Very interesting news about the placebo effect. Irving Kirsch whose 2010 book The Emperor’s New Drugs created such a stir is one of the main authors of the study. Another of the authors is Ted Kapchuk, the acupuncturist, who has been studying the placebo effect for many years.
The following is from the blog Neurotribes by Steve Silberman:
A provocative new study called “Placebos Without Deception,” published on PLoS One today, threatens to make humble sugar pills something they’ve rarely had a chance to be in the history of medicine: a respectable, ethically sound treatment for disease that has been vetted in controlled trials…
for the whole story via Meet the Ethical Placebo
The research report can be found here at Placebos Without Deception.
There is a cultural tendency to favor technological interventions even when with serious reflection we may not be so sure. The follow study raises some important issues about implanting defibrillators in elderly patients. Does this save lives or simply prolong dying?
from a study in Science Direct
We take the example of cardiac devices, specifically the implantable cardioverter defibrillator, or ICD, to explore the complex cultural role of technology in medicine today. We focus on persons age 80 and above, for whom ICD use is growing in the U.S. We highlight an ironic feature of this device. While it postpones death and ’saves’ life by thwarting a lethal heart rhythm, it also prolongs living in a state of dying from heart failure. In that regard the ICD is simultaneously a technology of life extension and dying. We explore that irony among the oldest age group — those whose considerations of medical interventions are framed by changing societal assumptions of what constitutes premature death, the appropriate time for death and medicine’s goals in an aging society. Background to the rapidly growing use of this device among the elderly is the ‘technological imperative’ in medicine, bolstered today by the value given to evidence-based studies. We show how evidence contributes to standards of care and to the expansion of Medicare reimbursement criteria. Together, those factors shape the ethical necessity of physicians offering and patients accepting the ICD in late life.
much more via Do we always want an implantable defibrillator?
from the New York Times by Walt Boganovich:
The initial accident report offered few details, except to say that an unidentified hospital had administered radiation overdoses to three patients during identical medical procedures.
It was not until many months later that the full import of what had happened in the hospital last year began to surface in urgent nationwide warnings, which advised doctors to be extra vigilant when using a particular device that delivers high-intensity, pinpoint radiation to vulnerable parts of the body.
Marci Faber was one of the three patients. She had gone to Evanston Hospital in Illinois seeking treatment for pain emanating from a nerve deep inside her head. Today, she is in a nursing home, nearly comatose, unable to speak, eat or walk, leaving her husband to care for their three young daughters….
much more via Harming Instead of Healing
Medicare should stop paying doctors who “self-refer” for imaging on equipment they own or lease — excluding payments for x-rays — because in most cases self-referral neither shortens the length of an illness nor provides cost-saving benefits, said researchers in the field…
read full story at No Medical, Cost Benefit to Imaging Self-Referral
from the New York Times written by Gretchen Reynolds
…when the patients were re-examined at 6 and 12 months, the results were substantially different. Over all, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. The evidence for cortisone as a treatment for other aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting, the review found. But in terms of tennis elbow, the shots seemed to actually be counterproductive….
The drugs approved for the market depend upon the quality of the research. This article in Vanity Fair is a detailed examination of the possible problems that arise as the major pharmaceutical companies shift there research to other countries.
Prescription drugs kill some 200,000 Americans every year. Will that number go up, now that most clinical trials are conducted overseas—on sick Russians, homeless Poles, and slum-dwelling Chinese—in places where regulation is virtually nonexistent, the F.D.A. doesn’t reach, and “mistakes” can end up in pauper’s graves? The authors investigate the globalization of the pharmaceutical industry, and the U.S. Government’s failure to rein in a lethal profit machine.
Here is a behind-the-scenes analysis the “key opinion leaders” (KOLs) that is physicians and researchers hired by pharmaceutical corps to influence other physicians to prescribe their brand of drugs.
The excerpt is from an article by Carl Eliot in the Chronicle of Higher Education.
Carl Eliot is a physician turned medical ethicist, He has just published a new book White Coats, Black Hats: Adventures on the Dark Side of Medicine
In the early 1970s, a group of medical researchers decided to study an unusual question. How would a medical audience respond to a lecture that was completely devoid of content, yet delivered with authority by a convincing phony? To find out, the authors hired a distinguished-looking actor and gave him the name Dr. Myron L. Fox. They fabricated an impressive CV for Dr. Fox and billed him as an expert in mathematics and human behavior. Finally, they provided him with a fake lecture composed largely of impressive-sounding gibberish, and had him deliver the lecture wearing a white coat to three medical audiences under the title “Mathematical Game Theory as Applied to Physician Education.” At the end of the lecture, the audience members filled out a questionnaire.
The responses were overwhelmingly positive. The audience members described Dr. Fox as “extremely articulate” and “captivating.” One said he delivered “a very dramatic presentation.” After one lecture, 90 percent of the audience members said they had found the lecture by Dr. Fox “stimulating.” Over all, almost every member of every audience loved Dr. Fox’s lecture, despite the fact that, as the authors write, it was delivered by an actor “programmed to teach charismatically and nonsubstantively on a topic about which he knew nothing.”
It is tempting to imagine that the Dr. Fox study reveals a deep flaw in the structure of medicine—for example, that health-care workers are too trusting of authority, or that Continuing Medical Education (CME) lectures are a sham. But what the study actually reveals may be something closer to the opposite. If medicine were simple and transparent, pretending to be a medical expert would be very difficult. An audience could spot incompetence right away. Pretending to be a medical expert is possible precisely because medical knowledge is so specialized and opaque. These days an ordinary doctor can no more expect to understand the intricacies of specialized medical research than the driveway mechanic who tinkered with his Volkswagen in 1962 can expect to fully understand the complex, computerized automobiles on the road today. Those who have tried to sit through a medical lecture in a field other than their own will secretly admit that they could have been fooled b y Dr. Fox as well…
much much more via The Secret Lives of Big Pharma’s ‘Thought Leaders‘
Below is an excerpt from a linked article that explores how some physicians are hiring firms to get them top-rating from search sites like Google. It largely focuses on a plastic surgeon implicated in a number of unfortunate results including death.
excerpt from SFWeekly.com written by Ashley Harrell
If you type the terms “San Francisco” and “plastic surgery” into the Google search engine — as countless people have —the first business that comes up is the San Francisco Plastic Surgery & Laser Center. Beneath the name of the business sits a short review: “Dr. Rajagopal is an excellent plastic surgeon. She is caring and experienced.” There’s no source name attached.
A broader search for Rajagopal reveals countless positive reviews all over the Internet. She’s apparently a “knowledgeable,” “truely gifted surgeon” with an “artistic eye” and access to “cutting edge” technology. On Citysearch, 30 out of her 32 reviewers have given her five stars, and numerous patients say there aren’t enough stars in the rating system for a doctor of this caliber. She comes in on Sundays. She gives flowers to her patients at the end of their surgeries.
“Once you meet Dr. Usha Rajagopal, you’d wish she was your mother!” Rosie W. of San Francisco wrote in a Yelp review of the doctor. According to a review on one surgery forum: “if any of you are thinking of going to Dr. Rajagopal, go right ahead. She is top notch, and really knows what she is doing.”
There’s just one big problem with all of these fantastic reviews directing readers to Rajagopal for medical procedures. It’s impossible to know which of them — if any — were written by actual patients. In fact, some of the reviews appear to be classic cases of what’s commonly referred to as astroturfing — ringing endorsements that look like a groundswell of support when in fact they are being paid for. The practice is named after Astroturf — synthetic carpeting designed to look like real grass…
|excerpt from Scientific American by Cynthia Graber
We expect scientists and doctors to be upfront about whether papers they publish may line their purses. But according to a recent study in the Archives of Internal Medicine [Susan Chimonas, Zachary Frosch and David Rothman,http://bit.ly/d7YVfE], nearly half of surgeons who made at least a million dollars from orthopedic device companies did not reveal that fact in their publications.
The study authors searched a public database in which five manufacturing companies disclosed the amounts they paid consultants. The companies shelled out almost $250 million in 2007 for consulting, about 62 percent of which went to only 41 orthopedic surgeons. Each made more than a million dollars…
The ostensible subject of this link is prostate cancer in families but it is not really the most important aspect. I feel the important aspect is the tendency of family members to be more intensely tested for a condition because a family member has been diagnosed with the condition. And then, because the extra testing finds evidence of most of the condition, the “experts” declare that there is a possible “genetic” cause while really what happened is that there has been extra testing.
It is a relatively subtle point but well worth the effort to understand. Additional, the author makes some excellent points about the way screening is done. Be sure to click through the links embedded within the article for much great in-depth information and analysis.
The excerpt below is from the Bioblog
Is prostate cancer common in families? It has been presumed to be so based on clusters of men in families that have been diagnosed with the disease. But in fact, it turns out that brothers of prostate cancer patients undergo more diagnostic activities – meaning it could be that they are diagnosed more simply because they are screened more.
It’s only natural – a first-degree relative gets a cancer diagnosis, and everyone in the family gets screened soon after for that cancer. It is encouraged by doctors because of the tendency for some cancers at least to have a clear genetic component. But the funny thing about prostate cancer is that similar to breast cancer, but even more so, the more you look for it the more you will find it. So a recent study tried to tease apart this cancer detection bias from a real genetic effect. Given that it is well understood now that a cancer diagnosis is a far, far different situation than having clinically significant (i.e. potentially harmful) cancer, they asked the pertinent question of whether or not prostate cancer clusters in families are due to genetics, or due to family members looking for it after a relative has been diagnosed. Apparently, in previous epidemiological studies, data simply for cancer rates have been used, without taking into account this potential bias…
much more via More Evidence That More Screening = More Cancer