Tuesday, June 30, 2009

Medical Biases

I recently attended a review course to prepare for the Boards. For 4 straight days we started at 7 AM and finished at 9:30 PM. This intellectual boot-camp took place in Vegas, but the only fun thing I got to do was eat dinner by myself at the Paris buffet; a Japanese tourist and I were the only ones loading up on the veggies and sushi.

The course itself was brutal, but a great way to prepare. Interestingly, a couple of presenters epitomized the state of affairs in non-pharmaceutical medicine; one continually railed against the misguided over-reliance on many virtually ineffective pharmaceutical treatments, while the other reluctantly discussed some herbs and nutrients that have significant evidence and efficacy.

The latter doc warned that the evidence was thin and that there were significant side effects with those natural items. Yet, this presenter did not do likewise when it came to drugs. For example, black cohosh, approved for use in menopausal problems by the American Academy of Ob-Gyn, was said to be worthless and potentially dangerous. Yet, nothing was said about hormonal replacement with estrogen, which has been shown to increase the risk of cancer by the NIH since 2002.

Amazing: estrogen is OK, yet poor little black cohosh, which has never been associated with any cancers, is not.

What is really going on? It is simple; let me illustrate with another example:

Initially it was reported that hip padding/protectors did not reduce the risk of hip fractures in falls sustained by the elderly. Later, it was shown that they DO INDEED reduce the risk of hip fractures by a whopping 50%. It turned out that one of the authors of the negative study had not disclosed his financial ties with hip replacement surgeries.

“Follow the money.”

It is extremely naïve to deny the fact that our beliefs do not influence our intellect.

PS, I do not sell non-pharmaceutical products. Occasionally, I speak for companies that do.

Monday, June 8, 2009

Still around…

Sorry I have not had time to blog.

I have been too busy studying for my Family Practice Boards (every 7 years.) It’s quite an ordeal for me; I have to memorize a lot of stuff (excessive pharmaceutical treatments taking precedence over nutritional, environmental and emotional issues) I don’t emphasize in my practice.

Nevertheless, I must remain up to date for many reasons, one of which is to get reimbursed by insurance companies who continue to dismiss the fact our practice saves them thousands of dollars, even though they have seen the future of health care; more social responsibility.

They are a bit concerned that their golden goose is threatened. Surely you saw right through their attempt to appear cooperative when the met with Mr. Obama last month at the White House, only to later oppose the plans to start a Public Health Insurance. Despite the plan being proposed to increase competition, a word they love, they fear they will be left in the dust.

If they truly believe in competition they would welcome the proposed addition. Perhaps they fear that, just like Medicare, the new plan will have a much lower cost due to lower overhead costs (more efficiency,) like Medicare; that is 5% compared to their bloated 15-25% overhead.

But, back to the Board Exam (next month.)

It turns out that this time around the exam-makers have finally added questions on non-pharmaceutical treatments; the evidence for some of these treatments cannot be denied any longer. They are asking doctors to bone up on treatments like:

Saw Palmetto: prostate problems
St John’s Wort: depression
Bilberry and other antioxidants: macular degeneration
Feverfew: migraines
Omega oils: heart and many other conditions
Sulfur: bladder
Vitamin D: osteoporosis, insulin resistance
Acetic acid, mineral/olive oils: ear canal infections
Capsaicin (red peppers:) shingles, burning mouth syndrome
Glucosamine: bones

Even though this is a very shy list, it is the first time my board exam includes this sort of things. I am sure the list will get longer. Maybe it will even be halfway decent by the time I retire….