[URL="http://money.msn.com/now/blog--americans-undergo-too-many-unneeded-surgeries"]Americans frequently undergo unnecessary surgeries[/URL][QUOTE]Here are some findings:
12% of all angioplasty procedures, which often include the insertion of stents, weren't medically necessary.
In 22.5% of cases in which a cardiac pacemaker/implantabl​e cardioverter-defibri​llator was installed, no evidence supported that decision.
In 17% of cases in which patients were told they needed back surgery/spinal fusion, no neurological or radiographic findings indicated such an operation was necessary.
Among patients told they needed total knee replacement surgery, 38% who received information about joint replacements and alternative treatments decided against the procedure.
Similarly, 26% of patients who received additional information about hip replacements decided against them.
In 43% of colonoscopies, no clinical indication showed a need for the procedure.
A study from earlier this year, looking at data from nearly 600 hospitals nationwide, found the rate of cesarean section deliveries varied tenfold across those hospitals -- from just more than 7% of all births to nearly 70%.
70% of hysterectomies were inappropriately recommended, "often because doctors didn't attempt treatment with non-surgical procedures."
USA Today broke down these unnecessary surgeries into three groups: the immoral, the incompetent and the indifferent.

Some patients, it says, fall victim to predatory doctors who defraud the insurance industry by performing operations that aren't medically justified. But a larger number of people, it adds, "turn to doctors who simply lack the competence or training to recognize when a surgical procedure can be avoided."

Experts and patients alike say questioning a doctor's decision to operate -- by researching the suggested procedure, asking for nonsurgical options and getting a second opinion -- can help reduce the number of unnecessary surgeries.

"We expect the physician to know what's best for a patient," William Root, the chief compliance officer at Louisiana's Department of Health and Hospitals, told USA Today. "We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage."[/QUOTE]

[QUOTE=cheesehead;362544]But I asked about [U]ineffective[/U] and [U]unnecessary[/U] procedures, not just procedures in general.[/QUOTE]

That is true. I suppose that I might, at least, argue that he is contending that the procedures recommended turned out to be unnecessary. They might have proven effective, if they were indeed necessary. However, that effectiveness would be at a considerable quality of life, as well as financial, cost.

[QUOTE]Yes, indeed. When that hammer is general distrust of doctors, the nail may be inappropriately driving patients away from proper treatment.[/QUOTE]It is a good point that the adage is a double-edged sword.

However, I do not believe that I have a general distrust of doctors. I do have one personal experience in particular, and others of which I have knowledge, which lead me to always urge careful consideration of courses of action in which mixed results might reasonably be considered possible.

To elaborate, many years ago, I fell and broke my left wrist. The doctor who treated it stuck it in a simple cast. He mentioned up front that the broken ulna MIGHT telescope upon itself and heal shorter. He mentioned this while he was wrenching on the incompletely anesthetized fracture. He also mentioned that surgery, and pinning was another option. I was in shock, and extreme pain at the moment, so I had nothing meaningful to say.

Three weeks later, he looked at an X-ray and pointed out that the ulna had indeed telescoped and shortened. At this point, he added that "this always happens. I could have pinned the fracture, but I've had bad experience with that, [U][I]so I decided not to do it."[/I][/U]

I also had an uncle who, in his late seventies or early eighties was diagnosed with prostate cancer and treated with radiation. I was not close enough to discuss this at the time, but my understanding of evaluating a case at that age is that one is most likely to die [U][I]with, not from[/I][/U] the cancer. In addition, he subsequently developed (perhaps coincidentally) colon cancer. This caused him to live out his last few years with a colostomy bag. Again, there is no way to assign causality between the radiation and the colon cancer. However, there is a good chance that treating his cancer at that age was unnecessary, if not outright counter-productive to his quality of life.

Now, back to my broken wrist. It came out of that cast severely displaced inward. This was in spite of the fact that I had told this alleged "healer" that I play keyboard instruments. I told him this after he asked if I were left or right handed, and what I then did for a living. I believe that there was a very cynical calculation which this person made as to what he was likely to be able to get away with in the malpractice arena, versus the least he might do to collect his fee. Further, he did not even bother to send me to occupational therapy. I then saw another doctor who did so. The therapist was shocked. She said, "I usually see such cases when they are right out of the cast."

This upshot was that for over 15 years my hand was badly aligned. Eventually, this began to cause joint pain, as by that time I also spent much time at computer keyboards. About this time, I was also on a decent enough HMO, with an understanding Primary Care doctor. He referred me to an outstanding orthopedist, who walked into my first appointment, and said, at a glance from the doorway, "Now That is a deformity."

While I had hoped to pursue a course known as the Ilizarov procedure [URL]http://en.wikipedia.org/wiki/Ilizarov_apparatus[/URL] the doctor could only locate external fixation device which would pin into a bone in the hand. He felt that the stress on the joint would cause problems. Note that he discussed all of this with me at length when I was in an appropriate mental state to evaluate the proposals. I ended up going with his recommendation that a bone graft be taken from the iliac crest, installed in the ulna, a plate attached, and pinned.

This seemed to work, and my hand was realigned. However, a year or two later, I had an accident in which I was carrying a heavy case as I stepped up onto a train. I lost my balance, and struck the wrist against the rubber bumper of the door. It hurt at the time, but subsided. It was only later that I realized that the fracture had separated, in fact, pulling out the screws which held the plate to the bone. Rather than knit properly, the ends of the disunion had calloused- formed scar tissue, essentially.

This resulted in a second surgery to clean the junction, and replace the plate with one on the underside of the bone. Unfortunately, this junction also calloused. Third time was a charm, though, only requiring yet another scraping out of scar tissue. At this point, the bone finally healed.

Now, you might say that this sequence called the second orthopedist's skills into question, except for one thing. If proper procedure had been followed at the outset, the fracture would have been fresh, and no graft would have been involved. I was also in my early thirties, instead of my late forties, so that healing might have been more immediate.

[QUOTE]Mish's closing advice about being one's own medical advocate is sound, but he doesn't seem to offer directions on just how best to go about that. Where does he discuss how to tell the difference between reliable and unreliable advice on the Internet?[/QUOTE]This was a personal account, not expert advice. One must be responsible for one's choices, and not everyone is cut out for that kind of research. However, medical advocacy is a good idea, whoever provides it.

[QUOTE]Mish seems only to urge readers to disregard their doctors' recommendations and to perform their own research, without any discussion of cases in which the doctors' recommendation may be superior to anything the patient might find in Internet forum postings by people with no medical qualification.[/QUOTE]I would have to re-read the article to really evaluate that contention, and I've really put a lot into describing my own background experience. However, my own impression was that he urged taking medical advice with an ample helping of salt, especially when there is a substantial pay-off to the adviser involved.

[QUOTE]... and the evidence Mish's article supplies that is applicable to that issue is ... ?
[/QUOTE]It is notoriously difficult to prove what the content of another person's mind might be, especially when the thoughts in question might be subliminal rather than direct and conscious. The surgical doctor (urologist) not only pushed very hard for surgery, but attempted what appears to be arm-twisting to that end. Some of the information he provided was called into question by the oncologist, at least in its presentation. Mish did not [U]only[/U] go trolling the internet. He consulted a doctor in a related specialty.

[QUOTE=only_human;362560][URL="http://money.msn.com/now/blog--americans-undergo-too-many-unneeded-surgeries"]Americans frequently undergo unnecessary surgeries[/URL][/QUOTE]

Very interesting. Thank you, Ross. It was good to finish my lengthy screed and find a post which seems to somewhat support my feelings on the subject.

[QUOTE=kladner;362563]That is true. I suppose that I might, at least, argue that he is contending that the procedures recommended turned out to be unnecessary. They might have proven effective, if they were indeed necessary. However, that effectiveness would be at a considerable quality of life, as well as financial, cost.[/QUOTE]

If I may share...

A few years ago a doctor recommended to me that he send electrified needles into my spine, and I undergo an MRI; all at very great profit to him and great expense to me.

You might imagine what I told him to do with that idea....

[url=http://www.nakedcapitalism.com/2013/12/yes-obama-democrats-mussolini-style-corporatists-just-like-republicans.html]Yes Virginia, Obama and the Democrats Are Mussolini-Style Corporatists, Just Like the Republicans | naked capitalism[/url]

Nice piece from the ever-erudite Yves Smith (pseudonym - this "Eve" is a she) - Only real revelation for me was the reason why Wall Street likes to label Obama "anti-business" at the same time it donated generously to his campaign(s) and benefited outrageously from his policies.

[QUOTE=ewmayer;362576][URL="http://www.nakedcapitalism.com/2013/12/yes-obama-democrats-mussolini-style-corporatists-just-like-republicans.html"]Yes Virginia, Obama and the Democrats Are Mussolini-Style Corporatists, Just Like the Republicans | naked capitalism[/URL]

Nice piece from the ever-erudite Yves Smith (pseudonym - this "Eve" is a she) - Only real revelation for me was the reason why Wall Street likes to label Obama "anti-business" at the same time it donated generously to his campaign(s) and benefited outrageously from his policies.[/QUOTE]


I am surprised at how close I am to the Right (Reich Wing, to some partisans!). My complaint about Obama has long been his Corporatism. My feelings are the same for both Clintons, and many other alleged "Center Leftists", (or is that "Left Centrists?") Nothin' Centerish about the lot. Bill Clinton added another example to what I call the "Nixon in China Syndrome." That is, conservatives can get away with things which no alleged liberal could. And conversely, alleged liberals can get away with things no conservative can. In Bill's case, it was "Welfare Reform" and "Banking Reform" with the repeal of Glass-Steagall.

I suppose the farther around the (political) Universe one travels, the closer you get, first to your supposed opposite, and then closer to where you started.

EDIT: I am also mildly amused that Reich Wingers, who would be (and really are) gung ho Corporatists, cannot maintain that position as long as Obama has occupied their home turf.

Ernst has frequently seemed not to comprehend the nature of evidence and its role in supporting allegations,or at least not to think it's necessary to show his readers any evidence. Here, he has linked to an article that has no evidence to support his reference to ineffective and unnecessary procedures.

[QUOTE=kladner;362563]I suppose that I might, at least, argue that he is contending that the procedures recommended turned out to be unnecessary.[/QUOTE]But Mish provides no evidence that they would be unnecessary for anyone else. That he himself didn't need them to stop his cancer (at least, as far as we know from his testimony) doesn't show that they would be unnecessary for anyone else.

[quote]However, I do not believe that I have a general distrust of doctors.[/quote]... and no one said you did.

Mish, however, seems to be promoting distrust in doctors.

[quote]I do have one personal experience in particular, < snip >[/quote]... but your testimony, like Mish's, proves nothing about whether any procedures in your, or your uncle's, particular experience would be unnecessary or ineffective in anyone else's case.

Do you understand that none of the details you describe about your uncle and yourself constitute the sort of evidence of effectiveness that comes from double-blind placebo-controlled clinical trials?

[quote]However, medical advocacy is a good idea, whoever provides it.[/quote]Fine, but Ernst didn't link to Mish's article in the context of medical advocacy.

[quote]However, my own impression was that he urged taking medical advice with an ample helping of salt, especially when there is a substantial pay-off to the adviser involved.[/quote]Fine, but that has nothing to do with providing examples or evidence of unnecessary or ineffective procedures.

(The following quote was in response to my question, "... and the evidence Mish's article supplies that is applicable to that issue is ... ?")
[quote]It is notoriously difficult to prove what the content of another person's mind might be,[/quote]I asked for evidence, not content of another person's mind.

[quote]especially when the thoughts in question might be subliminal rather than direct and conscious.[/quote]What in the world are you talking about?

I asked what evidence Mish's article supplied, not what was on his mind. You haven't cited a single piece of evidence from Mish's article.

[QUOTE=cheesehead;362587]But Mish provides no evidence...[/QUOTE]

Mish's article does provide indirect evidence. The relevant quote is:

[quote]The oncologist informed me that ... "based on your conditions, there is no statistical evidence that strongly favors any one course of action. Equal results are obtained by surgery, by radiation therapy, and by waiting".
[/quote]

It is not unreasonable to assume that the oncologist is referencing the kind of scientific evidence you desire. If so, then Dr. G was pushing a $20,000 surgery that had the same statistical outcome as doing nothing and most would consider this an example of an unnecessary surgery.

You are correct in that 1) Mish's case does not prove the problem is widespread. and 2) Mish's case does not prove a doctor was pushing an unnecessary procedure - the oncologist may not have been up on the latest literature.

However, Ernst isn't publishing in JAMA either. Ernst's style seems to use links to provides (some) evidence that there may well be a problem, leaving it up to the forum reader, if they so desire, to pursue more evidence on their own.

[QUOTE=Prime95;362588]Mish's article ...[/QUOTE]
:goodposting:

[QUOTE](The following quote was in response to my question, "... and the evidence Mish's article supplies that is applicable to that issue is ... ?")
Quote:
It is notoriously difficult to prove what the content of another person's mind might be,
I asked for evidence, not content of another person's mind.

Quote:
especially when the thoughts in question might be subliminal rather than direct and conscious.
What in the world are you talking about?

I asked what evidence Mish's article supplied, not what was on his mind. You haven't cited a single piece of evidence from Mish's article. [/QUOTE]

My general context had to do with the motivations of the urologist in promoting a certain course of action. I was attempting to allow for the possibility that, even if there were a financial element to those motivations, the doctor might not have been consciously conniving to come up with his next boat payment.

All these various anecdotes must be considered against the broader background (and statistics such as Ross provided) that the US spends twice as much per capita on medical care than the next-most-outlay-friendly nation on the planet, and for a result which taken on a whole-society basis can only be characterized as execrable.

Or do some of our readers believe we are exchanging charming personal-medical anecdotes in a vacuum?