Which Medical Practice Will Be Discredited Next?

An editorial in the current British Medical Journal makes a very sharp point that many of us have probably been thinking about in the last few weeks while reading the latest medical news in the papers:

It’s easy to feel contempt for deluded practitioners of the past who advocated bloodletting and tonsillectomies for all. Easy, that is, until one considers emerging evidence that coronary stenting and postmenopausal hormone replacement therapy may well be the contemporary equivalents of those now discredited practices.

This recent New York Times article tells of the compelling study which found that coronary stenting is typically no more effective than heart drugs, even though it is far more invasive — and, to be sure, profitable for the medical personnel involved.

Indeed, another article in the same issue of BMJ suggests that stenting is less common in Europe than in the U.S. mainly because “there have not been the same financial incentives to carry out some stenting.”

FWIW, we mentioned this subject briefly in Freakonomics:

If you were to assume that many experts use their information to your detriment, you’d be right. Experts depend on the fact that you don’t have the information they do. Or that you are so befuddled by the complexity of their operation that you wouldn’t know what to do with the information if you had it. Or that you are so in awe of their expertise that you wouldn’t dare challenge them. If your doctor suggests that you have angioplasty-even though some current research suggests that angioplasty does little to prevent heart attacks-you aren’t likely to think that the doctor is using his informational advantage to make a few thousand dollars for himself or his buddy. But as David Hillis, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, explained to the New York Times, a doctor may have the same economic incentives as a car salesman or a funeral director or a mutual-fund manager: “If you’re an invasive cardiologist and Joe Smith, the local internist, is sending you patients, and if you tell them they don’t need the procedure, pretty soon Joe Smith doesn’t send patients anymore.”

The BMJ editorial also asks a wise question. Perhaps some of you can offer an answer: “What other medical orthodoxies might join hormone replacement therapy and stenting on the ever-growing list of discredited interventions?”

I have one prediction: late-stage chemotherapy for many types of cancer.

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  1. Valerie says:

    I can’t believe no one has mentioned the ridiculously risky gastric bypass. Not to mention that after a bypass one can no longer absorb enough nutrients from food to avoid deficiencies. Bypass patients have to drink protein shakes and take vitamins for the rest of their lives. And many patients don’t lose weight or manage to regain any weight lost!

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  2. Valerie says:

    I can’t believe no one has mentioned the ridiculously risky gastric bypass. Not to mention that after a bypass one can no longer absorb enough nutrients from food to avoid deficiencies. Bypass patients have to drink protein shakes and take vitamins for the rest of their lives. And many patients don’t lose weight or manage to regain any weight lost!

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  3. Brad says:

    I don’t feel that the general public just abides by their doctors diagnosis any more. With the wealth of information on the internet, you can type your diagnosis into a search engine and come up with hundreds of reliable sites giving suggestions.

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  4. Brad says:

    I don’t feel that the general public just abides by their doctors diagnosis any more. With the wealth of information on the internet, you can type your diagnosis into a search engine and come up with hundreds of reliable sites giving suggestions.

    Thumb up 0 Thumb down 0
  5. Lor says:

    You asked what should be discredited: Asthma medication is a huge farce – please research the Buteyko breathing method. Buteyko was a Russian professor, and his methodology has resulted in up to 96% success rates in small clinical trials. Success being defined as the ability of an Asthma sufferer to ditch the cortisone & inhalers (completely), and control their condition.

    But there is nothing to be sold, other than a few lessons in breathing. And it isn’t a solution in a bottle – it takes months to get ones breathing under control with the exercises. The Buteyko method is just not commercial, as there really isn’t any pill for the pharmaceutical companies to sell, but it is hugely effective.

    http://en.wikipedia.org/wiki/Buteyko_method

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  6. Lor says:

    You asked what should be discredited: Asthma medication is a huge farce – please research the Buteyko breathing method. Buteyko was a Russian professor, and his methodology has resulted in up to 96% success rates in small clinical trials. Success being defined as the ability of an Asthma sufferer to ditch the cortisone & inhalers (completely), and control their condition.

    But there is nothing to be sold, other than a few lessons in breathing. And it isn’t a solution in a bottle – it takes months to get ones breathing under control with the exercises. The Buteyko method is just not commercial, as there really isn’t any pill for the pharmaceutical companies to sell, but it is hugely effective.

    http://en.wikipedia.org/wiki/Buteyko_method

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  7. ajit says:

    Problem is defining “late stage” of cancer. Doctors are poor at determining who is in a last stage and thus fit only for hospice care. A study in British Medical Journal published in 2000 (volume 320, page 469) where 343 doctors estimated the survival of 468 terminally ill patients showed that only 20% of the predictions were accurate. Average life of a patient on the study was 24 days; most doctors (63%) overestimated it this by a factor of 5.
    Similar results were seen in a more recent study (Journal of Clinical Oncology 2007; 25; 3313), with estimates being “overtly optimistic”.
    When you think that a patient has a relatively long life in front of him/her, there is a temptation to try and prolong it by further treatment. More accurate predictors of prognosis are needed to avoid this.

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  8. ajit says:

    Problem is defining “late stage” of cancer. Doctors are poor at determining who is in a last stage and thus fit only for hospice care. A study in British Medical Journal published in 2000 (volume 320, page 469) where 343 doctors estimated the survival of 468 terminally ill patients showed that only 20% of the predictions were accurate. Average life of a patient on the study was 24 days; most doctors (63%) overestimated it this by a factor of 5.
    Similar results were seen in a more recent study (Journal of Clinical Oncology 2007; 25; 3313), with estimates being “overtly optimistic”.
    When you think that a patient has a relatively long life in front of him/her, there is a temptation to try and prolong it by further treatment. More accurate predictors of prognosis are needed to avoid this.

    Thumb up 0 Thumb down 0