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Popular Medicine Not Always the Best Course of Treatment

In a co-authored investigative report by ProPublica and The Atlantic, journalist David Epstein outlines the epidemic being played out in hospitals, clinics, and doctor’s offices around the country. Despite evidence to the contrary, physicians frequently are prescribing medicines and treatments that are not necessarily the safest choice for patients. Epstein describes how factors such as not keeping up with current research, relying on popular but unfounded research findings, profits, and bending to demanding patients has led to over invasive treatments and tests, useless medication therapies, and even severe injuries and death.

A Tale of Two Stents
The report begins with the stories of two patients who both were recommended for stent placement. One, a high-stress middle-aged man with chest pains and high blood pressure, used Google to second guess his doctor’s stent recommendation. He avoided the procedure entirely by seeking a second opinion and remains healthy and stent-free. The second man was a 51 year old stage IV lymphoma survivor who, after rounds of chemo and radiation, was suffering from lung scarring. He went to the hospital with chest pains from the scarring and despite his prior cancer history was given a stent, along with medication that would prevent blood clots arising from the implantation site of the stent. Months later, the man’s scarring had progressed to the point where a lung transplant was needed. The anticoagulant medications from the stent had to clear his system before a transplant surgery could take place, or else the man could bleed to death. While waiting for the blood thinners to wear off, the man suffocated to death due to the scar tissue that had invaded his lungs. Using the stent stories of two men with two drastically different outcomes leads to the main point of the report: Widely-known and frequently used procedures are not always the right choice. American College of Cardiology recommendations have been altered to clarify which situations merit stent placement and this has reduced the number of needlessly placed devices. However, in the stents that are implanted, a recent study revealed that half of them are unnecessary. It is important to note here that stents are recommended and have been proven to be beneficial in patients who have suffered a heart attack.

More Current Clinical Practices Useless Rather Than Successful
Epstein cites a 2013 study conducted by 12 physicians that reviewed a decade’s worth of New England Journal of Medicine articles that focused on current clinical practices. In total, the panel examined 363 procedures or courses of treatment and found that 146 of them proved no benefit for the patient or were actually less successful than a past treatment or procedure it replaced. 138 articles were shown to be viable treatments and the effectiveness of the last 79 practices was inconclusive.

The author also references several prior reports in which physicians candidly address how hard it is to reverse years of clinical habit once a related medical finding has been undermined or even reversed. A 2007 study published in JAMA revealed that on average, it takes about 10 years for doctors to stop using practices and procedures that have been proven to be useless. Further compounding the issue is the passing of the 21st Century Cures Act and a recent vow by President Trump to clear the path for FDA drug approval, virtually allowing medications to speed to the market, even for uses for which a drug has not been proven to be successful. Some have argued that the 21st Century Cares Act is backed by pharmaceutical companies and their lobbyists, who hope to push drugs to the public without solid medical research on what diseases or conditions the medications successfully treats.

The Bottom Line
Ultimately, the takeaway of the report is to be your own advocate. Doctors obviously bear huge responsibility for your health, but do not always have the time, necessary information, or resources available to properly diagnose and treat each patient. If they did, medicine would be a perfect science, which common sense and news headlines tell us is not the case. Do your own research and seek second and even third opinions, if necessary and if your condition permits. Be forthcoming with your doctor and care team about what other conditions you have faced, even if you aren’t sure of their relation to current symptoms. Sometimes a procedure, medication, or device is unnecessary but causes no harm. In the worst case scenarios, however, popular medicine has proven to be fatal.