Other People’s Money
Medical care is expensive and to a large extent this is unavoidable. Medical knowledge has advanced considerably in even my lifetime and there are hundreds of new medical therapies and technologies of unquestionable value to both individuals and society as a whole. It is therefore impossible to bring back the Good Old Days when doctors were paid in chickens or bushels of produce from their grateful patients, all of whose medical care the kindly country doctor could provide out of his well-used black bag. On the other hand, it cannot escape anyone’s attention who works in the medical industry that we waste prodigious sums of money with very little to show for it. I happen to be at the cutting edge of this profligacy but only because we have easy access in the Emergency Department to most of the expensive toys, not to mention that the nature of our specialty predisposes us to use them even when maybe we could substitute a little clinical judgment for technology.
We don’t, of course, for various reasons most of which are out of our control. It cannot be denied, for example, that the threat of litigation drives a lot of our medical decision making. As our good blog friend the Happy Hospitalist points out, a large percentage of the money we spend in medicine is to rule out conditions that are either rare in and of themselves or, if common, not very likely given the clinical picture of the patient. We spend the money anyway because there is very little incentive for most physicians to control costs. Just one successful lawsuit against a physician for a missed diagnosis can damage his ability to maintain his credentials, cost him the average income of any two or three Americans in increased liability insurance, jeopardize his financial assets, and even end his career. Why risk our own money when we can use somebody else’s to protect us, even if it costs millions?
And I do mean millions. Not meaning to brag but I am a veritable titan of excessive medical spending. A brawny legend of mythical proportions. Where my ancient Greek ancestors proudly arrayed the sacred hecatomb before the shrines of their gods, I call them base amateurs. My pen casually checks tiny boxes on order sheets that every day effortlessly transfer many times the value of their paltry burnt oxen from the public treasury to the altar of my gods, chief among them being Expediency, Haste, and Fear.
I have ordered, for example, expensive CT scans of the brain by the hundreds, the only purpose of which was to rule out that one in fifty-thousand chance that we’ll find something requiring an intervention, on people who had no neurological deficits, no symptoms of intracranial pathology, and not even a decent mechanical reason why they should have something wrong in their head. This is not to say that every CT I order is inappropriate. A patient who has never been to the Emergency Department before and presents with the dreaded “Worst Headache of My Life” needs to get a CT of the head, even if his lumbar puncture is negative. That’s just reasonable suspicion and due diligence. But an otherwise healthy young adult with normal vitals, normal physical exam, who tripped on the ice, bumped his head, and has been sitting in the waiting room for five hours eating stale vending machine nacho chips and watching the Fresh Prince of Bel Air? Does he really need any workup at all?
I am embarrassed to say that, just to be legally safe and in proportion to the number of times any particular attending of ours has been named in a frivolous lawsuit, we often obtain a five-hundred-dollar CT of the brain even in face of a normal neurological exam and a chief complaint (“I bumped my head”) that didn’t even exist forty years ago when we had less technology but maybe more common sense..
(We actually have a CT scanner in our department you know….and, By The Blood of the previously mentioned Triune God, we’re going to utilize the hell out of it. The only reason we didn’t put it at the ambulance entrance and have the paramedics run everybody through it was their fear of a little ionizing radiation.)Â
This kind of thing is not confined to the head, of course, or to the overuse of CT imaging. The CT scanner is just the most obvious example of Medical Testing Gone Wild.
It is hard to say exactly how many of the laboratory tests and imaging studies that we order are unnecessary. The point, however, of good clinical medicine is to only order a test to answer a question. If a patient complains of vague abdominal pain but has a benign abdomen (soft, non-tender, non-distended) and if twenty dollar’s worth of quick, in-house labs show a normal white count and no electrolyte abnormalities, then the correct play would be to suspect, strongly, some intestinal gas and send the patient home with strict instructions to return for fever, vomiting, or increased pain. Hell, throw in a serum lactate if you’re worried about mesenteric ischemia and a two-dollar pregnancy test if you have even a slight suspicion about an ectopic pregnancy and you’ve pretty much ruled out everything immediately deadly to the patient and answered almost every possible clinical question in the negative. There is no need for the inevitable ultrasound or CT scan of the abdomen with oral and intravenous contrast which not only costs a couple of large ones but also ties up a bed in the department for two hours at a minimum (the time to drink the contrast, transport, and have the study read). We only order these tests out of fear of sending a patient home with something like an early intussiception and having them decide not to return even if clearly told to do so. What does it hurt, after all, to send the early abdominal pain home except that if it turns out to be something and the patient doesn’t come back, all the jury will care about is that you sent somebody home, not that you exercised what seemed like good clinical judgment and a laudable regard for the public treasury?
Thus does the expectation of zero-defect medicine make cowards of us all. I have ordered hundreds of expensive imaging studies and in almost all cases, where the clinical suspicion of anything being abnormal was low, the studies have been negative. Even the studies that I order with solid history, physical exam, or lab abnormalities as a justification and where I expect to hit paydirt are usually negative. I understand that sometimes a negative study is as important as a positive one but if the pre-test probability is low, maybe we should save ourselves the car fare and give the zebra a little more time to cook. Give the problem time to declare itself, I mean, if it really exists. It sounds cold-blooded but you can’t expect everyone to get a ten-thousand dollar workup for every complaint and then complain about the high cost of medical care. Everything is not an Emergency.
If, on the other hand, we remove enough clinical judgment from the medical profession by penalizing it so severely on the rare occasions when it is wrong, we may as well load every patient on a conveyor belt where, despite their complaint, they pass through a full-body CT scanner, an ultrasound station, an indiscriminate lab station, an automatic EKG, and then have cut-rate physicians in India email treatment recommendations to minimum wage technicians at the end of the line.
On another note, the health care system itself, independent of the threat of litigation, is set up to encourage waste. While we don’t actually have a Health Care System per se, just a bunch of independent doctors and hospitals, there are two common threads that run through all of our medical endeavors and which serve as perverse unifying principles. The first is the obvious and inevitable fragmentation of care in our hyper-specialized industry . The second is the sure knowledge of everyone involved that nobody is actually spending their own money.
Consider the typical Family Practice physician seeing his typical panel of thirty patients a day. If he just manages to keep to his schedule giving each patient fifteen minutes of his time that’s a full eight-hour day, not even counting the various patient care tasks for which he receives no reimbursement but still impose an inexorable demand on his time. Unlike lawyers who bill for every minute of their time, a physician is reimbursed for the amount of time the government (and the private insurance firms that follow the government lead) think he should spend with the patient and not how much time he needs to or actually does. Because the reimbursement is so low physicians are forced to substitute volume for quality, running increasingly comorbid patients (the inevitable result of advances in medical knowledge) through their practice at a breakneck speed without the possibility of adequately addressing their many medical problems safely or economically. In their haste to see all of their patients, primary care doctors are forced to refer many of them to expensive specialists for things that they could diagnose, treat, and manage themselves if they had more time. In this manner, specialists are used more as physician extenders than learned consultants who are only brought into the case to help solve thorny diagnostic puzzles or to perform interventions outside the primary care doctor’s scope.
This “gatekeeper” model, where the primary care physician’s chief purpose is to be a clearinghouse for referrals to other physicians, has been a disaster, both from a financial and patient care point of view. A patient being followed by a squad of specialists, none of whom have the time to adequately coordinate care, not only costs many times what it would cost to just let the primary care doctor bill for the time he needs but it leads to a dangerous fragmentation of care where one set of doctors literally have no idea what the other set might be doing. I have seen it many times, often in the elderly patient on a long and bewildering list of dangerous and often medically contradictory medications. When specialists refer to other specialists sometimes even the primary care physician doesn’t know what the hell is going on.
Volume is the problem. Medicine is not like ordering fast food and most of it cannot be automated or standardized despite the best efforts of our friends in the electronic medical records industry, most of whose products are designed more to capture billable activities than medical information. The patients are becoming more complex, not less, and to continue to increase the speed with which we process them will only lead to more fragmentation and expense. Or to put it another way, medicine is not like building an automobile where individual pieces are built off-site, brought together on the assembly line, and efficiently assembled into economical automobiles by reaping the advantages of specialization and division of labor. Our current medical practices are more akin to hauling the chassis of the car to various locations around town, putting on one piece here, another there, none for exactly the correct model and none in any rational order, and then several years later when it is done wondering why the ignition won’t crank and the “engine warning” light won’t go off.
We tolerate this state of affairs because, no matter how much we spend and how fragmented the care, somebody else is always paying for it giving the end user of medical services no incentive and more importantly, no leverage to change things even if they wanted to which most don’t. My demented granny may be followed by a squad of specialists, she may have had every imaging study and intervention under Heaven and Earth ordered for her, she may have hundreds of thousands of dollars spent to extend her life by a handful of months but since I ain’t paying a dime, spend away and the Devil take the hindmost.
this is so spot on I can’t stand it.
How do we get the public to understand that if we are practicing reasonable cost effective care we will miss certain things consistently? More importantly, how do we get them to accept that? Because if they don’t, and if every time some rare/atypical/masquerading problem is missed a lawyer is called, the money will keep being shoveled.
As a fellow ER doc, you give an excellent, and very accurate, description of how the medical-legal liability system increases costs. All of those studies that say it doesn’t are just plain wrong, especially in the ER setting. I’d much rather risk a grand or two of someone else’s money (or more) to protect my own credibility, money, and career rather than give a lawyer the easy opportunity of making me look incompetent for not ordering the test that would have picked up your problem (even if the odds of you having it were 1 in a thousand).
The time I went to the ER with abdominal pain I did in fact have a condition that went undiagnosed for a while. That was partly my fault, as I didn’t follow up with my PCP as would have been sensible, but I think it was taken for a case of food poisoning all around. Uncommonly for me, I’d had a large breakfast at Denny’s that morning. (I was coming off graveyard shift, which is also unusual in my line of work, and it stood for dinner.) It included eggs over easy and I assumed the runny yolks had something to do with it. Unlike the example here, it was very severe pain, so severe that I couldn’t drive and was forced to take an ambulance.
As it happens the breakfast did have a lot to do with it, but as I discovered a couple of months later when I went to the ER again with the same pain it was probably more the bacon than the eggs. Perhaps it was less busy that day, or maybe there was more concern since it was the second visit for the same complaint, because on that occasion they took the time to get more history. When they found out I’d been having frequent mild pain which I could never quite localize to either my abdomen or my back, they ordered the ultrasound that showed I needed an emergency cholecystectomy.
Although I can’t really blame anyone but myself since I failed to follow up, and although I appreciate being conservative with available resources, I kind of wish I’d had the ultrasound the first time.
A side note: It’s almost impossible to compare qualitatively different kinds of severe pain to say one is “the worst pain you’ve ever felt”. I had a hell of a time communicating this. It was awful, miserable, persistent pain. But was it more intense than the pain from that faceplant onto the pavement I did from my skateboard when I was 13? Or from the time I sliced a fingertip off with a meat slicer? Or the rock thrown to my forehead? I tend to overthink this kind of thing, so maybe I should have just said yes. But I didn’t want to sound like a shrieking lunatic either.
You are so right and it is frustrating.
Lab and imaging ordering strategies vary greatly within our group of docs.
Some are more willing to accept some risk and spend more time with patients and families explaining the limits of tests, their own risks including long-term cancer risk with CT/radiation, and detailing indications for return and followup.
Some check off every box, do long sequential workups and take up bed space, order CT and MRI for that 0.1% chance of an unlikely diagnosis and to CYA…
Let me get out my pad and prescibe you a pair of testicles because with the order every test strategy based on presenting complaint we should be replaced by a computer algorithm or MLP at a fraction of the cost.
Great article, by the way — enjoyed the writing and the analysis.
Believe me, if *I* were paying for the CAT scan out of my pocket (against my large deductible before my insurance kicks in), I would be VERY glad to discuss the situation with the doctor, come to an understanding on how likely something “real bad” was going on, and then provide a signature that it was my decision to go home, watch my symptoms, and CALL BACK if things got worse.
This kind of system would provide cover for the docs who are exercising their medical judgment, and make the patient a partner in his own care.
It would also cut the cost of medical care in our country in half…..to the benefit of all of us. There might be some price paid by the complete idiots who won’t take responsibility for themselves, but we have too little natural selection against complete idiots in any case, so that looks a lot like another point in favor of what I’m recommending.
I was talking with a colleague about this just today. Spot on, Dr. Bear.
Panda Bear burps out “How I Am Learning to Throw Money Away With Both Hands and a Big Shovel”
Welcome to the real world, that is precisely how patients feel when they see the bill from their doctors and hospitals.
Oh, you say were focusing on medicines wasteful spending?
Yea, so was I but my focus was on pure greed, AKA, for profit medical corporations.
Will you ever grow up and stop whining? Is this all you 2nd year residents talk about? Beitch, beitch, beitch.
If you don’t like the system either change it, leave it or go to some other country. I hear Saudi Arab pays well and wants ER docs. How about IRAQ?
Here is one bit of good news from today.
You may have a new treatment for your Cardiovascular patients presenting with crisis High Blood Pressure.
Will the wonders of CAM every cease?
“Daily Glass Of Beet Juice Can Beat High Blood Pressure, Study Shows”
“ScienceDaily (Feb. 6, 2008) — Researchers at Barts and The London School of Medicine have discovered that drinking just 500ml of beetroot juice a day can significantly reduce blood pressure. The study could have major implications for the treatment of cardiovascular disease.”
Check the ScienceDaily dot com website for the short story.
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(Remember, however, that criticisms of the medical profession do not validate CAM. I happen to think that a large portion of the money we spend on medical care in this country is wasted. Fifty percent? Thirty percent? Who knows? But CAM? One hundred percent of the money spent on it is wasted. The only saving grace of CAM spending is that it is usually (but not always) private money shelled out in the free market by free buyers and sellers who are free to let the market set the price. It’s all wasted but it’s a free country and if you can keep the sheep strolling into your massage parlor, well, God love you for an entrepeneur. Spending on real medicine is usually through a third party and therefore nobody cares about the cost on a tactical level. -PB)
Don’t bitch about your bill. Either pay it, don’t pay it and go to collections or go take some Yohimbe and Ginko Biloba stay away from emergency rooms and have a nice day.
Never seen someone brag so much about refusing to act like the professional they purport to be.
If physicians ever get their wish and get the government out of healthcare, they’ll be lost in the real world.
Matt: He is acting like a professional. The professional you and your lawyer friends want him to be: one who takes no chances and runs no risk of doing anything that could possibly be construed as “not doing everything possible”.
That’s hardly a professional. And the standard has never been in court “doing everything possible.” Your comment merely reflects the fact that physicians are making decisions with little understanding of what their risk is. Then blaming their lack of understanding and unwillingness to learn on everyone else.
Again, that’s why though many of them clamor to be in the “free market”, few would survive.
PB relies: “Remember, however, that criticisms of the medical profession do not validate CAM.”
I agree. Nice spin.
However I spin it this way and emphasize that those criticisms do not validate medicine either.
In fact, it shows the standard of care today is seriously lacking in the protocols you learned in med school.
What I greatly admire about medicine is that you have so many truly dedicated professionals doing their best every day without regard to financial considerations or ego considerations to improve medical care. Truly outstanding.
PB repeats a trusim: “I happen to think that a large portion of the money we spend on medical care in this country is wasted. Fifty percent? Thirty percent? Who knows?”
The official authoritative figure is about 25%.
But I agree, no one really knows since that figure is based on following protocols that I will show below may be false, questionable and unreliable in point of fact.
More vitriol from PB “But CAM One hundred percent of the money spent on it is wasted.”
Save your lying breath for St. Peter at the Gate.
Try telling that whooper to the close to 100% of cancer patients who have taken, will take or are now taking the 67% of all cancer drugs that are derived from natural sources, i.e., CAM sourced but now synthesized by big pharma to sell as potent cancer remedies.
Or, try telling that to the coming crop of Hypertensive crisis CV patients who will no doubt receive some Beet Juice derivative in pill/lozenge form manufactured and purified by big pharma to treat HBP, as noted by the remarkable study mentioned above.
I entreat you to use protection when you have intercourse b/c the thought of you sending your genes into the future is truly depressing. The same thought goes for your fellow m.d. whiny sycophants who post on this blog.
On medical economics PB blurts out: “The only saving grace of CAM spending is that it is usually (but not always) private money shelled out in the free market by free buyers and sellers who are free to let the market set the price. It’s all wasted but it’s a free country and if you can keep the sheep strolling into your massage parlor, well, God love you for an entrepeneur. Spending on real medicine is usually through a third party and therefore nobody cares about the cost on a tactical level. -PB)”
Yea, all that remains is for you to PROVE IT.
Lacking any proof your words are demented deceit as per usual.
Or does the demand for EVIDENCE only apply to CAM and not Medicine in your pea brain?
Try holding the thought while you review the following article on exactly what “real medicine” REALLY KNOWS.
You and medicine are so clueless you are dangerous.
“Diabetes Study Partially Halted After Deaths”
By GINA KOLATA
Published: February 7, 2008
“For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.”
“Medical experts were stunned.
“It’s confusing and disturbing that this happened,†said Dr. James Dove, president of the American College of Cardiology. “For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do,†he added.
“Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through diet and medication, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.
“It will be similar to what many women felt when they heard the news about estrogen,†Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.â€
“Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.”
“The low-blood sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea….required to get blood sugar levels low, as measured by a protein, hemoglobin A1C, which was supposed to be at 6 percent or less.”
“So it was quite a surprise when the patients who had worked so hard to get their blood sugar low had a significantly higher death rate…”
“…“there may be some scientific principles that don’t hold water in a diabetic population.â€
Go to the NYTimes Online and search for the title to read the entire article.
Or go to MedPage, they have the whole story as well.
“Remember, however, that criticisms of the medical profession do not validate CAM.”
Yes. But they do validate that medicine does not know it all.
See this blockbuster story for pure evidence of the falsity of major medical DOGMA:
“Diabetes Study Partially Halted After Deaths’
By GINA KOLATA Published: February 7, 2008
The nytimes has the story as does Medpage.
PB says “I happen to think…”, yea its your blog go ahead and expose your ignorance and naivety to the world.
(I have been very indulgent about letting you post on my site. You have a point of view and I have no objection to your airing it. But watch the insults. I am many things but “ignorant” is not one of them, especially about medicine, a topic upon which I am not the world’s foremost expert but nonetheless do know a little something about. I certainly know more about real medicine than you do, just by virtue of education and type of practice.-PB)
I ask when was the last time you were right?
Inform “dingo” that he can’t even get being a smart arse right.
He should have said ‘go home and drink your beet juice’ if he’d read the linked story.
It is so like m.d.’s to think they are clever when they are more like idiot savants.
Is there any end to m.d. whining?
im1dc, you really crack me up. Here’s a study that implies that a major medical belief about the management of diabetes may have been inaccurate.
What’s going to happen now? Well, presumably more studies will be done to examine this effect and see if it is actually real. Researchers will work towards discovering the mechanisms which cause it, and meanwhile the standard of care may well change.
THAT’S EXACTLY HOW “ALLOPATHIC” MEDICINE WORKS.
Could you provide an example where a major study showed some CAM/naturopathic/homeopathic/quackeripathic technique to be useless (this part shouldn’t be too hard, because virtually all studies have shown this) and there was revolutionary change in the practice of alternative medicine as a result, or any change at all?
I didn’t think so.
Matt, perhaps you’d like to tell us precisely what your definition of a “professional” is? Pardon my ignorance but I am failing to see exactly what behavior or rhetoric you are referring to here. In all honesty, I sit on the Professionalism Committee where I attend school and I am interested to know exactly how your definition is different than that of mine and many of my colleagues, who find nothing unprofessional about Panda’s actions, in this instance or others.
im1dc,
I don’t really think Panda has EVER intimated that there aren’t problems in Allopathic medicine, both in practice and politics. I’m fairly certain he’s said more than a few negative things about training. All in all, he’s one of the most realistic docs out there in looking at the flaws of his own career.
What about you? I’d love to hear you critically analyze your own specialty and the other types of CAM you support. Instead of pasting long articles about how one study found the miracle benefits of beet juice, tell us where you think CAM has failed, where the system is dysfunctional, what modalities are harmful. As it stands right now, you give the appearance of believing your own career is flawless and your inability to engage in a more balanced debate strategy undermines your argument.
As for modern pharmaceuticals originally derived from plant extracts (and other natural sources), what you are failing to take into account is that the vast majority of the “natural” substances which contain biologically active and clinically relevant molecules also contain harmful toxins, ineffective structural analogues, and variable amounts of the effective molecule. Warfarin was first isolated from spoiled sweet clover as bishydroxycoumarin. I challenge you to get a patient with artificial heart valves or CAD to eat enough spoiled sweet clover each day to be therapeutically anti-coagulated. Do you even know what toxins might exist in the natural plant material and how do you guarantee the patient gets the amount they need? An overdose of warfarin is, after all, a great way to poison rats.
The most educated toxicologist will tell you that ANYTHING is a poison, it just depends on the dose. That applies to beat juice and all of your “natural” alternatives. Fortunately, more often than not, the biologically active substance is too dilute in nature to be of much if any use in a clinical setting, so it is usually difficult for individuals to harm themselves with an overdose from a “natural” source. However, the other side of the coin is that even if there are beneficial effects from a molecule in that natural source, it is almost impossible to consume enough of the original source to be of any measurable benefit. Hence the reason for the purified versions extracted and/or synthesized into pharmaceuticals.
Is the system perfect? Hell no. No one is saying it is. What I am saying is that measurable therapeutic effects and side effects are a far better treatment option than eating spoiled sweet clover. You can’t really say the same for the vast majority of “nutriceuticals.”
Funny how im1dc always preaches we should be humble, knowlegdable, and kind when he’s the polar opposite of any of those qualities. Why don’t you take your own advice and take a good self-inventory before casting stones?
And what exactly is the “a-ha” moment you’re expecting us to have? Where exactly are these scales over our eyes you keep frantically trying to rip off? As we keep repeating, we all well know the book isn’t closed on medicine and all there is to be learned is not already known. Why do you think we receive scientific training in the first place and are expected to keep current on the literature and ideally contribute our own original clinical research to the field? Why do you think medical researchers are the source of the articles you keep quoting to us and not chiropractors and other charlatans?
For a self-appointed crusader, you’ve failed to grasp fundamental principle of warfare – know your enemy. How exactly do you expect to accomplish much more than flailing around wildly if you can’t even figure that one out?
“I have been very indulgent about letting you post on my site. You have a point of view and I have no objection to your airing it.”
That you have and I have taken advantage of it when I could.
However several posts of mine have failed to appear.
The selective censorship, imo, is indicative of your inability to face the truth.
(Dude, I am under attack by spammers receiving anywhere from five hundred to a thousand spam comments every single day. Some even slip through my spam filter (probably fifty a day) and need to be moderated. I am sure I have accidently deleted some of your comments but that’s only because they might get mixed up in a long list of comments promising naked pictures of Paris Hilton or Viagra, Cheap, Cheap Cheap. If you ever again accuse me of censoring your comments on purpose I will not allow any of your comments on my blog ever again. You’re a welcome guest on my little corner of Yahoo’s server, real estate that I pay for every month, but this is not a public service, I am not the government, and I have no obligation to anybody to tolerate or allow anything at all except that I believe in free and lively debate. -PB)
Panda Bear, I find this insulting: “But watch the insults.”
Have you forgotten the things you said in your posts to and about me?
Maybe, Doctor, you should take a dose of your own medicine to cure the insult.
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(By the way, when I delete a legitimate comment I always state the reason and usually give its author the opportunity to remove the “TOS” violation and repost it. -PB)
MSII, SH:
im1dc has been told these facts and asked these questions before. He’s never acknowledged or answered them before, and I doubt he’ll do that now. All he can really do is dig up material that points up problems in a field that’s set up to continually examine itself for problems.
He either cannot or will not understand that locating a problem is a sign the system is in fact working, not the opposite. Just as he cannot or will not understand that the fact this never happens (in anything he has cared to cite) in CAM is a sure sign that CAM is not working. You’d have a better chance getting Santa Claus to answer a letter than you have of getting im1dc to deal with the facts.
(I know this is true because when kids in my town write to Santa they get letters back in return. My wife writes them.)
Matt: You fail to understand that the standard for “professional” in medicine these is largely not the creation of the medical profession but the legal. Lawyers have made it into what it is today. Were the medical profession be allowed to determine its own standards, profitability would hardly be an issue. Your demand that all MDs perform to your standards is not founded on sound medical judgment. But it should be.
This isn’t theoretical. My childhood GP, in the days before the lawyers had run roughshod over medicine, operated out of an office where he was the only practitioner. He had one nurse and one receptionist/clerk. That was all the staff he needed. Most of his patients paid cash, as “Major Medical” was pretty much all the insurance anyone had, and — as PB often points out — primary care isn’t that expensive anyway for as often as most of his patients saw him. He had no trouble making a decent living. Today, my PCP works out of a clinic he shares with a half-dozen other MDs and two PAs. They have to share because that’s the only way they can afford the overhead of the enormous staff needed to handle mounds of paperwork required by law, Medicare, managed care, as prudent self-protection against absurd torts, etc., etc. At this they’re barely profitable, if they’re typical.
Which of these scenarios more closely resembles a free market? In which of them is cash flow a serious issue?
And how do you expect anyone aware of this to take you seriously>
PB: With regard to your spam problem, have you considered installing a captcha plugin? It looks like there are several available for WordPress. They can be annoying to users, but cut down the spam by quite a lot.
“I entreat you to use protection when you have intercourse b/c the thought of you sending your genes into the future is truly depressing. The same thought goes for your fellow m.d. whiny sycophants who post on this blog.”
And so the troll throws off his laughable costume of ‘concerned healthcare professional’ and shows his true nastiness in all its glory.
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(Well, I thought it was kind of funny so I didn’t delete it. I also want to point out that as I currently have four children, the cat is out of the bag, so to speak.-PB)
an otherwise healthy young adult with normal vitals, normal physical exam, who tripped on the ice, bumped his head, and has been sitting in the waiting room for five hours eating stale vending machine nacho chips and watching the Fresh Prince of Bel Air
Kind of boggles the mind, doesn’t it? Why would the young man bother? Surely only because he is severely mentally retarded and thinks a day lounging in the ER waiting room is….special.
im1dc, why did you bow out of the discussion at the “Freeloader Heaven” post?
The study you reference (diabetes) showed a slight but significant increase in mortalities among the aggressive control group. Oddly enough, they had 10% fewer MIs. The causes of death in many cases are not known.
The study was exactly that, a way for us to increase our knowledge. It took a quite rational assumption (blood sugar that approximates normal is good for diabetics) and observed outcomes. Oddly enough, it was found to be incorrect in this case. That is why these studies are done. This is not some evil conspiracy by physicians nor does it invalidate diabetes treatment. Type 2 diabetics do much better with blood sugar control in the A1c range of 7 than the untreated range of 12-15.
Lowering blood sugar (insulin or oral meds) is how physicians treat diabetics medically. How do CAM practitioners treat diabetics? Don’t say dieting and weight loss; these are always prescribed and rarely used.
Doctor J says of im1dc “And so the troll throws off his laughable costume of ‘concerned healthcare professional’ and shows his true nastiness in all its glory.”
Doctor J, since I replied in kind to Panda Bear’s rudeness to me I suppose your comment to me therefore applies to PB?
Yes? Or, are you a hypocrite too, Dr. J?
From Medpage.
More evidence that CAM and Medicine together helps patients.
(Don’t let Panda Bear read this, his BP might go through the roof)
Meta-Analysis Suggests Acupuncture May Boost IVF Success Rate
40 minutes ago TODAY
BALTIMORE — Acupuncture during embryo transfer may improve the odds of pregnancy with in vitro fertilization, results of a systematic review suggest.
Also from MedPage today:
“Depression in Residents, not Burnout, Poses Patient Safety Risk”
Ahhh, this explains a lot of what I read here.
Maybe I have too harsh on you Panda Bear.
Nahhhhh, you’re DEPRESSED. Seek professional help.
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(Let me give you an example of residency training. I am just about to go in for my 9PM to 9AM shift (and I have three in a row this weekend) and I am suffering from viral gastroenteritis. I have been vomiting, I have back pain, malaise, diarrhea and I feel like utter and total crap. I will probably take a Zofran when I get to work and I may asks for some IV fluids but there is no way I can just call in sick without screwing somebody else over, the person on call, forcing them to get out of bed and work for 12 to fourteen hours on their day off. So I have the prospect of what will turn out to be a fourteen hour shift ahead of me where I will not have time to sit down, eat, or rest in any manner; I will come home exhausted and sick, hopefully get some sleep, and then go back in ten hours later at which time I hope I feel better but maybe I won’t and I will spend the whole weekend nauseous, tired, crapping my brains out so you can diagnose me with depression. You have no idea what real doctors go throught to train to the point where you can pretend to be colleagues on an equal footing. -PB)
“In all honesty, I sit on the Professionalism Committee where I attend school and I am interested to know exactly how your definition is different than that of mine and many of my colleagues, who find nothing unprofessional about Panda’s actions, in this instance or others.”
You find nothing unprofessional about ordering tests that aren’t medically indicated?
CC asks #1) “…why did you bow out of the discussion at….”
Answer to #1) I had no more time to give to it.
I do however have a major mea culpa for you, the others and Panda Bear on chiropractic usage of Homeopathic remedies.
I found out this week that I have used one for decades without being aware of it.
Its a tablet not a liquid and not diluted to nothingness.
In fact, I thought it was herbal not Homeopathic, which is why I denied using Homeopathic remedies.
Oops! I’m embarrassed. No intent to deceive, just a stupid mistake on my part.
This particular formula, 303 by Dee Cee Labs, I have found is excellent for achy sore muscles, mild to moderate anxiety and or mild insomnia.
It’s widely used throughout the chiropractic profession.
This may explain why 50% or so of chiropractors when surveyed said they use Homeopathic remedies in their practice.
But note this is herbal, not a diluted to nothingness remedy of Homeopathy.
I have had ER and Family Docs, Orthos and Neuros laugh in my patient’s faces when they told or showed them what they were taking and then wrote out prescriptions for muscle relaxers, anti-anxiety and anti-depression medications, pain meds or sleeping pills only to find that most patients continued with the 303 but not the prescription.
They’ve stopped laughing today and they don’t belittle me or the 303 anymore either.
And CC asks #2) “That is why these studies are done. This is not some evil conspiracy by physicians nor does it invalidate diabetes treatment.”
Are you kidding me?
Where have I ever given you or anyone here the notion that a) I don’t fully understand scientific research, b) That I believe in “conspiracy” or “evil physicians”, or c) That the ACCORD study failure with Type 2 Diabetics “invalidates diabetes treatment”?
If that is what you think then you are out of touch with reality.
I believe in medicine, even though I am aware of its faults, frailties and frauds.
It just so happens I also believe in aspects of CAM even though I am aware of its faults, frailties and frauds.
And finally CC states #3) “Type 2 diabetics do much better with blood sugar control in the A1c range of 7 than the untreated range of 12-15.”
Answer to #3) My wife is an insulin dependent diabetic and has been for over 3 decades. There is little you can tell me about Diabetes that I don’t already know, however, I do thank you for the attempt.
FYI, she has been under constant excellent Medical care, not CAM, for the condition. My children had their Pediatrician’s growing up and have their own family physicians today.
Professionally, I’m not exclusive as you, PB and the other CAM bashers here appear to me to be.
You are flat out wrong about what the ACCORD study showed with Type 2’s in tight control.
What it showed is that the accepted medical dogma/paradigm that lower blood glucose is better is flat out wrong when measured by mortality.
That’s MAJOR news.
Time to rewrite the textbooks!
What is excellent about the ACCORD study is that they recognized the problem, stopped it, published it and then said to the world ‘there is more going on in Type 2 Diabetics than we thought when we focused solely on low A1c’s’.
CC, that will saves lives and that’s a good thing.
I think those researchers are superb professionals who did the right thing and will do the right thing including looking at their data to try to determine what really happened. As well as designing a new study to test newer hypotheses based on what they learn.
To be candid CAM can’t match the quality of scientist doing the great work of medicine.
Not that we CAM doesn’t have great scientists too but we just don’t have the numbers, the money or the great questions to ask that medicine does.
Facts are facts, medicine is a half Century ahead of CAM in that way.
Panda Bear says “I am suffering from viral gastroenteritis.” and blah, blah, blah…ad nauseam, plus the usual arrogant ad hominem.
Reply: Chicken soup.
Get better.
Â
(Thanks. I got a zofran ODT from the Charge Nurse and felt better for most of the shift. But I just want to point out that my job is an order of magnitude more, let’s say “important,” and useful than yours to the extent that I literally cannot call in sick. You have no idea how real doctors are trained or what we have to go through to listen to you claiming some revealed wisdom after an easy stint in a crapulent chiropracty mill learning quackery and a little real medicine at a sub-junior college level.
So sorry. -PB)
Panda Bear, et. al., Does the US FDA require a ‘suicide rating’ on every new drug?
BTW, the article is a good read but the comments are even better.
‘Suicide rating’ could be given to every new drug licensed in UK”
February 9, 2008
Alexi Mostrous and David Rose
“Every new drug licensed in Britain will be given a “suicide rating†under proposals for a big shake-up in the rules governing pharmaceutical development. European regulators are also to require pharmaceutical companies to include a comprehensive suicide assessment into trials of new medicines.”
“The reform, based on a system adopted recently in the United States, has been fuelled by a growing body of evidence that drugs that affect the brain can heavily influence behaviour through seemingly innocuous changes in body chemistry…”
Reconstruct the link:
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/ww
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.co
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/tol
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article3337966
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(You know, I see a lot of half-assed suicide gestures but actual, full bore, I-really-wanted-to die-and-therefore-did-not-advertise-my-intentions-to-people-who-would-be-sure-to-get-me-to-the-hospital-in-the-nick-of-time-and-took-a-lethal-dose-not-some-minimal-attention-getting-dose-which-will-only-lead-to-my-wasting-useless-and-expensive-mental-health-resources patients. No point, just commenting. People will kill themselves if they want. Sure, a particular drug may give ’em the energy to do it but putting warnings on the box? Fine. No problem. I’m neither for or against it and, as usual, I ask, what is your point? -PB)
My statements regarding the ACCORD trial are correct. The trial showed that aggressively treated (“lower is better”)type 2 diabetics had a higher rate of death from all causes and a lower rate of MIs than type 2 diabetics maintained at an A1c level of around 7. Both groups showed improvement compared to diabetics in general. The additional causes of death in many cases were not known. I realize that this is a fascinating finding that further adds to our understanding of a tricky and pervasive disease, that is that lower is good but even lower is not as good.
“This may explain why 50% or so of chiropractors when surveyed said they use Homeopathic remedies in their practice.
But note this is herbal, not a diluted to nothingness remedy of Homeopathy.”
Maybe. I looked at the manufacturer’s website (one of many) and it does call it “homeopathic”. It obviously is not, as it contains large amount of active ingredients (valerian root and passion flower.) Valerian root contains active ingredients similar to valium/benzos, and passion flower also contains sedatives/hypnotics. I don’t doubt that certain herbals have pharmacologically active ingredients and cause measurable physiological effects. But in those cases, how are they different from drugs?
If this really is how chiropractors define “homeopathy”, then I apologize for calling it a sham treatment (since demonstrable active ingredient is present) but maintain that the terminology is misleading. “Real” (dilutional) homeopathy is still a sham treatment.
That being said, how is this herbal preparation superior to, say, valium/generic diazepam? Valium also has sedative, muscle relaxant, and hypnotic properties, is manufactured in more dosage iterations, and lacks other ingredients of unknown quality. Would you rather give a heart failure patient a set dose of digoxin or a preparation of Foxglove (containing digitalis, among other things) of less certain dose and manufacture because it is “natural”?
Why would I prescribe a patient suffering from irritability, anxiety, insomnia, and muscle aches 303 instead of a low dose of diazepam? Is there a benefit?
I am still curious as to whether you consider “vertebral subluxations” real medical problems, as you alluded to in our other discussion. If they are, 1.)what conditions do they cause 2.)can they be demonstrated radiographically?
“There is little you can tell me about Diabetes that I don’t already know”
And you call others arrogant! I would wager than your average internist/endocrinologist could tell you quite a bit you don’t already know about a disease that you admit you do not treat.
“And I do mean millions. Not meaning to brag but I am a veritable titan of excessive medical spending. A brawny legend of mythical proportions. Where my ancient Greek ancestors proudly arrayed the sacred hecatomb before the shrines of their gods, I call them base amateurs. My pen casually checks tiny boxes on order sheets that every day effortlessly transfer many times the value of their paltry burnt oxen from the public treasury to the altar of my gods, chief among them being Expediency, Haste, and Fear.”
best paragraph i have read on this blog yet. absolutely hilarious.
a really great article, especially toward the end. you really highlight the foundation of the problem. even as a med student, i long for the days of proper family practice. students today scoff at the profession (i certainly couldn’t handle how it is today), but really, it should be the most respected profession. our government needs to back off a little and let the experts do the caring.
their attempts at controlling costs have clearly failed.
also, im1dc bores me.
The more medblogs I read, the less I want to go into medicine…
-College sophomore, who used to have her heart set on this…
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(You just have to know what to expect. Except when I am getting near the end of a shift and some selfish, completely self-centered drug-seeking moron can have the power to keep me past the end of my shift if he decides to fake vague cardiac symptoms, I generally don’t mind the minor complaints, the more ridiculous the better. It just adds a little humor to what can sometimes be a grim job.
You also have to realize, and I will elucidate it further in a future article, that most medical spending is wasted. By this I mean it is almost completely useless, not for the least of which reasons that most medical problems are lifestyle related, not out-of-the-blue diseases like you see on TV (although even in Emergency Medicine we occasionally get somebody brand new and come up with an obscure but correct diagnosis). Take something like Emphysema. We get the same patient ten times a night, the two-pack-a-day 120-pack-year-smoker with the lung capacity of a yorkshire terrier who continues to smoke and come in twenty times a year for “Shortness of Breath.” Sometimes we admit him and sometimes we give him a breathing treatment and send him home but I don’t think we’re extending his life by much in the end. Maybe the several million dollars we spend on him over the course of a decade gives him an extra six months but he spends it as a bloated, out-of-breath, sweaty-and-urine smelling invalid who can’t even make it to the bathroom to pee without panting like he sprinted up ten flights of stairs.
Or, consider the completely demented, immobile ninety-year-old patient I see almost every shift who is on thirty medications the utility of which even in a healthy person would be questionable (why does a ninety-year-old woman who spends her life laying in her own feces and urine being fed through a PEG tube and who hasn’t spoken since the Clinton Administration need to be on a statin for example?). Every patient like this, for example, is on Namenda, a new and expensive drug for dementia which is only marginally effective in early Alzheimers and totally useless in the end stages but they keep grinding it up and putting it down her PEG tube.
If you are going to recoil at things like this maybe you shouldn’t go into medicine. -PB)
“Doctor J says of im1dc “And so the troll throws off his laughable costume of ‘concerned healthcare professional’ and shows his true nastiness in all its glory.â€
Doctor J, since I replied in kind to Panda Bear’s rudeness to me I suppose your comment to me therefore applies to PB?
Yes? Or, are you a hypocrite too, Dr. J?”
im1dc, you are obviously too intellectually lazy to look up the term ‘troll’. From wikipedia: [An Internet troll, or simply troll in Internet slang, is someone who posts controversial and usually irrelevant or off-topic messages in an online community, such as an online discussion forum, with the intention of baiting other users into an emotional response or to generally disrupt normal on-topic discussion]. PBear posts controversial yet on-topic messages. Your posts are rarely, if ever, on-topic and almost always irrelevant to the discussion at hand.
If you read what you wrote you not only insulted PBear you also insulted my “fellow m.d. whiny sycophants who post on this blog”. Do you even know what a sycophant is? PBear is many things but he is certainly not in a position of power over us – in other words, agreeing with someone does not make you a sycophant to them.
You may not believe it, but your vehement denial, the claim that you are a not a troll, does not make you less of a troll. Kind of like how your fervent yet misguided belief in the theory of subluxations causing disease does not actually make subluxations cause disease.
And since I am not a troll, nor is PBear, calling you one does not make me a hypocrite.
Please answer CC’s question regarding vertebral subluxations.
Panda Bear barfs out:
“(Thanks. I got a zofran ODT from the Charge Nurse and felt better for most of the shift. But I just want to point out that my job is an order of magnitude more, let’s say “important,†and useful than yours to the extent that I literally cannot call in sick. You have no idea how real doctors are trained or what we have to go through to listen to you claiming some revealed wisdom after an easy stint in a crapulent chiropracty mill learning quackery and a little real medicine at a sub-junior college level. So sorry. -PB)”
I see you are still a depressed 2nd Year ER Resident striking out at your betters.
(Come on, man. Just admit that medical school and residency are more demanding and intellectually rigourous than chirpracty school. The admission standards alone belie your belief that chiropracty school is even remotely on the same level as medical school. -PB)
Since you somehow managed to replicate your genetic material I do hope your 4 offspring got all of their good looks, brains and personality from their mother, no offense meant, I just want them to be able to make and have friends as well as form rational independent judgments based on fact and reject feckless hyperbole, nasty rhetoric, childish insults and the type of smears you effortlessly spew.
(They definitely got their good looks from Mrs. Panda Bear.  That’s no lie. -PB)
Now to the mattresses:
You claim: “I just want to point out that my job is an order of magnitude more, let’s say “important,†and useful than yours to the extent that I literally cannot call in sick.”
That’s delusional.
(No. I cannot call in sick except in the most dire of circumstances. That’s just the way residency works. -PB)
You offer opinion but no proof. Why is that? Could it be that you don’t have any?
Yup, that’s got to be why you don’t offer any, you have none.
I have to wonder if delusions are an as yet undocumented side effect of Zofran?
I happen to have PROOF that what you claim is false: When ER’s shutdown fewer people die from medical doctors and medicine.
Don’t believe me? That is a well known and established statistical observation when ER’s go on strike and hospitals stop admitting patients.
Most people seem to get by without ‘best guess’ medical care.
You weren’t aware of that tidbit? Why am I not surprised.
Read “Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer” by Shannon Brownlee, copyright 2007, Bloomsbury USA, New York.
(You obviously have not been reading my blog lately. -PB)
You foolishly assert, due to feverish demenita no doubt: “You have no idea how real doctors are trained or what we have to go through to listen to you claiming some revealed wisdom after an easy stint in a crapulent chiropracty mill learning quackery and a little real medicine at a sub-junior college level.”
That’s ignorance and myth speaking.
Here’s the reality:
Chiropractic colleges are certified by a Fed Agency, the CCE, and they are also regionally accredited by the relevant College and University agency — the same ones that accredit Medical Schools.
In case you still don’t ‘get it’ chiropractic colleges and classes are the equivalent or better than yours in every way.
(Bwahhaaa. Bwahhaaa. Har Har. Stop. You’re killing me! -PB)
To drive home the point, two chiropractic colleges have recently gotten into trouble with the standard setting agencies and were put on watch to improve or face revocation.
Thus, not only are our educations through professional school equivalent, if there is any backsliding of standards at chiropractic institutions it is found and addressed by outside authorities almost immediately and announced to the world, threatening the existence of the college.
That does not happen with Medical Schools. They hide their sins, not wanting them to be exposed. Yet, med schools also suffer the same deficiency’s periodically.
Let me repeat you are not superior in any way. That’s simply the fact of the matter as judged by outside independent education authorities who judge both our institutions.
Now wipe the egg and drool off your face.
As I recall I had more hours than a med school grad the year I graduated. I believe the same thing holds true today.
Where our educations significantly differ is in residency programs. Medicine focuses on residency specialization and chiropractic does not.
There are good reasons for the difference and there is no need to change either system, imo.
That is not to say that Chiropractic does not have specialties, it does, it’s just that it doesn’t mean the same as in medicine.
I have mentioned several times without apparent success that medicine and chiropractic don’t necessary treat the same conditions or complaints even though we treat the same patients.
Medicine does handle the sicker patient.
Chiropractic attempts to restore normal functioning naturally in patients that are ‘dis-eased’ not ‘diseased,’ but that is not always possible and medicine must intervene.
(Dis-eased? Har. -PB)
I don’t have a problem with that and am bewildered why you and the other M.D.’s here do have a problem with that.
Can you explain to me why helping a patient feel better, function better and avoid drugs or surgery is a bad thing?
Given that — by your own definition — you practice quackery every day in the ER (most of what you do is not scientifically valid or reliable) I would think you would be less critical of others and be pushing hard for evidence based medical outcomes instead of the ‘best guess’ medicine you now practice.
You practice an art not a science don’t forget.
Once again, read “Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, by Shannon Brownlee to see why I can say that with impunity and certainty.
BTW, you would have gotten better faster with no side effects and fortified your body with nutrients from the chicken soup as I suggested instead of the injection of Zofran.
(It was PO, Zofran ODT that is. -PB)
Zofran’s side effects include: blurred vision or temporary blindness; fever; slow heart rate, trouble breathing; anxiety, agitation, shivering; feeling light-headed, fainting; or urinating less than usual or not at all.
Less serious side effects may include: diarrhea or constipation; weakness or tired feeling; headache; dizziness or drowsiness.
Which side effects did you experience near the end of your shift? Be honest.
(None. It alleviated my nausea fairly quickly and I was subsequently able to drink a big glass of orange juice and eat some graham crackers.  I have no doubt that Zofran can have some side-effects in some people but fortunately, I am not one of them. Now, there are some medications I have tried that do give me the rare side effects. Before my colonoscopy I was instructed to take Dulcolax and it made me so sick that, after ten minutes of heaving I was thinking of going into the Emergency Department but toughed it out and the nausea subsided. I drank the gallon of Miralax-laced gatorade without incident and everything went well after that. -PB)
Doctor, I thought you were trying to get rid of your diarrhea and fever not encourage it by taking a medication that can and does cause it. How smart was that?
I suspect any ‘relief’ you felt really came from the placebo effect.
(I took the Zofran for debilitating nausea, that is, nausea so severe that it impaired my ability to work. Zofran is a well-studied drug and was previously used almost exclusively for chemotherapy patients. It does what it’s supposed to and is one of those rare medication that works almost better than advertised. It does for nausea what penicillin did for infections and NSAIDs did for analgesia. It is not a perfect drug because such an animal does not exist but the side effects are rare and usually well-tolerated. I have no qualms endorsing or prescribing it although it’s still pretty expensive so for my poor patients I still prescribe other agents. -PB)
Panda Bear requests that I state the point of posting this:‘Suicide rating’ could be given to every new drug licensed in UKâ€
The point Panda Bear is that Britain recognizes that all prescription medications may have fatal untoward side effects and that in the USA the FDA is far behind in protecting the public from big pharma (and medical doctors).
(Whoa. Not even remotely true. If there’s one thing we are all painfully aware of it’s the side effects and dangers of every intervention and medication. And you can commit suicide with just about every prescription and non-prescription medication currently on the market. Just take a couple of bottles of Tylenol or a big old handful of Aspirin and then we’ll talk. I have no objection to putting suicide ratings on medications…but isn’t that also making it easier for people to commit suicide, you know, because they can select a drug with a good rating as opposed to some crappy little SSRI? -PB)
“CC” once again you ask good questions and make valid points that require a response from me.
First, you say “I am still curious as to whether you consider “vertebral subluxations†real medical problem”
I though I addressed that (it may have been in one of the my posts that PB’s spam filter filtered out) but here it is again.
A chiropractic subluxation is not a medical subluxation.
A medical subluxaton of course is a “real medical problem’.
A chiropractic subluxation on the other hand is a patient complaint and chiropractic construct and only if not reduced can it be considered a medical problem.
A chiropractic subluxation has five components 1) Kinesiopathogy 2) Neuropathophysiology 3) Myopathology 4) Histopathology and 5) Arthropatholophysiology.
A medical subluxation is simply a joint out of place but not dislocated.
Not at all the same things, though similar in some respects.
On homeopathy you say, “Maybe. I looked at the manufacturer’s website (one of many) and it does call it “homeopathicâ€. It obviously is not, as it contains large amount of active ingredients (valerian root and passion flower.) Valerian root contains active ingredients similar to valium/benzos, and passion flower also contains sedatives/hypnotics. I don’t doubt that certain herbals have pharmacologically active ingredients and cause measurable physiological effects. But in those cases, how are they different from drugs?
“If this really is how chiropractors define “homeopathyâ€, then I apologize for calling it a sham treatment…”
“CC,” chiroprators and chiropractic does NOT define homeopathy. Only homeopathy can define homeopathy.
I honestly don’t know why the Formula 303 is called homeopathic since it isn’t diluted to nothing.
I was not aware that the manufacturer called it homeopathic until the other day. I used it b/c it worked for my patients with few to no side effects and did not cause dependency or require periodic increasing dosages for therapeutic effect as does valium, etc.
You shouldn’t apologize to me, I should apologize again to you for not knowing that I was using a homeopathic product, if that is indeed what it is (as you point out).
The only thing I can think of that caused my error is that when I began using Formula 303 (long ago) homeopathic was not printed on the forms or bottle. Either that or I overlooked and or forgot about it.
I have no excuse. I made an error.
The ACCORD study finding cannot be explained away so simply as you try.
Obviously diabetic patients need expert medical care to help manage their blood glucose but it is now known that lower is not necessarily better, i.e., there is a piece of the puzzle missing, at least with Type II’s.
You ask “That being said, how is this herbal preparation superior to, say, valium/generic diazepam?”
I can think of several reasons. It is not habit forming. Patients can tailor the dose to their needs much more easily. It doesn’t cause dependency. Patients don’t have to increase the dose to achieve the desired effect after taking it for a period of time. It clears the body faster than meds. As far as I am aware there is no suicide rating necessary. It can be taken with OTC or prescription pain meds without worry. ETC.
There are downsides. It is not as potent or powerful as prescription meds and cannot reach a maximum dose, i.e. a patient can down an entire bottle in one sitting and not become incoherent, die or need their stomach pumped. So it’s no good for patient’s needing heavy sedation, thus it’s not appropriate in every case.
And, as you point out the dose in one pill to the other supposedly may very more than that of pharmaceutical grade medications, thus either diluting or increasing the effect from one time to the next.
I never found the latter to be a problem.
You asked whether I would use one over the other, i.e. Formula 303 versus Valium.
My answer is simple: I’d recommend the use the one most appropriate for the patient’s condition, pure and simple.
I’m not opposed to medication but I am opposed to over medication which is too prevalent today.
On that point let me quote some interesting facts for you: “As reported by Eisenberg in 1998, 106,000 people die each year from improperly prescribed medications. This makes it the fourth leading cause of death in the United States. Only heart disease, cancer and stroke kill more Americans and only 15,000 people die each year from illegal street drugs.” Eisenberg, JAMA, 1998.
“Medication errors were common in nearly one out of every five doses in typical hospital and nursing care settings” Barker, et al, Archives of Internal Medicine, 2002
Are you ready for this:
“There is an excess of 54,000 prescription drugs and 300,000 OTC drugs on the market. Americans consume over half of all drugs in the world today and we are only 5% of the world’s population.” CNN Headline News, Nov 18, 1995.
I posted, “There is little you can tell me about Diabetes that I don’t already knowâ€
Your reply: “And you call others arrogant!”
I was not trying to sound arrogant much less be arrogant about diabetes.
That damned disease is a humbling horror.
I don’t disagree that an Endocrinologist specializing in Diabetes could and would tell me lots that I don’t know.
How much would be useful in helping my wife is another story.
Again I’m not being arrogant, just stating what I believe to be true.
We’ve been fortunate to have had two or three fantastic Endocrinologists in the past that treated her. I do wish we lived near them still. Alas, where we live today the locals are focused on printing $$$ and are a tiresome bunch, in our opinion.
“CC” I suggest you read “OVERTREATED: Why Too Much Medicine is Making Us Sicker and Poorer” by Shannon Brownlee, copyright 2007, Bloombury USA.
It’s a fair expose of the state of medicine today as seen by someone who took a serious look at your profession.
It isn’t pretty and it must change.
“Doctor J” I would prefer to ignore you but your lengthy post makes it impossible.
Yes, you are a hypocrite b/c you call me out for name calling but do not hold Panda Bear, yourself or the other M.D.’s on this blog for doing exactly that to me FIRST.
You will just have to live with yourself.
I did not start the name calling, labeling or smears. That doesn’t make me innocent but it doesn’t make me a hypocrite or a troll either.
I hit back when struck.
Try reading “OVERTREATED: Why Too Much Medicine is Making Us Sicker and Poorer” by Shannon Brownlee, copyright 2007, Bloombury USA.
It should give you an idea of my opinion of what you do and just how honest and trustworthy I think you are.
If I tell you that I don’t know a soul who fully trusts his doctor or the medical profession anymore would it shock you?
It shouldn’t. And those souls include M.D.’s, Ph.D.’s as well as ordinary folk.
Buddy you have a professional problem and its exemplified by your two faced attitude toward me.
Panda Bear weighs in with “Whoa. Not even remotely true” in regard to Britain’s suicide warning rating now required on prescription medications.
PB, don’t take any exams this week.
You entirely miscast the argument, ie. you just don’t get it.
What Britain is doing is alerting M.D.’s and patients that certain drugs may cause them to have suicide ideation.
That way if they do have those thoughts and feelings they can stop the medication, i.e., blame the damned pill.
DUHHHH
They are not trying to help suicidal patients get enough of the right pills to do the job.
Further, they and everyone else is aware someone that really wants to commit suicide will eventually be successful.
Pills are used by females to commit suicide much than males, so by default it is chiefly to stop overwrought females from blaming themselves for their woes and to focus on the medication as causing their negative thoughts and feelings.
I think its a good action to take and hope the FDA recognizes it and does it here.
Now, how about answering the question about which side effects of Zofran you experienced?
I would love to post something witty here regarding this hilarious string of posts by im1dc but I’m just exhausted. Super congrats im1dc, you’ve made me speechless at the senselessness in that string of fanatic-esque, manifesto-ish posts. My mother would tell you that’s tough to do. Congrats. 🙂
Honestly, does anybody actually listen to this guy? He’s not even capable of stringing together an intelligent argument or engaging in coherent verbal sparring. Instead, he’s trying to juggle 6 arguments at once, creating post after long-winded post, chock full of petty insults and off-topic comments. At some point my eyes glazed over from all the childish language and baseless studies. Furthermore, how does someone as busy as a chiropractor find the time to write such lengthy posts? Business must not be that good this time of year. Or perhaps people are finally becoming wise to the fact that CAM modalities are worthless?
Panda’s first sentence above states: “Medical care is expensive and to a large extent this is unavoidable.”
The ONLY way, imo, to avoid expensive medical care is to avoid medical care b/c the medical profession is hopelessly CORRUPT.
Too many M.D.’s have cash registers where their heart’s should be.
Here’s today’s PROOF: {Read and weep the latest expose of medical malpractice, lack of ethics and immorality}
Orthopedic-Device Makers Accused of Paying Doctors
Congress Told Practice Is Deep-Seated
By Avram Goldstein
Bloomberg News
Thursday, February 28, 2008; Page D08
“Four makers of artificial hips and knees paid doctors more than $800 million in royalties and fees in four years to influence their choice of implants, a U.S. investigator told Congress.”
“The unidentified companies control about three-quarters of the $9.4 billion worldwide market for hips and knees, said Gregory E. Demske, an assistant inspector general at the Health and Human Services Department, at a hearing yesterday of the Senate Special Committee on Aging.”
“Illegitimate” payments, the extent of which is unknown, influence orthopedic surgeons’ medical judgment and are so common that it will be difficult to eliminate the practice, Demske and other witnesses said. The fees have enriched doctors and distorted the market by bolstering sales of lower-quality devices, they said.”
“”Industry and physicians are equally culpable,” said Sen. Herb Kohl (D-Wis.), chairman of the panel. “Some physicians make it known to the companies that they will be loyal to the highest bidder. Where does the patient’s well-being fit into the equation?”
Yes, indeed, “where does the patient’s well-being fit into the equation”?
I think better of you Panda Bear precisely b/c you are leading a one man one doctor crusade against excess medical care, for which I admire you (really), but you are far too naive and poorly focused to be able to see the extent of rot all around you everyday in the ER and in the hospital.
 (Whoa. I am not leading a crusade. I’m just pointing out the way things are and, I hope, giving my readers ammunition to debate the glib and ignorant when they opine that everything will be better if health care is free. Medical care isn’t even my big political issue. I think it’s ridiculous that most people who are mostly healthy worry about it so much and I am an order of magnitude more interested in the war on islamofascism than any other issue. I happen to be involved in the medical care industry and it’s the focus of this blog, that’s all. -PB)
Once again I encourage you and the others here to read:
OVERTREATED: Why Too Much Medicine Is Making Us Sicker and Poorer”, Shannon Brownlee, copyright 2007, Bloombury USA New York.
The above article was taken from the washington post online.
To: Random MSII & L-Dub
Your comments were read but their content was nonexistent.
I’m frankly fed-up with the cry baby M.D.’s on this blog.
I don’t ask that you like me or what I post, in fact I what I post ought to make you uncomfortable b/c its the truth about YOUR profession and the truth is UGLY. (NB – I support what I post, something you don’t do)
If you can’t keep up don’t post to me or about me b/c you come off as malcontents unable to respond rationally so you respond emotionally like a child.
Hey, are you two also 2nd year ER Residents?
(Now, to be fair I am a third-year resident, about to start my fourth (and last) year of residency training. -PB)
If so you may be clinicall Depressed and need to seek psychiatric care.
Don’t take my word for it, that’s according to a recent study that is still available on MedPage. Perhaps you ought to check it out.
Oh, and read “OVERTREATED” and then change professions.
im1dc,
Of course my post had no content. It was a post about being speechless regarding the complete and total one-sidedness of your posts. It wasn’t intended to respond to the content of your posts because its a futile exercise. The only support for my post would have been contacting my mother regarding the nature of my tendency to keep my mouth shut.
Panda has an order of magnitude more patience than I because he actually engages in debate with people who are more interested in proving how right they are and how wrong their detractors are than they are in learning anything new or finding tangible solutions to real problems. You have it all figured out and you paint everything with incredibly broad strokes, so mostly I’m not interested in even attempting the “discussion.” Your “discussion” is so incredibly one-sided that it is impossible to actually engage in a true discussion with you should I disagree on any point.
I think Panda paints with broad strokes too much of the time, but I find a stark difference in that he actually does criticize his own profession and speaks about its failings. He’s critical of “western” medicine from the inside, while you are pointing from the outside and never give us any words of wisdom regarding your own field and how it might improve itself. He opines on what he thinks might be solutions to problems within the realm of the MD and “western” healthcare and speaks about lack of consensus on these issues within our field. In your case, your opinion is simply that the majority of “western” medicine is bad and the majority of doctors are money hungry and corrupt. What’s the point in engaging that? I was educated at a small liberal arts college and had friends of varying political opinions and social and religious backgrounds. However, it was possible to engage in a positive discussion with those people because the point of listening to the other person was not simply to formulate an argument against a differing opinion but to simply engage in the discussion and broaden our own understanding of all viewpoints. We were never going to agree, but that wasn’t the point. I find the secret to this is to ask questions regarding someone else’s viewpoint more than I espouse my own without similar questioning in turn. Obviously the same standard it difficult to hold on a blog – the medium is entirely different. By its very nature, the author is giving their opinions on a subject and it is difficult to integrate the kind of interplay I am suggesting as a model.
So you’re right, I haven’t really attempted to engage you because I don’t see the point. I disagree that my previous post was irrational or malcontented or on the emotional level of a child. I think name-calling is pretty unacceptable if you’re actually an adult trying to engage in productive debate. And I hold everyone equally accountable for their own actions. IMHO, it is the height of emotional immaturity to begin namecalling or insulting others because “they did it first.” Did I insult you in my previous post (or this one)? My sincerest apologies then. It was not my intent. I was espousing an opinion regarding the the perceived tone of your posts, not making an ad hominem attack.
I actually don’t share Panda’s hardline views in terms of chiropractic medicine. I think the concept of subluxations is pretty shady. However, I did have a hip problem caused by a lack of flexibility while engaged in some rather strenuous taekwondo classes that was solved by a chiropractor (in 1 visit) when XRays revealed nothing regarding the source of my pain. Thus I am disinclined to say that all of chiropractic medicine is useless. In some areas I think you overlap with PM&R and the physical therapy of “western” medicine. Since I don’t believe PM&R or physical therapy are shady, I think chiropractors have a service to offer in those areas. And its usually easier to get in to see a chiropractor whereas I might have to wait longer for PT or PM&R. But I also choose not to see chiropractors who push the vertebral subluxations as their major focus of patient care. I’m not really sure what you think of those chiropractors but I’ve always felt I received good care from them without adjustments or treatment for any subluxations.
And to address your question, I think my posting name is self-explanatory regarding my current educational status – I’m a 2nd year medical student. Of course, this tells you little about my personal background, life experience, knowledge of the medical system, but I’m certain you will draw your own conclusions. But let it be known I draw none about your background other than that you are a chiropractor by training. Also, it is reasonably safe to say I am not clinically depressed (and I would question how you could discern or imply that based on my posts which are generally evenly measured and infrequent) – but if I was, I am surprised that you would not suggest I see a chiropractor or change my diet or see an herbalist rather than a psychiatrist who are some of the biggest prescribers in all of “western” medicine. I guess I’m really just not sure on where you think “western” medicine should leave off and chiropractic care and other CAM should leave off.
Is that more substantiative? Probably not, but then again I am not trying to prove any points on any easily researchable subject. My opinions here are strictly that – personal opinions. I would enjoy yours more if you showed a willingness engage the debate on a more measured level like many of the other dissenting posters on this board. That is really my only “point.”
Holy overly long post batman. Sorry Panda, I didn’t realize that had gotten so long. I didn’t mean to use your blog as my own forum regarding the nature of what we call “debate” in America today (since I think the issues and behavior I am concerned about extend far beyond what a few blog commenters do). Please feel to delete that if so inclined. This is your soapbox, not mine.
(Don’t sweat it. All I have to do is click “approve.” It’s not like I have to do any work when people post long comments.-PB)
Also, Random MSII, your comments add value to Panda’s blog. Well spoken, if I might add.
On to im1dc – “Yes, you are a hypocrite b/c you call me out for name calling but do not hold Panda Bear, yourself or the other M.D.’s on this blog for doing exactly that to me FIRST.”
You know what, you’re right. I remember the first posts you deposited on this website as some sort of ‘hydrophilic proof’, and you were resoundingly retorted, debunked, and indeed mocked a little (or a lot, depending on the thickness of your dermis) for your profound lack of understanding of the subject matter. You took offense at the mocking and have since taken it upon yourself to show us all what fools we really are, while ignoring the retorts and debunking. This is all very basic strategy from the troll handbook. “someone who posts controversial and usually irrelevant or off-topic messages in an online community, such as an online discussion forum, with the intention of baiting other users into an emotional response or to generally disrupt normal on-topic discussion“.
I called you out for name-calling as well as other trollish behavior. I really don’t care if you name-call, as it shows us far more about you than it does about us.
But it is kind of amusing to read what you consider intelligent assaults on the medical profession, as if you’re teaching us anything we don’t already know…
What’s wrong with medicine in the USA today, Panda Bear?
Here’s one example:
“Patients still stuck with bill for medical errors”
By JoNel Aleccia
Health writer
“When Kevin Baccam of Urbandale, Iowa, went in for hernia surgery in August 2005, he expected to come home with a scar on the right side of his groin.”
“But the 33-year-old school district controller actually wound up with two scars in the delicate region — one on each side — after the surgeon mistakenly operated on the left and had to start over.”
“Nearly as painful, Baccam said, was when he opened his mail a few weeks later and saw his health insurance had been billed for both operations.”
“I’m not really a very litigious person,†Baccam said. “But that’s when I got a little more angry.â€
“Baccam’s going to court now, records show, suing [the following names are redacted] Dr. & Clinic. It’s the principle of the thing, said Baccam, who’s hoping for a settlement.”
“But if the mistake had occurred at a different time, or in a different state, Baccam might not have been billed at all.”
“Spurred by federal and industry moves to cut payments for avoidable mistakes, hospitals across the country have joined a growing movement not to charge patients or their insurers for serious, preventable errors.”
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Try to at least read the list of “Preventable Medical Mistakes” listed in the blue sidebar.
Reconstruct link: http
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/www.
msnbc.
msn
.com/id
/23341360
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I have ambivalent feelings about medical errors. I really think medical people try to do the best they can, but errors still happen.
Mistakes are often our best teachers and I’ve made my share.
I am not ambivalent about charging the patient for their errors. That is plain wrong.
Panda Bear, from the “Medical Mistakes” list in the above story I found this:
“18. Patient death or serious disability due to spinal manipulative therapy.”
I read “spinal manipulative therapy” to mean M.D.’s are doing (more likely incompetently trying to do) spinal manipulative therapy, ie., chiropractic.
Interesting, yes?.
M.D.’s doing chiropractic. ROTFLMAO.
I will be on the lookout for your posts calling M.D.’s who do spinal manipulative therapy every nasty thing you called me and my colleagues.
Will you admit that you were wrong about chiropractic and apologize to me now?
Will you admit that M.D.’s and hospitals are trying to perform spinal manipulative therapy, ie., chiropractic?
Today’s medical practice reality (what your peers are doing) make your anti-chiropractic comments part of an orchestrated campaign to libel, demean and harm chiropractic.
That’s simple dishonesty and pure hypocrisy too.
It also violates the Federal Court’s anti-trust decision against the AMA brought by the chiropractic profession.
Geez Marie, how loathsome the practice of medicine and M.D.’s have become.
PS When patients need spinal manipulative therapy send them to a chiropractor. Do not try chiropractic yourself. You won’t help them and you may harm them.
Chiropractors are THE professionals of spinal manipulative therapy. We do it safely. We do it effectively. If you care for your patient send them to professionals not some M.D. wannabee.
(DOs do manipulation. MDs do not, generally, except those very few who take some courses in it. I think it’s all hokum and bunk but I’m sure my DO colleagues whose medical education is actually almost completely similar to MDs except for the OMT, would take exception to you claiming to be the professionals of manipulation. -PB)
‘Doctor J’ says to im1dc “You know what, you’re right.”
Yes, I know I am right.
You were correct to acknowledge that I was correct b/c it was obvious.
Isn’t it interesting that only you have acknowledged that simple truth so far?
What does that say about your M.D. colleagues here?
You should have stopped with the above, but you went on to try have it BOTH ways, proving you have low character and are leaning toward hypocrite:
“But it is kind of amusing to read what you consider intelligent assaults on the medical profession, as if you’re teaching us anything we don’t already know…”
Dude, what I post is supported fact not supposition, egotistical hyperbole or the make believe mythology you guys post.
That’s why I supply links and references. Argue the facts not the person (ad hominem).
If I accept the your basis of argument, that you already know the things I post (I don’t), then why is it when I post facts you, Panda Bear and the others become so upset and attack the messenger (ad hominem argumentum)?
I’m mostly sympathetic to medicine and M.D.’s though I do believe medicine in the USA must change b/c its broken.
My perspective is that patients and their welfare come first.
What I see on this blog is that you and the others think you come first. You are overworked and underpaid, etc., etc., etc.
Not so, you are, imo, a bunch of whiny sniveling juveniles who should never have gone into medicine given your attitudes toward patients.
We are finally getting to the point where I will be able to count how many rotten apples it takes to spoil the whole barrel.
im1dc,
Here’s what I mean by 1-sided. A quick google search lead to the following articles:
http://cbs3.com/health/Risk.of.Chiropractic.2.661491.html
http://www.chirobase.org/03Edu/lattanze.html
http://www.reviewjournal.com/lvrj_home/1998/Oct-15-Thu-1998/news/8411636.html
http://newsroom.progressive.com/2002/August/MN-fraud.aspx
There are frauds and unethical people in every profession. Its unreasonable and blind to make sweeping judgments about an entire profession based on a few weblinks.
Did I not acknowledge that you were not the first to “namecall?” I thought I did, but perhaps not directly enough for you to notice. But I think its a moot point. You get no points from me being nasty just because someone was nasty to you first.
Also, the article on MSN cites the National Quality Forum for that list of medical mistakes. On their website, they include chiropractors as one of the healthcare groups they watch and study. Their definition of spinal manipulative therapy is: “Spinal manipulation, also known as adjustment, references procedures that stretch, mobilize or manipulate the spine, paravertebral tissues and other joints.”
So I’m thinking chiropractors are grouped into those making the mistakes in that particular area.
Random MSII posts to im1dc:
“There are frauds and unethical people in every profession.”
We are as one with that fact of life.
“Its unreasonable and blind to make sweeping judgments about an entire profession based on a few weblinks.”
Yes, of course, I agree completely.
If you interpretrf my pithy remarks as being ‘unreasonable, blind and sweeping judgments about an entire profession (medicine)’ I apologize that my abrasive style so mislead you.
I admire and respect medicine and M.D.’s.
But, I don’t look ‘up’ to either and that is what upsets so many M.D.s on this blog, imo.
Random MSII posts to im1dc “Also, the article on MSN cites the National Quality Forum for that list of medical mistakes. On their website, they include chiropractors as one of the healthcare groups they watch and study.”
I saw that too.
I don’t know what to make of it exactly.
Does the “National Quality Forum” have a medical bias and lack chiropractor input?
Or are they simply looking at the prinicple modality used by chiropractors?
Too hard to tell b/c the organization and members are not public.