Archive for the 'health care' Category

Lyme Disease and Bad Medicine

Saturday, April 19th, 2014

I got Cure Unknown: Inside the Lyme Epidemic (2008) by Pamela Weintraub from the library and found something surprising: an angry foreword. Weintraub is a science journalist; the foreword is by Hillary Johnson, another science journalist and apparently a friend of Weintraub’s.

In her anger, Johnson says several things I say on this blog. (more…)

High-Frequency Trading and Health Care

Thursday, April 17th, 2014

High-frequency trading is a misnomer. It’s actually short-latency trading, a name that makes clearer why it is so unsavory. As Michael Lewis explains in Flash Boys, short-latency traders use a buy order on one exchange to quickly buy that stock on other exchanges before the original buy order reaches the other exchanges. Lewis writes:

The deep problem with the system was a kind of moral inertia. So long as it served the narrow self-interests of everyone inside it, no one on the inside would ever seek to change it, no matter how sinister or corrupt it became — though even to use words like “corrupt” and “sinister” made serious people uncomfortable.

I thought of health care. Our health care system — centered on treating symptoms with drugs you take for the rest of your life — serves the narrow self-interests of those inside it, such as doctors and medical school professors. That is surely one reason its predatory aspect is rarely mentioned.

But I also noticed how poorly Lewis, an excellent writer, describes the problem. “Moral inertia”? No, the problem is not that Person X or Person Y is slow to get outraged. “Corrupt”? No, no one is being paid off to look the other way or vote a certain way or introduce a certain bill. “Sinister”? It’s unclear what that means. Is Lewis just using a fancy synonym for “bad”?

Elsewhere Lewis uses the word predatory, which seems accurate. Short-latency traders preyed on those who sold stock, taking advantage of their ignorance. Of course, no one is forced to buy or sell stock and the loss on one trade is small. But everyone gets sick.

 

 

Assorted Links

Wednesday, April 2nd, 2014

Assorted Links

Saturday, March 22nd, 2014

Thanks to Casey Manion.

Heart Emergencies by Appointment at Mt. Sinai Hospital

Tuesday, March 18th, 2014

A recent Bloomberg News article looked into why Mt. Sinai Hospital in New York did a very large number of heart procedures, making its cardiologists very well-paid. One reason, the journalists discovered, is that patients had been told to lie:

On a pair of representative Sundays in 2012, 10 patients told ER workers they’d been instructed to arrive there before their cath-lab appointments, according to internal hospital correspondence. Two of them said they’d been coached to say they were having acute symptoms of heart disease, according to the exchanges.

Even more remarkable, the journalists found, was that many patients had cardiology appointments before they showed up at the emergency room:

Certain patients who showed up at Mount Sinai Hospital’s emergency room on Sunday mornings stood out [because] they already had appointments. Each was scheduled for a procedure at Mount Sinai’s catheterization lab, where cardiologists thread wires and tubes into blood vessels to detect disease and insert cardiac stents. The New York hospital’s cath lab has regularly scheduled such emergencies-by-appointment, according to three doctors and another medical professional, all of whom said they had direct knowledge of the practice.

Larry Husten, a medical columnist at Forbes, argues that this is an example of a widespread problem.

Assorted Links

Friday, March 14th, 2014

Thanks to Steve Hansen.

Assorted Links

Wednesday, March 12th, 2014

Thanks to Patrick Vlaskovits.

Sleep and Depression: More Links

Friday, March 7th, 2014

In 1995, hoping to improve my sleep, I decided to watch TV early in the morning, for reasons explained here. One Monday morning I watched tapes of Jay Leno and David Letterman that I’d made. Nothing happened. On Tuesday, however, I woke up and felt great: cheerful, eager and yet somehow calm. I had never felt so good so early in the morning. Monday had been a normal day, I had slept a normal length of time. The good feeling was puzzling. Then I remembered the TV I had watched. It had seemed so innocuous. The notion that 20 minutes of ordinary TV Monday morning could make me feel better Tuesday but not Monday seemed preposterous. Absurd. Couldn’t possibly be true.

Except for one thing. I had done something to improve my sleep. Plenty of research connected sleep and depression. That research made it more plausible that something done to improve sleep would improve mood. I went on to confirm the morning faces/mood linkage in many ways. The research connecting sleep and depression had been the first signs of a hidden mechanism (we need to see morning faces for our mood regulatory system to work properly) I consider very important.

Two new studies further connect sleep and depression. One of them found that people who sleep normal amounts of time are less influenced by genes associated with depression than those who sleep longer or shorter lengths of time. The other found that teenagers who sleep less than usual are at greater risk of depression.

The theories that psychiatrists have used to justify anti-depressants (e.g., “chemical imbalance”) do not explain the many connections between sleep and depression. Depression is associated with lots of bad things, unsurprisingly, but the association with bad sleep is especially strong. It is not easily explained away. You might think that if you are depressed you are more tired than usual and therefore sleep more/better than usual. The opposite is true.  All this might have generated, among psychiatric researchers, a search for a better theory — an explanation of depression that can explain the sleep/depression connections — but it hasn’t.

 

Assorted Links

Wednesday, February 26th, 2014

Fermented Foods, Eczema, and the Room for Improvement in Medicine

Tuesday, February 25th, 2014

When I was a graduate student, I had acne. Via self-experiment, I discovered that the antibiotic my dermatologist had prescribed didn’t work. He appeared unaware of this possibility, although antibiotics were (and are) very commonly prescribed for acne. “Why did you do that?” he said when I told him my results. As I’ve said before, I was stunned that in a few months I could figure out something important that he, the expert, didn’t know. He had years of training, practice, and so on. I had no experience at all. Eventually I gathered additional and more impressive examples — cases where I, an outsider with no medical training, managed to make a big contribution with tiny resources. The underlying message seemed to be that professional medicine rested on weak foundations, in the sense that big conclusions could be overturned with little effort.

Two recent posts  (here and here) on this blog argue that eczema, which afflicts about 10% of Americans, can be cured and prevented with fermented foods. This observation makes perfect sense because of two pre-existing ideas: 1. Eczema is due to an overactive immune system. 2. Fermented foods “cool down” that system (a variant of the hygiene hypothesis). Professors of dermatology failed to put them together, but people outside medicine were able to.

After I learned that eczema could be cured easily and safely, statements by medical professionals about eczema became horrifying. A dermatologist recently wrote about eczema on Reddit:

Eczema is a chronic condition, which includes hand eczema. It’s a condition of dry and sensitive skin. Topical steroids are a useful adjunct in getting your skin clear, and – in certain cases – keeping your skin clear. I tell my patients that the most important thing in management of eczema is the skin care regimen. This means avoidance of irritating factors and restoration of the skin barrier.

The National Eczema Association:

The exact causes of eczema are unknown. You might have inherited a tendency for eczema.. . . Many doctors think eczema causes are linked to allergic disease, such as hay fever or asthma. Doctors call this the atopic triad. Many children with eczema (up to 80%) will develop hay fever and/or asthma.

The Mayo Clinic website: “The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body’s immune system.”  The various remedies listed have nothing to do with the immune system.

What else don’t they know? Doctors have great power over our well-being. Imagine learning that the driver of the car you are in is nearly blind.

DIY Medical Devices: No Science, Please

Wednesday, February 19th, 2014

An article about DIY medical devices — devices created outside of big companies — does illustrate the predatory nature of our health care system:

It can still be difficult for inventors to break into the medical-device market. Amy Baxter, a pediatrician specializing in pain management, found this out firsthand. When her four-year-old son developed a fear of needles, Baxter set up shop in her basement and created Buzzy, a vibrating ice pack shaped like a bee that numbs the sting of injections. . . She says, “I decided to use my solution as a mother to be a better — more globally impactful — doctor.” Baxter held randomized controlled trials comparing the device to ethyl chloride spray and published the results. But when she launched the product in 2009, she found it nearly impossible to get her product into hospitals.

“It’s the nature of the system marketing to hospitals to pad prices and make items disposable to ensure repeat sales,” she says. Medical sales reps paid on commission will only take the time to push a new product if it is very expensive, with a high profit margin, or if it’s a cheap item that has to be reordered often, she says. “A reusable, low-cost product doesn’t work.”

On the other end, she says, hospitals’ complex budgetary processes often disconnect the physicians who order products — and pass the price on to patients and insurance companies — from their true cost. “Decisions to buy aren’t as straightforward as looking at a catalog,” she says. “There is no easy way to comparison shop, and less incentive in the medical environment.”

The result of all this inefficiency [which curiously works only in one direction -- to make things worse for consumers and better for health care professionals], Baxter says, is not only notoriously inflated hospital prices — like $36.78 for a $0.50 Tylenol with codeine pill and $154 for a $19.99 neck brace — but also a high barrier to entry for devices like Buzzy, which is currently available only online, with no marketing beyond word of mouth.

A predatory relationship is one where one side is much more powerful than the other side and uses that power to take from the other side.

The article says nothing about science — better understanding of the connection between environment and health. Science is so poorly understood by so many people that even a doctor, such as Baxter, fails to understand that it exists:

The more people become involved in medical making, says Baxter, the less the human body will seem like a mysterious black box whose problems and solutions are only within the realm of experts. [Not true. Making is not science. There is still a great need for science -- Seth] “The truth is,” she says, “the place where the body interfaces with the rest of the world is just engineering.”

No, it isn’t just engineering. There is a vast amount we don’t know about the world’s effect on the body. Even a small improvement in understanding how environment (including food) controls health (e.g., how to sleep better) can easily be worth billions of dollars per year, more than all DIY medical devices put together. And knowledge (and the associated benefits) spreads at no cost at all, in contrast to medical devices.

Engineers assume people will get sick. Scientists do not.

Thanks to Alex Chernavsky.

Assorted Links

Wednesday, January 22nd, 2014
  • A very common knee surgery ($14 billion per year spent on it in America) turns out to be no better than sham surgery in many cases. Plainly this supports critics of medicine who say there is overtreatment. To be fair there is good news: 1. At least this particular operation wasn’t contraindicated by high school biology.  2. The study was done and published. 3. And publicized widely enough to influence practice.
  • Heart guidelines based on fake research probably killed tens of thousands of people. Making useless knee surgery look good.
  • “The time you’re taking to help this girl, you could be …” A great talk by Jessica Alexander about ten years working for NGOs. Her book is Chasing Chaos: My Decade In and Out of Humanitarian Aid.
  • On EconTalk, Judith Curry, the climatologist, makes the excellent point that it is weird to call someone who believes climate questions are more complex than portrayed a “denier”. In every other use of the term, a denier is someone who avoids recognizing complexity, i.e., the opposite. On the other side of the ledger, Curry makes an elementary physics mistake when she says that as an ice cube floating in your drink melts, the water level of your drink rises. (It stays the same.)

Thanks to Allan Jackson.

Assorted Links

Saturday, January 18th, 2014
  • Dangers of Splenda. Never use it in baked goods.
  • Overdiagnosis of attention deficit disorder. “So many medical professionals benefit from overprescribing that it is difficult to find a neutral source of information. . . . The F.D.A. has cited every major A.D.H.D. drug, including the stimulants Adderall, Concerta, Focalin and Vyvanse, for false and misleading advertising since 2000, some of them multiple times.”
  • David Suzuki, prominent environmentalist, former genetics professor, founder of the David Suzuki Foundation, once voted the greatest living Canadian, is asked a question about climate change that turns out to be surprisingly hard.
  • Confucius Peace Prize. Awarded to Putin because Russia makes China look good?
  • Top 10 retractions of 2013. There is a website for retractions (Retraction Watch) but no website for discoveries that could have been made but weren’t, except maybe this blog. I’m not joking. I am far more alarmed by lack of progress than retractions.

Thanks to Dave Lull.

Who Tests the Genetic Testers? And the Experts?

Wednesday, January 15th, 2014

In the New York Times, a writer named Kira Piekoff, a graduate student in Bioethics, tells how she sent her blood to three different companies, including 23andMe, for genetic analysis and got back results that differed greatly. As usual, none of the companies told her anything about the error of measurement in their reports, judging from what she wrote. So she’s naive and they’re naive (or dishonest). Fine.

I’m unsurprised that a graduate student in bioethics has no understanding of measurement error. What’s fascinating is that the experts she consulted didn’t either, judging by what they said.

A medical ethicist named Arthur L. Caplan weighed in. He said:

The ‘risk is in the eye of the beholder’ standard is not going to work.We need to get some kind of agreement on what is high risk, medium risk and low risk. [Irrelevant -- Seth] If you want to spend money wisely to protect your health and you have a few hundred dollars, buy a scale, stand on it, and act accordingly.

As if blood sugar and blood pressure measurements aren’t useful. A good scale costs $15.

A director of clinical genetics named Wendy Chung said:

Even if they are accurately looking at 5 percent of the attributable risk, they’ve ignored the vast majority of the other risk factors — the dark matter for genetics — because we as a scientific community haven’t yet identified those risk factors.

She changed the subject.

J. Craig Venter, the famous gene sequencer, does not understand the issue:

Your results are not the least bit surprising. Anything short of sequencing is going to be short on accuracy — and even then, there’s almost no comprehensive data sets to compare to.

The notion that “anything short of [complete] sequencing” cannot be helpful is absurd, if I understand what “short on accuracy” means. He reminds me of doctors who don’t understand that a t test corrects for sample size. They believe any study with less than 100 subjects cannot be trusted.

I told a friend recently that I have become very afraid of doctors. For exactly the reason illustrated in these quotes, from well-known experts who are presumably much more competent than any doctor I am likely to see. The experts were unable to comment usefully on something as basic as measurement error. Failing to understand basics makes them easy marks — for drug companies, for example — just as the writer of the article was an easy mark for the experts, who managed to be quoted in the Times, making them appear competent. Surely almost any doctor will be worse.

Joseph Biederman is Still at Harvard

Saturday, January 11th, 2014

Joseph Biederman is a professor of psychiatry at Harvard Medical School. It makes a certain sense. According to Wikipedia, in 2007 he was

the second highest producer of high-impact papers in psychiatry overall throughout the world with 235 papers cited a total of 7048 times over the past 10 years as determined by the Institute for Scientific Information.

And he has won several awards:

Biederman was the recipient of the 1998 NAMI Exemplary Psychiatrist award. He was also selected by the Massachusetts Psychiatric Society Awards committee as the recipient of the 2007 Outstanding Psychiatrist Award for Research. In 2007, Biederman received the Excellence in Research Award from the New England Council of Child and Adolescent Psychiatry. He was also awarded the Mentorship Award from the Department of Psychiatry at the Massachusetts General Hospital.

But there’s also this:

Biederman had pioneered the diagnosis of bipolar disorder in children and adolescents, a disorder previously thought to affect only adults. One of the world’s most influential child psychiatrists, Biederman’s work led to a 40-fold increase in pediatric bipolar disorder diagnoses and an accompanying expansion in the use of antipsychotic drugs – developed to treat schizophrenia and not originally approved for use in children – to treat the condition. However, Biederman and his colleagues Spencer and Wilens failed to accurately disclose the large consultancy fees they were receiving from pharmaceutical companies that make antipsychotics whilst conducting this research.

For which Biederman received a slap on the wrist from Harvard.

And there’s this:

Dr. Biederman pushed [Johnson & Johnson] to finance a research center at Massachusetts General Hospital, in Boston, with a goal to “move forward the commercial goals of J.& J” [said Biederman in an email]

In other words, he felt no shame in admitting that he considered the commercial goals of Johnson & Johnson more important than the health of children with severe problems. One of the few people who can really help these children — by doing good research — he preferred to help Johnson & Johnson.

Man Beats Prostate Cancer Without Surgery

Friday, January 10th, 2014

This story by investment blogger Mish Shedlock about a prostate cancer diagnosis illustrates the bias of doctors toward dangerous expensive treatments:

The biopsy showed I had cancer. My “Gleason Score” was 6. The surgeon who performed the biopsy strongly recommended surgery. He gave me a cost of $20,000.

Bad recommendation. Shedlock got rid of his cancer, as measured by PSA (Prostate Specific Antigen) tests, without surgery or any other expensive or dangerous treatment.

The surgeon said something else also highly misleading. He told Shedlock he was “10% cancerous”. When Shedlock repeated this to his oncologist,

The oncologist replied “That’s not correct. Of the 12 samples, only one had cancer and one was questionable. The cancerous sample was 10% cancerous.” Now that is a hell of a lot different than being 10% overall cancerous.

His oncologist seemed unfamiliar with data:

I informed the oncologist that I was going to have a PSA test every month. He commented something along the lines of “Why do you want to do that? Every six months is sufficient. The tests are not that reliable.”  . . . [I thought:] The more unreliable a test is, the more tests one should take to weed out erroneous outlier results.

This reminds me of the dermatologist I had in graduate school. After I tested the two medicines he had prescribed for my acne, and found that one of them didn’t work, and told him this, he said, “Why did you do that?” Haha.

The oncologist predicted that the cocktail that cured Shedlock “would not do [him] any good”.

I am sorry Shedlock does not name the doctors involved, as I did in a similar situation. I too avoided recommended surgery and my surgeon made highly misleading statements. Shedlock wrote about bad health care more generally here.

Thanks to Steve Hansen.

ADHD Experts Have a Bad Case of Gatekeeper Syndrome

Saturday, January 4th, 2014

Gatekeeper syndrome afflicts many many healthcare professionals. People with gatekeeper syndrome dismiss or ignore any solution that does not involve them (or someone like them) being a gatekeeper and charging “toll”, i.e., making money. When I was a teenager, I had acne. None of the dermatologists I saw showed any interest in what caused it or even seemed to understand it was possible to learn the cause. All of them prescribed drugs (antibiotics) so powerful I had to see them again and again to get the prescription refilled. That’s garden-variety gatekeeper syndrome.

A recent New York Times article about Attention Deficit Hyperactivity Disorder (ADHD) illustrates gatekeeper syndrome among professionals from whom you might expect better. The article describes ADHD experts at various universities wringing their hands: Did we overemphasize drugs at the expense of “skills training”?

Some authors of the [1999] study — widely considered the most influential study ever on A.D.H.D. — worry that the results oversold the benefits of drugs, discouraging important home- and school-focused therapy and ultimately distorting the debate over the most effective (and cost-effective) treatments.

What about finding the cause(s) of ADHD? And getting rid of it/them? Maybe that would be a good idea? None of the experts quoted in the article even seems aware this is possible.

When an ordinary psychotherapist or doctor has gatekeeper syndrome, I think they’re just a foot soldier. The experts in the Times article are not foot soldiers. They’re generals. They are professors at world-famous universities, such as UC Berkeley and McGill, with enormous influence.  (One is a former colleague of mine, Stephen Hinshaw.) They don’t need to see patients and dispense treatments to make a living. They have assured income (tenure) and prestige. They enjoy freedom of thought.

Too bad they don’t use their freedom and prestige to better help the children they study and the tens of millions of children who will be diagnosed with ADHD until someone (not them, apparently) figures out what causes it. Instead, they study who should get the revenue stream that each new diagnosis provides.

Thanks to Alex Chernavsky.

Missing Data in Clinical Trials: FDA Officials Refuse to Set Limits

Sunday, December 29th, 2013

People who believe in “evidence-based medicine” say that double-blind clinical trials are the best form of evidence. Generally this is said by people who know very little about double-blind clinical trials. One reason they are not always the best form of evidence is that data may be missing. Nowadays more data is missing than in the past:

By [missing data] he [Thomas Marciniak] means participants who withdrew their consent to continue participating in the trial or went “missing” from the dataset and were not followed up to see what happened to them. Marciniak says that this has been getting worse in his 13 years as an FDA drug reviewer and is something that he has repeatedly clashed with his bosses about.

“They [his bosses] appear to believe that they can ignore missing and bad data, not mention them in the labels, and interpret the results just as if there was no missing or bad data,” he says, adding: “I have repeatedly asked them how much missing or bad data would lead them to distrust the results and they have consistently refused to answer that question.”

In one FDA presentation, he charted an increase in missing data in trials set up to measure cardiovascular outcomes.

“I actually plotted out what the missing data rates were in the various trials from 2001 on,” he adds. “It’s virtually an exponential curve.”

Another sort of missing data involves what is measured. In one study of whether a certain drug (losartan) increased cancer, lung cancer wasn’t counted as cancer. In another case, involving Avandia, a diabetes drug, “serious heart problems . . . were not counted in the study’s tally of adverse events.”

Here is a presentation by Marciniak. At one point, he asks the audience, Why should you believe me rather than the drug company (GSK)? His answer: “Neither my job nor (for me) $100,000,000’s are riding on the results.” It’s horrible, but true: Our health care system is almost entirely run by people who make more money (or make the same amount of money for less work) if they exaggerate its value — if they ignore missing data and bad side effects, for example. Why the rest of us put up with this in the face of overwhelming evidence of exaggeration (for example, tonsillectomies) is an interesting question.

Thanks to Alex Chernavsky.

Assorted Links

Sunday, December 15th, 2013
  • Interview with sufferer from mercury amalgam fillings. Stephen Barrett, founder of Quackwatch, says mercury amalgam fillings are perfectly safe. For many people, this might be true. It is not always true.
  • “She was given a three to five year sentence.” One of the greatest wrist-slaps of all time. She deserves at least one year in jail per falsification, which would be several thousand years in jail.
  • Ron Unz, the minimum wage and social innovation
  • Dairy consumption and heart disease risk. “The majority of observational studies have failed to find an association between the intake of dairy products and increased risk of CVD, coronary heart disease, and stroke, regardless of milk fat levels.”
  • Tourism and mental illness. “A Canadian woman was denied entry to the United States last month because she had been hospitalized for depression in 2012. Ellen Richardson could not visit, she was told, unless she obtained “medical clearance” from one of three Toronto doctors approved by the Department of Homeland Security.” Horrifying.
  • Snorting baby shampoo to cure sinusitis. A good example of personal science. His understanding of biofilms led him to try baby shampoo. It is also interesting that he doesn’t try to strengthen his immune system to solve the problem or maybe he doesn’t know how to. A professional sinusitis researcher would never discover what he did, yet another example of how our healthcare system ignores cheap treatments.

Thanks to Allen Jackson and Phil Alexander.

Dark Picture of Doctors

Monday, November 25th, 2013

A New York Times article about error in a risk calculator paints an unflattering picture of doctors:

1. The risk calculator supposedly tells you your risk of a heart attack, to help you decide if you should take statins. It overestimates risk by about 100%. The doctors in charge of it were told about the error a year ago. They failed to fix the problem.

2. The doctors in charge of the risk calculator are having trouble figuring out how to respond. The possibility of a simple retraction seems to not have occurred to them. As one commenter said, “That the researchers, once confronted with the evidence it was faulty, struggled with how to handle the issue is quite telling.”

3. In the comments, a retired doctor thinks the problem of causation of heart disease is very simple:

Statins . . . are only one component in the prevention and treatment of coronary artery disease. Item number one is to have a normal weight. Item two is never smoke. Item three is exercise. Four is to eat an intelligent diet. Five is to remove stress from your life as much as practical. If everybody did these five things (all of which are free), the incidence of coronary artery disease would plummet and many fewer would need statins.

This reminds me of a doctor who told me she knew why people are fat: They eat too much and exercise too little. She was sure.

4. In the comments, a former medical writer writes:

Several years ago, I wrote up, as internal reports, about two dozen transcripts recorded at meetings with local doctors that a major drug company held all around the country. The meetings concerned its statin. Two ideas presented at these meetings by the marketing team, and agreed with by the physician attendees, were: 1) the muscle pain reported by patients was almost never caused by the statin but was the result of excessive gardening, golfing, etc; 2) many children should be prescribed a statin and told that they would have to take the drug for life.

5. Another doctor, in the comments, says something perfectly reasonable, but even her comment makes doctors look bad:

I am a physician and I took statins for 2 years. Within the first 6 months, I developed five new serious medical problems, resulting in thousands of dollars spent on treatments, diagnostic tests, more prescription medications, and lost work. Neither I nor any of my 6 or 7 different specialists thought to suspect the statin as the source of my problems. I finally figured it out on my own. It took 3 more years for me to get back to my baseline state of health. I had been poisoned. I see this all the time now in my practice of dermatology. Elderly patients are on statins and feel lousy, some of whom are also on Alzheimer’s drugs, antidepressants, Neurontin for chronic pain, steroids for fibromyalgia. These poor people have their symptoms written off as “getting older” by their primary physicians, most of whom I imagine are harried but well intentioned, trying to follow guidelines such as these, and so focused on treating the numbers that they fail to see the person sitting in front of them. The new guidelines, with their de-emphasis on cholesterol targets, seem to tacitly acknowledge that cholesterol lowering has little to do with the beneficial actions of statins. The cholesterol hypothesis is dying. If statins “work” by exerting anti-inflammatory benefits, then perhaps we should seek safer alternative ways to accomplish this, without subjecting patients to metabolic derangement.

6. A patient:

My previous doctor saw an ultrasound of my Carotid Artery with a very small buildup and told me I needed to take crestor to make it go away. That was four years ago and I still suffer from some memory loss episodes as a result. The experience was terrible and he’s toast because he denied it could happen.

7. A bystander:

For the past couple of years my job has involved working with academic physicians at a major medical school. After watching them in action — more concerned with personal reputation, funding and internecine politics than with patients — it’s a wonder any of us are limping along. And their Mickey Mouse labs and admin organizations can barely organize the annual staff holiday potluck without confusion and strife. So these botched-up results don’t surprise me at all.

I am not leaving out stuff that makes doctors look good. Maybe this is a biassed picture, maybe not. What I find curious is the wide range of bad behavior. I cannot explain it. Marty Makary argued that doctors behave badly due to lack of accountability but that doesn’t easily explain ignoring a big error when pointed out (#1), an immature response (#2), a simplistic view of heart disease (#3), extraordinary callousness (#4) and so on.  In her last book (Dark Age Ahead), Jane Jacobs wrote about failure of learned professions (such as doctors) to police themselves. Again, however, I don’t see why better policing would improve the situation.

Thanks to Alex Chernavsky.