August 19th, 2011 by Davis Liu, M.D. in News, Opinion
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Newsweek has a very provocative and yet incredibly too simplistic piece for the public and patients on its cover story – One Word Can Save Your Life: No! – New research shows how some common tests and procedures aren’t just expensive, but can do more harm than good.
The piece is actually well written and highlights facts that have been apparent for some time. More intervention and treatment isn’t necessarily better. Having a cardiac catheterization or open heart surgery for patients with stable heart disease and mild chest pain isn’t better than diet, exercise, and the prescription medication treatment. PSA, the blood test previously suggested by many professional organizations, isn’t helpful to screen for prostate cancer, even though the value of the test was questioned years ago. Antibiotics for sinus infection? Usually not helpful.
Certainly doctors do bear part of the blame. If patients are Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
November 9th, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion
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Take medical uncertainty. Add financial incentive to treat. Voila! Increased utilization. Now take away financial incentive to treat. Guess what you get?
MedPageToday explains, in the case of hormone therapy for prostate cancer:
Medicare accomplished what clinical guidelines and evidence-based medicine couldn’t: it reduced unnecessary use of androgen deprivation therapy (ADT) in prostate cancer.
Inappropriate use decreased by almost 30% from 2003 to 2005, following enactment of the Medicare Modernization Act, which lowered physician reimbursement for ADT. Appropriate use of ADT did not change during the same time period, according to an article in the Nov. 4 issue of the New England Journal of Medicine.
“Our findings suggest that reductions in reimbursement may influence the delivery of care in a potentially beneficial way, with even the modest [reimbursement] changes in 2004 associated with a substantial decrease in the use of inappropriate therapy,” Vahakn B. Shahinian, MD, of the University of Michigan in Ann Arbor, and co-authors wrote in conclusion.
“The corollary is that reimbursement policies should be carefully considered to avoid providing incentives for care for which no clear benefit has been established. The extreme profitability of the use of gonadotropin-releasing hormone (GnRH) agonists during the 1990s probably contributed to the rapid growth in the use of ADT for indications that were not evidence-based.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
October 5th, 2010 by Davis Liu, M.D. in Better Health Network, Health Tips, News, Opinion, Research
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The New York Times recently ran a piece that wondered if doctors were treating patients with cholesterol-lowering medication unnecessarily because a web-based calculator over estimated a person’s risk. The program was proudly sponsored by the pharmaceutical roundtable and was available at the American Heart Association.
The implication was obvious. Simple tool determines an individual’s risk for heart attack or death from heart attack. It over estimates risk. Patients treated unnecessarily. To be also clear, the program did underestimate risk as well.
Unfortunately, the article missed an important point. While the simplified calculator may not be as accurate as the more complex algorithm used by the National Cholesterol Education Program, the truth is doctors are likely to be overtreating patients not because the former program is presented by the pharmaceutical roundtable, but for another reason. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
June 29th, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion, Research
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An article on the Knight Science Journalism Tracker comments on German media coverage of the “Is there male menopause?” question. An excerpt:
One study, but very different types of headlines: “‘Male Menopause’ discovered” and “Men have no Menopause.” Both types of headlines are based on one study published in the New England Journal of Medicine, which analyzed 3219 European males between 40 and 79. Blood samples provided testosterone levels and questionnaires (!) asked about the “general, sexual, physical, and psychological health.”
What the scientists found was nothing more and nothing less than a correlation between a low testosterone level and three clinical symptoms (“decreased frequency of morning erection, decreased frequency of sexual thoughts, and erectile dysfunction”). So, one could call it an age-related testosterone deficiency, affecting only a minority (about 2%) of elderly men.
But one shouldn’t name it “andropause” or “male menopause” — and the scientists themselves did NOT use the term in the whole article — because this term immediately suggests a relation to menopause, which is a completely different and natural developmental phenomenon for every woman above the age of 50. Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
June 22nd, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, News, Opinion
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Boston Celtics basketball player Kendrick Perkins injured his knee during the NBA Finals against the Lakers when he landed awkwardly. Unable to weightbear, he left Game 6 not to return for the following pivotal Game 7.
Based on his mechanism of injury and his physical examination, his trainer reported that he tore his medial collateral ligament (MCL) as well as the posterior cruciate ligament (PCL). More amazingly, this was done without the help of a MRI. Since Perkins was unable to play the final game, there was no urgent medical need to expedite the test, as regardless of the result his season was already done.
How do doctors know what’s wrong without X-ray vision or an imaging test? (Note that Perkins did get a X-ray, but X-rays generally don’t show ligament injuries.) Is it guessing? Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
