covers some of the shorter UVA rays that are not covered by avobenzone...and it's more stable in sunlight.

But when avobenzone is combined with octocrylene, oxybenzone, or other ingredients it's more stable and has a broader spectrum.

Recommend zinc oxide or titanium dioxide for sensitive skin. They block UVA and UVB by sitting on top of the skin...not binding to it.

Water resistance ratings refer to how long the product is effective during swimming, heavy sweating, etc.

Explain to patients that a product labeled "water-resistant" lasts about 40 mins in water...and a "very water-resistant" product lasts about 80 mins.

Proper application is key. Instruct people to apply sunscreen 20 minutes before sun exposure...and reapply at least every 2 hours.

Emphasize applying enough...about 1/2 to one teaspoon per body part (leg, arm, back, face, etc)...or about 1 ounce for the full body. Applying only half the amount will give only half the protection.

Advise avoiding sunscreen/insect repellent combos. Suggest using separate products because the sunscreen needs to be applied more often than the repellent. Advise patients to apply the sunscreen first, then the repellent.

SUMMARY-COMMENT:
There are new ways to help you prevent the kind of damage to your skin that can cause not only wrinkles, but also skin cancer, which is the second most common form of cancer in the United States.

• Use skin care products with UVA/UVB and broad spectrum protection. Before going outside, apply sun-resistant skin care products such as body wash, makeup, and lip balm. Use sunscreen (SPF 30 or greater) that contains a broad spectrum protection ingredient such as oxybenzone, sulisobenzone, avobenzone, ecamsule, titanium dioxide or zinc oxide.

• Buy clothing with UVA/UVB protection. Everyone knows that the more you cover up, the less chance you have of damaging your skin. But did you know that you can get additional protection by choosing clothes made from fabrics that reflect ultraviolet light? These fashions, from bathing suits to sweatsuits, come with a label that states the UPF (ultraviolet protection factor) of the clothes. The higher the UPF, the more protection you receive.

• Add UPF to your own clothes. Special laundry additives are available that apply sun protection to your clothes for up to 20 washings. You can find more information about additives and purchase them online.

• Choose sun-resistant accessories. While you are outside, wear sunglasses that block at least 99 percent of UVB rays and at least 95 percent of UVA rays. Select a sun hat made with UPF fabric. Take an umbrella with you, even when it’s not raining.


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MEDICAL ETHICS CHECKLISTS

Hospitals using a checklist designed for the World Health Organization (WHO) cut deaths after surgery by 46% and surgical complications by 36%.

Using this as an example medical residents working in the intensive care unit at the Washington Hospital Center in Washington, D.C., got a different kind of reminder when caring for patients -- an ethics checklist.

The idea is the brainchild of Daniel K. Sokol, PhD, a medical ethicist at the University of London St. George's Hospital Medical School who served as a visiting bioethics scholar at the Washington Hospital Center in January and February. Sokol wrote about the ethics checklist in the March 4 British Medical Journal and said bioethicists at hospitals in Canada and the United Kingdom also are considering the idea.

"Having an ethics checklist changes the focus away from the purely clinical to include the ethical dimension," Sokol said. "In the back of my mind I had this idea of the surgical checklist, where uniformly the results have been quite astounding. I see no reason why there shouldn't be a similar thing for ethics."

The eight-item checklist at Washington Hospital Center -- actually an ID-sized badge that residents wear on lanyards -- covers ethical issues that commonly arise in the hospital setting. Is the patient able to make medical decisions? Is there a do-not-resuscitate order? Is there a disagreement among family members about how care should proceed?

Residents are asked to review the list for each patient, note any potential issues and call the hospital's bioethics staff if they need help resolving problems. The hospital's three ethics consultants already handle about 300 queries a year, said the director of bioethics and spiritual care. She said getting doctors to use the checklist could help avoid ugly squabbles with families and prevent lawsuits.

"We want to recognize the potential for an ethical problem earlier downstream and intervene early enough so that patient care doesn't get compromised and the family doesn't get negatively impacted by the emotional rollercoaster the ICU presents," he said. "It's preventive ethics at its best."

The ethics checklist will be considered at the Loyola University Chicago Stritch School of Medicine, said Kayhan Parsi, PhD, a clinical ethicist."What the checklist does, in my mind, is it more formally integrates ethics into the care of patients so it really just becomes part of the culture," Parsi said. "It actually standardizes care so everyone gets treated in a similar fashion."

Clinical Ethics Patient Assessment
• Patient's wishes unclear/refusal of treatment
• Questionable capacity to consent to, or refuse, treatment
• Disagreement involving relatives/surrogates/caregivers
• End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
• Confidentiality/disclosure issue
• Resource or fairness issue
• Other (please note)
• No notable ethical issues


Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for What types of sunscreens to use!

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PART III OF IV BELIEVING IN MEDICAL TREATMENTS THAT DON’T WORK

HOMEOPATHIC REMEDIES

Homeopathic remedies are said to be safe—at least not harmful because the “active ingredients are so diluted.” The FDA, however, is alerting consumers that ZICAM COLD REMEDY NASAL GEL, ZICAM COLD REMEDY NASAL SWABS, and ZICAM COLD REMEDY SWABS, KIDS SIZE, a discontinued product that consumers may still have in their homes, have all been associated with long lasting or permanent loss of smell (referred to as anosmia). These products, marketed by Matrixx Initiatives, are zinc-containing, nasal cold remedies used to reduce the duration and severity of cold symptoms. However, these products have not been shown to be effective in the reduction of the duration and severity of cold symptoms. This advisory does not yet cover oral zinc tablets and lozenges taken by mouth.FDA recommends that consumers stop using these products and throw them away. See the FDA website for How to Dispose of Unused Medicines.

800 Zicam complaints from FDA.
The company didn't turn over to US regulators 800 consumer complaints about side effects linked to its withdrawn Zicam nasal spray and swabs." The company halted sales of "the cold remedies on June 16 after the Food and Drug Administration warned consumers the treatments may cause a loss of smell." The agency "found 800 reports of consumer concerns in May during a routine inspection.

Since the introduction of Zicam Cold Remedy Nasal Gel to the market in 1999, FDA has received reports of anosmia associated with the use of Zicam zinc-containing intranasal products. The reports vary. Many people state that the loss of sense of smell occurred with the first dose of the Zicam product, although some people report it happened after later doses. The loss of sense of smell may be long-lasting or even permanent in some people.

Loss of the sense of smell may cause serious problems, such as failing to smell smoke, a gas leak, or spoiled food. Also, loss of the sense of smell is often linked with a loss of the sense of taste. People who cannot taste could unintentionally eat spoiled food and not appreciate flavors, and lose much of the pleasure of eating. Further, there is evidence in the published scientific literature that various salts of zinc can damage olfactory function in animals and humans.

Zicam and hundreds of other homeopathic remedies — highly diluted drugs made from natural ingredients — are legally sold as treatments with explicit claims of medical benefit. Yet they don't require federal checks for safety, effectiveness or even the right ingredients. They're somewhat similar to dietary supplements, which use many of the same natural ingredients and also aren't federally tested for safety or benefit.

Many scientists view homeopathic remedies as — ineffective but mostly harmless because the drugs in them are present in such tiny amounts.But an Associated Press analysis of the Food and Drug Administration's side effect reports found that more than 800 homeopathic ingredients were potentially implicated in health problems last year. Complaints ranged from vomiting to attempted suicide.
In its review of homeopathy, the AP also found that:

_ Active homeopathic ingredients are typically diluted down to 1 part per million or less, but some are present in much higher concentrations. The active ingredient in Zicam is 2 parts per 100.

_ The FDA has set strict limits for alcohol in medicine, especially for small children, but they don't apply to homeopathic remedies. The American Academy of Pediatrics has said no medicine should carry more than 5 percent alcohol. The FDA has acknowledged that some homeopathic syrups far surpass 10 percent alcohol.
_ The National Institutes of Health's alternative medicine center spent $3.8 million on homeopathic research from 2002 to 2007 but is now abandoning studies on
homeopathic drugs. "The evidence is not there at this point," says the center's director, Dr. Josephine Briggs.

_ At least 20 ingredients used in conventional prescription drugs, like digitalis for heart trouble and morphine for pain, are also used in homeopathic remedies. Other homeopathic medicines are derived from cancerous or other diseased tissues. Many are formulated from powerful poisons like strychnine, arsenic or snake venom
Homeopathy sprang from the inventive — some would say fanciful — mind of German physician and chemist Samuel Hahnemann in the late 1700s. Experimenting on himself, he became convinced that if an ingredient causes a symptom in a healthy person, it will treat the disease that causes the same symptom. He also theorized that diluting ingredients to minuscule, even untraceable, concentrations paradoxically makes them more powerful. To this day, homeopaths put forth mystical-sounding explanations involving "vital force" and "healing energy, with arcane ingredients and names like "nux vomica" and "arsenicum album.”.

Since 2002, the U.S. homeopathic remedy market exploded by 89 percent to an estimated $830 million last year, according to market research company Mintel. By 2007, homeopathic remedies were taken by almost 4 million Americans, or 2 percent of adults, federal data show.

Though many homeopathic remedies consist mostly of sugar or alcohol, thousands of patients swear by their effectiveness anyway.

The FDA's own side effect reports potentially implicate at least 843 homeopathic ingredients just in the year ending September 2008, the AP found. It is impossible to verify how many were taken at low homeopathic concentrations. But dozens apparently were, and they were linked to side effects, including muscle and joint pain in reports submitted by consumers, doctors and others.

According to the FDA letter to the Zicam company “a homeopathic drug product marketed without an approved NDA is not subject to the enforcement discretion. But when there is evidence of a safety risk associated with the product, as is the case for the Zicam Cold Remedy intranasal products, the Agency enforces the Act’s new drug approval requirement, a provision that is essential to protect the public health by holding firms responsible for demonstrating, based on adequate and well-controlled clinical investigations, that a product is safe and effective for each of its intended uses before marketing it. Therefore, an approved NDA is required for the Zicam Cold Remedy intranasal products, regardless of their homeopathic status. Your introduction of the Zicam Cold Remedy intranasal products into interstate commerce, without an approved application, violates sections 301(d) and 505(a) of the Act, 21 U.S.C. §§ 331(d) and 355(a).

Additionally, Zicam Cold Remedy intranasal products are misbranded under section 502(f)(2) of the Act, 21 U.S.C. § 352(f)(2), because their labeling does not bear adequate warnings regarding the risk of anosmia associated with the product. In light of this failure to bear adequate warnings, these products are also misbranded under section 502(a) of the Act, 21 U.S.C. § 352(a), taking into account the considerations set forth in section 201(n) of the Act, 21 U.S.C. § 321(n).

See http://www.fda.gov/cder/regulatory/applications/default.htm.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for an Ethics checklist to help hospitals avoid lawsuits

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PART II OF IV Believing in Medical Treatments That Don’t Work

AP reporter M. Marchione writes that ten years ago the government set out to test herbal and other alternative health remedies to find the ones that do work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do. And the government is still spending the money.Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer; have all proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.

Critics also say the federal center's research agenda is shaped by an advisory board loaded with alternative medicine practitioners. They account for at least nine of the board's 18 members, as required by its government charter. Many studies they approve for funding are done by alternative therapy providers; grants have gone to board members, too. "It's the fox guarding the chicken coop," said a previous director of the Office of Alternative Medicine, a smaller federal agency that preceded the center's creation. "This is not science, it's ideology on the part of the advocates." The center was handed a flawed mission, many scientists say.

Congress created it after several powerful members claimed health benefits from their own use of alternative medicine and persuaded others that this enormously popular field needed more study. The new center was given $50 million in 1999 (its budget was $122 million last year) and ordered to research unconventional therapies and nostrums that Americans were using to see which ones had merit. That is opposite how other National Institutes of Health agencies work, where scientific evidence or at least plausibility is required to justify studies, and treatments go into wide use after there is evidence they work - not before.

"There's very little basic science behind these things. Most of it begins with a tradition, or personal testimony and people's beliefs, even as a fad. And then pressure comes: 'It's being popular, it's being used, it should be studied.' It turns things upside down," said a senior editor who reviews alternative medicine research submitted to the New England Journal of Medicine.

Yet to be politically correct the government continues to fund studies of purported energy fields, distance healing and other approaches that have little if any biological plausibility or scientific evidence. Taxpayers are bankrolling studies of whether pressing various spots on your head can help with weight loss, whether brain waves emitted from a special "master" can help break cocaine addiction, and whether wearing magnets can help the painful wrist problem, carpal tunnel syndrome.

An acupressure weight-loss technique won a $2 million grant even though a small trial of it on 60 people found no statistically significant benefit - only a trend that could have occurred by chance. The researcher says the pilot study was just to see if the technique was feasible.

Some say "It's become politically correct to investigate nonsense." Many scientists say that unconventional treatments hold promise and deserve serious study, but that the federal center needs to be more skeptical and selective. Many of the studies that have been funded I would not have funded because they seem irrational and foolish - studies on distant healing by prayer and energy healing, studies that are based on precepts and ideas that are contrary to what is known in terms of human physiology and disease.

Critics say that unlike private companies that face bottom-line pressure to abandon a drug that flops, the federal center is reluctant to admit a supplement may lack merit - despite a strategic plan pledging not to equivocate in the face of negative findings.

Echinacea is an example. After a large study by a top virologist found it didn't help colds, its fans said the wrong one of the plant's nine species had been tested. Federal officials agreed that more research was needed, even though they had approved the type used in the study.
Herbal Supplements

That reasoning was used to justify the $2 million weight-loss study, approved in 2007. It will test Tapas acupressure, devised by Tapas Fleming, a California acupuncturist.
Use of her trademarked method requires employing people she certifies, and the study needs eight. It involves pressing on specific points on the face and head - the inner corners of the eyes are two - while focusing on a problem.

In a federally funded pilot study, 30 dieters who were taught acupressure regained only half a pound six months later, compared with over three pounds for a comparison group of 30 others. However, the study widely missed a key scientific standard for showing that results were not a statistical fluke. The pilot trial was just to see if the technique was feasible. The results were good enough for the federal center to grant $2.1 million for a bigger study in 500 people that is under way now.



Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Part III of IV, Believing in Treatments that don't work- HOMEOPATHIC REMEDIES

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PART I OF III Believing in Medical Treatments That Don’t Work

Dr. David H. Newman writes* about how medical ideology often gets in the way of evidence-based medicine." Dr. Newman contends that "the practice of medicine contains countless examples of elegant medical theories that belie the best available evidence." For instance, despite "recent press reports detailing the dangers of cough syrup for children" that "have noted that cough syrup doesn't work," the use of these cough remedies "is common." Dr. Newman claimed that although "treatment based on ideology is alluring," the "uncomfortable truth is that many expensive, invasive interventions are of little or no benefit."

Another example is in the early throes of a heart attack, caused by an abruptly clotted artery, the stunned heart often beats quickly and forcefully. For decades doctors have administered “beta-blockers” as a remedy, to reduce consumption of limited oxygen supplies by calming and slowing the straining heart. Giving these drugs in the early stages of a heart attack represents elegant medical ideology.

But it doesn’t work.

Studies show that the early administration of beta-blockers to heart attack victims does not save lives, and occasionally causes dangerous heart failure. While two studies support the use of beta-blockers after heart attack, there are 26 studies that found no survival benefit to administering beta-blockers early on. Moreover, in 2005, the largest, best study of the drugs showed that beta-blockers in the vulnerable, early hours of heart attacks did not save lives, but did cause a definite increase in heart failure.

Remarkably, the medical community has continued to strongly recommend immediate beta-blocker treatment. Why? Because according to the theory of the straining heart, the treatment makes sense. It should work, even though it doesn’t. Ideology trumps evidence.

The practice of medicine contains countless examples of elegant medical theories that belie the best available evidence.

He noted that "the administration's plan for reform includes identifying healthcare measures that work, and those that don't," but "to place evidence above ideology, researchers and analysts must be trained in critical analysis, have no conflicts of interest and be a diverse group." And, "perhaps most importantly, we as doctors and patients must be open to evidence," he concluded.

ADDITIONAL EXAMPLES

• Patients with ear infections are more likely to be harmed by antibiotics than helped. While the pills may cause a small decrease in symptoms (for which ear drops work better), the infections typically recede within days regardless of treatment. The same is true for bronchitis, sinusitis, and sore throats. Unnecessary antibiotics are still given to more than one in seven Americans each year for these conditions alone, at a cost of more than $2 billion and tens of thousands of serious adverse medication effects requiring treatment.

• Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment. Yet doctors perform 600,000 of these surgeries each year, at a cost of over $20 billion.

• More than a half million Americans per year undergo arthroscopic surgery to correct osteoarthritis of the knee, at a cost of $3 billion. Despite this, studies show the surgery to be no better than sham knee surgery, in which surgeons “pretend” to do surgery while the patient is under light anesthesia. It is also no better than much cheaper, and much less invasive, physical therapy.

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

The critical question that looms for health care reform, asks Dr. Newman, is whether patients, doctors and experts are prepared to set aside ideology in the face of data.

Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats?
Can we stop asking for, and writing, these prescriptions?
Can we stop performing, and asking for, knee and back surgeries?
Can we handle what the evidence reveals?
Are we ready for the truth?

Somewhere along the line, theory trumped reality. Administering a medicine or performing a surgery became more important than its effect.

New York Times (4/2/09) Well blog
Caveat:
Evidence-based medicine is an important advance, although it can be a double-edged sword. When the evidence base applies, we should use it, and it reasonable for Medicare and other payers to insist on it. It is critical, however, to appreciate that there will always be patients for whom there is no evidence. They may so differ demographically from study participants from which the guidelines derive that it is doubtful as to whether guidelines are relevant. Or they may have conditions, such as rare diseases, for which there is no evidence band likely never will be. We must avoid the trap of those patients being shut out of care for lack of evidence.


Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for Part II of IV, Believing in Treatments that don't work

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