GlassHospital

Demystifying Medicine One Month at a Time

Category: medical skepticism (page 2 of 5)

Stomach Draining?

FDARecently the US Food & Drug Administration (FDA) approved a device for market called “AspireAssist.”

The device is hooked up to an incision in your abdominal wall after each meal that allows you to drain 30% of your stomach contents directly into the toilet.

Harder to gain weight (and easier to lose it!) when you’re diverting a third of caloric intake from your body into the sewer system.

It works like a “G-tube” in reverse — the kind of tube that puts liquid calories INTO your stomach in the event you can’t swallow (i.e. you’ve had a stroke or some kind of oral surgical issue that won’t let you chew and swallow). Therefore it was deemed ‘safe enough’ because SO FAR it has a low complication rate.

But keep in mind to get FDA approval the manufacturers only had to show efficacy and safety in two small trials totaling less than 200 patients. This is a lower barrier to market than would occur if the new product were a medication. [Devices and medications are held to different approval standards at the FDA.]

As for whether AspireAssist is ‘ready for prime time,’ I share the healthy skepticism of my friends over at “Updates in Slow Medicine,” who wrote:

From the Slow Medicine perspective, removing food after eating directly from the stomach using an A-tube remains an experimental approach to weight loss, and we would only recommend an AspireAssist device to a patient of ours enrolled in an appropriate clinical trial.

With more clinical experience it’s possible this could be a solution for many folks struggling with obesity. But only when we know more.

Does Medical Marketing Work?

20140929-dollars-for-docs-300x200_1You bet it does.

In the ‘old days,’ doctors were taken on junkets to sunny destinations and indoctrinated with the latest and greatest in brand name medications. The trips were paid for by the pharmaceutical firms that manufactured these drugs.

Trips like this started to become unseemly, and the public began demanding more transparency in the relationships their doctors had with drug companies. A database was created to keep track of the monies flowing to docs from drug companies.

Docs can still get a meal (as long as it’s ‘educational,’ i.e. there’s a lecture along with it) and the traditional branded pens and pads of paper for the office. Sometimes drug reps (the sales people for the pharma firms, known in the trade as ‘detailers’) bring by bagels or doughnuts to woo the staff and steal a few minutes to tell us about their latest product.

The big money comes to the select few who become ‘thought leaders,’ i.e. spokespeople on behalf of certain drugs. This can range from five to six figures. Per year.

Docs have always been a little defensive about having these relationships explored or highlighted. “No drug company influences the way I prescribe,” is a common sentiment.

“I prescribe the best products that are on the market,” is another retort — not hard to defend, as the brand name drugs create the perception (at least) of being the best.

Conventional wisdom has always held that drug companies wouldn’t spend the billions that they do on marketing if it wasn’t beneficial. Proof of that has been hard to come by, though, as there wasn’t a way to clearly demonstrate a relationship between drug company payments and the rate of prescribing brand name (i.e. heavily marketed, more expensive) drugs.

Now there is.

In a beautifully conceived and executed investigative report, the non-profit news source ProPublica has linked the pharma payment database with the Medicare Part D (which since 2003 has paid for prescription drugs for seniors) database.

You know what?

There’s a perfectly linear correlation: Docs that receive payments (in one database) prescribe more brand name drugs (from the other database).

Nothing about this is illegal. There’s no doubt that some of the doctors receiving payments genuinely believe the brand-name products they prescribe are better. It’s just that no one can claim with a straight face any longer that payments to doctors don’t influence the way we prescribe.

(Mind you, the drug companies have known this all along, but have kept this information private as ‘proprietary’ information. Trade secrets, you know.)

If you like this kind of reporting, you can listen to a story about the investigation here:

Medical Me-Tooism

mediacalmetooism4b_wide-cf5d190b9eea4633b75292465de7ecb0d66a1bcf-s800-c85My father turns 78 in a few weeks. Though in my medical (and filial) opinion he’s aging well, he begs to differ — seeing his own aging as the piling on of indignities and infirmities.

Everything is relative, though, as he’s often taught me. When he compares himself to his peers, he often wonders if he should be undergoing the same medical routines and procedures that they are. My advice when he feels that impulse: Take a heavy dose of caution.

I wrote about this in an essay for NPR, accompanied by a wonderful collage by Katherine Streeter. Please click on the picture and take a look.

Sticking to Basics

I’m often asked for medical advice by friends, family members, even new acquaintances. It comes with the territory: What about this diet? What should I do about this symptom? What about this medication?

People are usually disappointed when I don’t share their enthusiasm about the latest health fads. Members of my family, in particular, are often underwhelmed by my medical advice.

I’ll be the first to admit that I do a poor job of conveying why I’m skeptical about the newest medical technology, reports of the latest health news and fashions, and even people’s symptoms. Most symptoms, after all, aren’t explainable, at least to the level of detail we all want.

“What’s causing my symptoms?” Is it a virus? Bacteria? Arterial blockage? In spite of all the science and technology in medicine, what we do is more about taking educated guesses (“playing the probabilities”) than providing precise diagnostic information.

But prevention is different. We know a lot about it, based on huge bodies of epidemiological research. Most of prevention is fairly straightforward. You’ve heard the advice again and again — so much so that it’s easy to tune out. There really aren’t shortcuts:

  • Get enough sleep.
  • Move your body — throughout the day.
  • Eat well — a healthy assortment of foods. Mostly plants, and not too much. [An idea popularized by author Michael Pollan.]
  • Interact socially. Isolation is not good for the body, soul, or mind.
  • Take some time to reflect.

Recently I’ve come across a couple of ‘content items’ that do a much better job of conveying these messages. One is a set of books and ideas around the world’s so called “Blue Zones.” If you haven’t heard about them, Blue Zones are the places in the world where people both live the healthiest and longest — people in these communities often live well beyond 100 years.bz_zones

  • Okinawa, Japan
  • Ikaria, Greece
  • Sardinia, Italy
  • Nicoya, Costa Rica
  • Loma Linda, California

In all of these places, people have preventive medicine embedded in their lives, without even having to think about it. Their daily activities involve walking most places, eating healthy diets rich in local plants, with a lot of intergenerational social interaction. Interestingly, folks in these communities do drink alcohol — but limit it to 1-2 drinks/day maximum. And they do eat meat — but not very often and in small portions. One thing that won’t surprise you: Blue Zoners do not eat refined sugars (all the convenience and packaged foods that we’re trained to eat because they’re cheap and widely available).

Summarizing these themes visually in under two minutes is another gem from the idea lab of Dr. Mike Evans from Toronto. You’ve seen some of his other videos here. I love them. Just watch the one below, and follow his advice. That’s what I’m trying to do in my own life.

From the Evans Health Lab:

What are your thoughts on Blue Zones and Dr. Mike’s advice?

People of the Book

51LnzMAiHuL._SY344_BO1,204,203,200_Doctors are a group that prize scientific evidence in plying our trade — whether making recommendations to our patients or arguing with each other about how to interpret and act upon our profession’s ever-growing body of research.

I find it pretty easy to lapse into the rationalization that “the latest evidence” is usually right, and therefore should heavily weight both our actions and our “knowledge base.”

But a new book challenges this rationalizing — pointing out that over the decades, many assumptions about best medical practices later come into question and are thrown out — a process known as “Medical Reversal.”

I blogged about this before, as several articles in this genre stood out to me. Now that line of research has been turned into a book: “Ending Medical Reversal,” by Vinay Prasad and Adam Cifu. I was delighted to be asked to review this book for Johns Hopkins Press, and glad to see that they’ve published it (in fact, they used a statement in my review as a blurb (!) on the book jacket).

If you like to know how medical knowledge gets disseminated, communicated, retracted, and paved over, then this will be an enjoyable read. The NYTimes just reviewed the book, with a recommend, only questioning the rather esoteric title, suggesting instead that the book be called “OOPS!” or “Are You Kidding Me?”

I like those.

*                         *                         *                          *                         *                         *

This past week I had the opportunity to meet the great Roz Chast, author of the award-winning graphic memoir “Can’t We Talk About Something More Pleasant?”

She visited the Tulsa City-County Library as part of a series of programs put on in conjunction with Clarehouse, a local not-for-profit hospice. The goal of the series is to increase awareness and dialogue about improving care for people at the end of life.dr john schumann 3

« Older posts Newer posts »

© 2019 GlassHospital

Theme by Anders NorenUp ↑