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Why Doctors Order Too Many Tests

While cleaning out some old files, I was delighted to find an article I had clipped and saved 35 years ago: a “Sounding Boards” article from the January 25, 1979 issue of The New England Journal of Medicine. It was written by Joseph E. Hardison, MD, from the Emory University School of Medicine; it addresses the reasons doctors order unnecessary tests, and its title is “To Be Complete.” Today we have many more tests that can be ordered inappropriately and the article is even more pertinent and deserves to be re-cycled. He says,

When challenged and asked to defend their reasons for ordering or performing unnecessary tests and procedures, the reasons given usually fall under one of the following excuses…

He lists ten excuses:

  1. To be complete. (This implies a need to go beyond a rational diagnostic process. “Complete” is a nebulous concept; you could always do one more test.)
  2. The “they say” excuse. (Who are “they” and do they really say that? If they do, do they say it for science-based reasons or is it just an opinion?)
  3. The “we’ll get in trouble if we don’t” excuse. (This expresses student doctors’ fears of the attending physician, who may not actually chastise them for not ordering an alpha-fetoprotein test on every patient.)
  4. The “if we don’t order everything at once, it won’t get done” excuse, commonly given in large city hospitals. (Should rational health care suffer because of institutional inefficiency?)
  5. The “as long as he is in the hospital, we might as well” excuse. (Why should a patient’s care depend on where he’s located or how readily available a test is?)
  6. The “academic” excuse. The false idea that the evaluation of a patient should be somehow different or more complete in an academic institution. Here Dr. Hardison quotes a dictionary definition of an academic as “very learned but inexperienced in or unable to cope with the world of practical reality.”
  7. The “malpractice” excuse. I have personally heard this excuse all too many times. One of my friends was challenged on the witness stand about why he ordered an x-ray in a trauma case when he had testified that it was not really indicated by the patient’s findings. He answered, “I ordered it so I could tell you here in court today that I had done so.” It’s a sad state of affairs when doctors make decisions based on fear of malpractice suits rather than on the patient’s welfare.
  8. The “protocol” excuse: the patient is a candidate for a study that requires these tests for its protocol. (Best find out first if the patient is really going to be enrolled in the study and consult the researchers or wait and let them order the tests they need.)
  9. The “if it were my mother or father, I’d want it done” excuse. He comments, “The parent who has his child for a doctor had best beware.” (In other words, when doctors are emotionally invested in patients, reason flies out the window.)
  10. The “how do we know he doesn’t have it?” excuse. (Carrying that excuse to its logical consequences would mean ordering every possible test on every patient, and getting a lot of false positive and irrelevant results. A better question is “do we have any reason to suspect he might have it?”)
  11. I can think of two more excuses:

  12. The “knowledge is good” excuse. If anything is abnormal, we want to know. The more we know about our bodies, the better. (That’s not always true; sometimes we are better off not knowing irrelevant or insignificant information.)
  13. The “fishing expedition.” I don’t have any idea what’s wrong with this patient, but maybe if I order a lot of tests, something will turn up. (Not only is this an admission of incompetence, it’s likely to turn up misleading information, to lead to the wrong diagnosis, and to do more harm than good.)

Too many tests can be hazardous to your health for several reasons:

  • Because of the way normal values are determined (testing a lot of presumably normal people and cutting off the ends of the resulting Bell curve), there is a good chance that one out of every twenty tests will give an “abnormal” result that is not really abnormal. Being 6 feet 7 inches tall falls at one extreme of the Bell curve but it is “normal” for that person and doesn’t mean he has a disease.
  • False positive results become increasingly likely when a disease is rare and/or when the patient’s history and physical don’t already point to that diagnosis.
  • Following up on false positive results can be a wild goose chase, with more unnecessary tests and procedures. There’s no way to tell for sure whether a suspicious shadow on an x-ray represents a deadly disease or a harmless artifact without invasive procedures that carry risks.
  • Imaging procedures and other tests frequently identify “incidentalomas,” abnormal findings that are mere curiosities and that have no impact on the patient’s health other than to sometimes cause unnecessary worry.
  • Some tests involve potentially harmful radiation; and even the simple act of drawing blood can cause pain, bruising, and a tiny risk of infection. Even minor risks are not justified if the likelihood of benefit is too low.
  • Lab errors occur: machine malfunctions, misreading results, mixing up samples, recording and transcription errors, etc.
  • Overdiagnosis leads to unnecessary treatments.
  • Tests cost money, sometimes a lot of money, which is not healthy for your own wallet or for society’s health care budgets.

The need for a test can be informed by scientific studies. Does routinely ordering x-rays on all patients with ankle injuries improve outcomes? No, it doesn’t. Simple sprains are much more common than fractures, and x-rays expose patients to radiation. Science-based guidelines like the Ottawa ankle rules have been developed to help clinicians decide when to order tests.

Another consideration is “what difference will the test make?” What are we going to do differently if the result is x rather than y? If we can’t answer that question, we probably shouldn’t be doing the test. That’s particularly pertinent in genomic testing, where patients may be told they are at high risk of developing a disease that they can’t do anything to prevent.

And then there’s CAM. Many tests offered by CAM practitioners have not been validated, some are known to be bogus, and some are used to diagnose bogus diseases.

And then there are the patients who demand tests because of something they read on the Internet.

Conclusion

Every year there are more tests available for doctors to order. Doctors should not order any of them without good reason. Doctors should be guided by good judgment grounded in science. Patients should not be hesitant to question their doctors if they don’t understand why a test is being done or what difference the results will make.

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128 thoughts on “Why Doctors Order Too Many Tests

  1. Björn Geir says:

    Thanks Harriet.
    As a physician past his prime I can only bow humbly and admit I have (and I dare say all of us have) frequently succumbed to most if not all these fallacies. One can never avoid useless tests altogether. ‘Unnecessary’ is commonly a matter of retrospective definition.
    I have tried (and teach) to make a habit of asking myself before ordering a test or a diagnostic intervention what is my theory, do we need to test it and how best to test it? And finally and most important, before ordering, to decide and preferably document a plan of what to do in case of a negative, an indecisive or a positive result?

    Finally one can also contemplate the cultural and public education aspects of our age of the “worried-well” :)
    This entertaining piece says it all: http://youtu.be/FqQ-JuRDkl8

    1. agitato says:

      Very entertaining! Thanks for the link. I ended up watching all of James McCormack’s videos. Bohemian Polypharmacy was good too.http://www.youtube.com/watch?v=Lp3pFjKoZl8&feature=kp. They were all good.

  2. David Winchester says:

    Many specialty societies have developed recommendations similar to the Ottowa ankle rules for a variety of tests and interventions. I am most familiar with cardiology where we have used a RAND derived methodology for generating “appropriate use criteria” for stress tests, echocardiograms, angiography, even pacers and defibrillators. I greatly appreciate your thoughts on the motives of physicians as I am actively researching how these criteria can be applied to shift the ordering patterns of people who ascribe to these thought processes.

  3. Psychability says:

    “Because the patient asked for it”.
    That’s the excuse I have most seen for unnecessary tests (and treatments). In order to avoid this trap, one has to be able to communicate clearly with patients, to have confidence in their own medical judgment and to deal with their own need to be liked. There is a common belief in the patient world that the best doctors order the most tests.

    1. KayMarie says:

      I talk to a lot of patients on a patient support board. Unfortunately there isn’t a test to prove you have it, so “the patient asked for it” happens a lot.

      For some reason “rule everything else out” becomes “do every test imaginable for every remote possibility that could ever happen to that one person in all the world this year”. There was a study done that showed that if you ran patients who met the diagnostic criteria for the symptoms and had zero red flags or indications that anything else could be going on through the usual set of “just in case” tests…95% of them had no abnormal findings and most of the abnormalities were the “normally abnormal” sorts of things that are atypical, but happen from time to time and you find them every so often in a person who has no symptoms.

      The main thing that happened to the patients from all this testing was their symptoms got worse because running test after test with all the poking and prodding and fasting and preparing for the tests only to get “we found nothing” each time is really stressful.

      However, pretty much every patient I talk to whose doctor is following what I think are “best practices” of less testing is better for the patient seems very upset the doctor didn’t at least do a this or that test. Often a test that isn’t even likely to be all that helpful for finding one of the “but what if it is…” things they have none of the indications for.

      I think the more data is always better trap is really easy to fall into both for doctors and for patients. Even worse when a practice has an expensive doo dad that really needs to earn its keep.

      Personally, it took a long time (and consulting with Dr. Pubmed) for me and my PCP to finally determine what may be going on with some of my odd symptoms which probably are from a relatively rare, but generally considered to be typically under-diagnosed issue. We both agreed to not do the confirmatory test as it sounded painful and what little that can be done is unlikely to be harmful. We switched a few things up and I felt better so that was all the conformation we needed. I also know what things to avoid a few of the complications that could happen and would have had this figured out sooner rather than later had I been foolish enough to do anything on my new and improved do not try this at home list.

  4. goodnightirene says:

    I would like to know about the “Ottawa Ankle Rules”–will google. Since childhood, I have been prone to ankle-twisting and have had about a gazillion x-rays of my ankles, and most recently I had some taken of my pinkie toe–which actually is broken, unlike the many ankle incidents. I am always reassured that I have not had “too many” x-rays, although none of those doing the reassuring have the slightest clue as to how many I have had–in addition to annual mammograms all these years.

    Whenever I attempt to question or take a pass on lab work or other testing, I am told that it is “better to be safe than sorry”, which wasn’t on your list.

  5. Andrew says:

    It’s amazing the amount of unnecessary preoperative testing I deal with on a daily basis as an anesthesiologist. The majority of the EKGs, chest x rays and stress tests are not needed and impose a huge financial stress on our society. The goal is to allow anesthesiologists to direct the Preop process but everywhere I have trained and practice seems to send the majority of the patients to clinics staffed by nurse practitioners and PAs that mostly follow hospital protocols that still produce waste.

    The worst example that I deal with are up in labor and delivery where every single patient gets a complete blood count (CBC) instead of just a hemoglobin. The CBC includes a platelet count which may randomly show a low platelet count in an a symptomatic patient that could potentially prevent epidural analgesia. Even worse is when the admitting nurse orders a full set of labs including PT/INR, PTT (which test the bloods ability to clot) for a patient with an isolated high blood pressure. The nurses basically assume the patient may have pregnancy induced hypertension or preeclampsia that can lead to bleeding issues. They order these unnecessary tests on a verbal order because “the doctors might need them”. It then ties our hands specifically when a patient is either delayed epidural analgesia, or a spinal for a c section for fear of a devastating epidural hematoma and possible paralysis. Hospital systems try to do away with verbal orders to prevent this but it hasn’t seemed to work everywhere I have practiced.

    Many of the private surgeons I work with get cardiac clearance for every single patient so they can avoid a rare cancellation the morning of surgery. This is another poor reason to order unneeded tests.

    1. OleanderTea says:

      I’ve been the patient refusing a test “just in case” before.

      Yes, I’m asthmatic. But if my peak flow is fine, my colour is fine, and I’m not wheezing, you don’t need a chest x-ray before doing toe surgery.

  6. Sagely says:

    I went to my ob/gyn this year and said I didn’t want any tests because I’m perfectly healthy and I just wanted a refill on my birth control (I think having to come in once a year for a refill is dumb). My doctor looked at me like I had a third eye. I just had the gosh darn tests last year and the American Cancer Society says I can have a pap every three to five years. I convinced her I didn’t need one after much convincing and I would get one next year. But she still insisted I needed two other exams. Doctors don’t listen to patients.

    1. Windriven says:

      Two thoughts:

      1. Did your physician mount a compelling argument for the other two tests?

      2. If you and your physician don’t share the same philosophical approach to your health care you ought to shop for a new OB/Gyn. Absent mutual trust, respect, and understanding, the relationship serves neither of you well.

  7. StellaB. says:

    Patient satisfaction has been shown to increase with the number of tests ordered. I’ve explained PSA until I’m blue in the face and had the fool test turned down at most 3 or 4 times. Tests are a cultural expectation.

  8. Harriet Hall says:

    I just heard that a friend’s healthy 21-year-old son had a routine physical and the doctor ordered a panel of blood tests and a urinalysis. He was told his vitamin D level was too low and he was slapped with a $3000 bill after his insurance approved and paid only $16. I don’t blame the insurance company; they shouldn’t have to pay for tests that were not indicated.

    1. Nell on Wheels says:

      I ran into a similar situation two years ago when my PCP ordered a lipid panel that my insurance company subsequently decided was inappropriate for a person of my age and with my specific medical conditions. The panel was included along with other routine blood work that *was* deemed normal and appropriate for a person of my age and with my specific medical conditions. Fortunately, it only cost me $32, so I just let it go. Mind you, my PCP is generally opposed to testing for the sake of testing and so tends to order fewer tests rather than more. We’re perfectly in agreement on this. On the other hand, I have a family history of hypercholesterolemia and early heart attacks, and despite also a being vegetarian and regular exerciser, my levels have been creeping up while staying within “high normal” levels with favorable ratios.

      I was also billed $18, out of a total $3,500 bill for a diagnostic MRI that was otherwise fully covered, for some part of the procedure that was deemed “experimental” by my insurance company. I was too busy dealing with breast cancer and chemo to follow up on that one.

      What concerns me is that the burden of paying for unnecessary tests falls on the patient who, more often than not, has no way of knowing whether the tests ordered by their doctor are necessary, whether they will be covered by their insurance, or how much they will cost until they’re faced with the denial from the insurance company and a big fat bill.

      Perhaps if doctors had to pay for the tests-that insurance companies reject, or if they were the first ones contacted when a coverage of a test was declined so they would have to spend time upfront defending their orders to the insurance companies, they would be less likely to cavalierly order them. By the same token, patients should be required to receive advance authorization for any tests they insist on despite their doctor’s recommendation against them, as well as an estimate of their out of pocket costs for those tests.

      1. MTDoc says:

        Sounds to me that your PCP was right, and the insurance company wrong. Why take a family history if you are going to ignore an opportunity to intercept a treatable condition. My clinic included lab and X-ray. Medicare would routinely deny payment for a hemoglobin or hematocrit, and the patient can not be charged. We were routinely asked to justify any charge other than a brief office visit. However, it was cheaper to eat the charge than to write a letter to justify a $2 fee. Medicare denials and appeals are another story. But, I’m sure glad I didn’t have to pay for a $7,000 helicopter ride that medicare denied because the crew choose a hospital that had a cardiologist, but was five minutes further away.

      2. Windriven says:

        “Perhaps if doctors had to pay for the tests-that insurance companies reject”

        Perhaps if insurance companies had to pay, say, 50 times the amount denied plus legal fees, plaintiff’s time, etc. for rejected tests and therapies that were later deemed appropriate by an independent panel, there would be fewer rejections. Of course premiums would go up.

        So perhaps better still is to have a single payer for all routine care and have optional private insurance for heroics and whatnot, more like many European models. That would cut 20% or more right off the top of a good deal of health care costs.

        Finally, if your insurance company is nickel and diming over a lipid panel which costs just this side of nothing to run, you might consider shopping carriers.

        1. Nell on Wheels says:

          My suggestion was prompted by Harriet’s story of the $3000 bill for “a panel of blood tests and a urinalysis” for a healthy 16-year-old. She said she didn’t blame the insurance company because “they shouldn’t have to pay for tests that were not indicated.” But why should the patient be expected to know whether those tests were indicated and then be on the hook for paying for them if they’re not?

          Too many doctors these days are totally unaware of how much tests, procedures, or medications cost or whether they’re covered by the patient’s insurance. They wrongly assume that if the patient has insurance and a doctor orders a it, it’s covered. When it’s not, it’s up to the patient initiate the appeal process, which may or may not be successful, and which, as you note, requires time, sometimes money, and a certain savvy about how the system works, something most patients don’t possess.

          I’m a military brat who grew up going to military clinics and have experienced the “socialized” medicine in Europe first hand–I received excellent care from both. I also navigated Medicare for my mother and did battle with hospital billing departments for my stepfather–and won, saving him some $3,000. I’m all for single-payer. But that’s not what we have and it doesn’t look like we’re going to have that anytime soon–if ever.

          Because I’m a self-employed consultant, I have an individual plan. While my insurance company nickle and dimed me on the lipid panel and that mysterious $18 “experimental” procedure, those costs were barely drops in a very large bucket during two years of cancer treatment that they covered 100% after an annual $1,200 deductible and $1,200 out-of-pocket maximum, paid seamlessly out of a Health Savings Account that I stock up at the beginning of each year so that I never have to deal with a bill.

          I *do*, however, scrutinize each and every EOB statement, which is how I discovered the denials. If it had been a $3000 denial like the example in Harriet’s story, you bet your ass I would have contested it. But I’ve learned to pick my battles.

          1. Windriven says:

            “My suggestion was prompted by Harriet’s story of the $3000 bill for “a panel of blood tests and a urinalysis” for a healthy 16-year-old.”

            I would simply point out that at Legacy Salmon Creek near Portland, a CBC with Diff costs about $25
            A metabolic panel is about $32
            Lipids are about $45
            Vitamin D is a whopping $98
            And the draw is $7

            These are the actual hospital charges. My insurer is discounted by about 50% of the invoiced amount. Whoever charged $3k for a panel of blood tests (of course there are lots of blood tests and I just chose common ones) and a urinalysis seems to think mighty highly of their services.

            1. Nell on Wheels says:

              Agreed. But when I was shopping around for health insurance several years ago, I tried getting price lists for standard tests and procedures from the labs in my area. Not one could provide such a list. They all said it depended on your insurance. Even when I said I wanted to know what the price would be if I had no insurance because I was considering a catastrophic policy, they couldn’t give me a price.

              Recently, I discovered that the price to have a diagnostic mammogram at the hospital (to which my ob/gyn referred me) was twice what it cost to have it done at an independent facility less than 1/2 mile away. Pretty much the same story for an MRI, which of course involved a lot more money than a mammogram.

              On the other hand, my stepfather’s surgeon charged *less* than the going rate because his Medicare HMO wouldn’t pay for services out of network so we paid cash. (The surgical facility and anesthesiologists were a whole different byzantine mess.)

              I would be interested to find out (1) what tests that healthy 16-year-old had that were worth $3,000, (2) whether the costs were actually denied or simply subject to the deductible and out-of-pocket requirements, (3) whether the doctor had any idea what they would cost when he ordered them, and (4) whether they could have been performed cheaper elsewhere.

              1. Windriven says:

                All four, really good questions.

            2. Nell on Wheels says:

              Quest Diagnostic prices April 2014:
              Difference
              btwn Charge
              Quest and Plan
              Charged Allowance I Paid
              CBC, PLT, DIFF* 40.56
              Metabolic Panel* 44.65
              TSH* 125.47
              210.68 (174.68) 36.00**
              Lipid Panel 141.68 (128.89) 12.79
              Thyroxin 47.59 (41.03) 6.56
              T-3 Free 217.40 (201.22) 16.18
              Bilirubin, Direct 20.02 (15.23) 4.79
              Venipuncture 20.55 (14.80) 5.75

              Total: 657.92 (575.85) 82.07

              * Included together under same code for payment
              ** Total paid for CBC, PLT, DIFF; Comprehensive Metabolic Panel; TSH

              1. Windriven says:

                Yow! Some of the Quest prices are a lot more than Legacy. The lipids and the draw particularly caught my attention.

              2. Nell on Wheels says:

                You should see the numbers for just one round of my chemo!

                Which all raises the question: How often do providers actually get paid what they charge (let’s call it “list price”), and (since I suspect they most often do not), what is their actual cost given that they still make profits accepting the the steep discounts most insurance companies demand?

                An article in The New York Times several years ago revealed that there is no rhyme or reason to what medical providers charge: “It is not based upon the cost, and it’s not based upon the market forces, other than the whim of the C.F.O. of the hospital.”

                “If you line up five patients in their beds and they all have gall bladders removed and they get the same exact medication and services, if they have insurance or if they don’t have insurance, the hospital will get five different reimbursements, and none of it is based on cost,”

                Getting Lost in the Labyrinth of Medical Bills, NYTimes, 6/22/2012

              3. Windriven says:

                I have some small expertise on this as a matter of study over the years. Hospitals all keep a sort of price list called a Charge Master. Insurers receive discounts off this in one form or another and each insurer generally negotiates its own discounts.

                Your note about the capricious nature of Charge Master pricing is absolutely true in every specific case that I know of.

                When one considers the travesty that is our (US) health care system it becomes clear that insurers, hospital groups, and
                Group Purchasing Organizations form a malignant ménage a trois of obfuscation and greed.

                The President could have accomplished more to reduce the cost of health care by passing legislation demanding all Charge Masters and the actual costs for each item be publicly available on line. And sort of like Sarbanes-Oxley, if the number of procedures performed times the actual cost lines in the Charge Master don’t total to something very close to the hospital’s actual operating expenses on their 10-K filing, somebody’s gonna go to jail. Similar measures can be created for insurers and GPOs, largely being IMHO legalized kickback schemes that limit competition and innovation, should be made illegal.

        2. goodnightirene says:

          “…you might consider shopping carriers.”

          As IF most people have anything to say about their employer-provided h/c coverage. Over the years, our small employer has changed carriers on average of once per year. This has resulted in my having to get a different surgeon (at an entirely different facility) about two weeks prior to scheduled rotator cuff surgery–and that’s just one example. Our employer will change insurance carrier every time a salesperson drops by and tells him he can save $2 a year. He never bothers to even notify us until it’s a done deal.

          The same thing has begun happening to my daughter’s family. Their employer even pulls insurance entirely at times and several months may pass while he “shops around”. They looked into Obamacare, but without a subsidy (they didn’t qualify) that would have left them with pretty poor coverage. The boss got new insurance about the time O-care kicked in, but there is only ONE doc in their town who takes it. My daughter is trying desperately to get her thyroid condition under control with this one doc (who she does not like) before the insurance gets changed or cancelled again!

          By the way, I completely agree with your solution to the problem.

          1. Windriven says:

            @Irene

            I have considerable sympathy for both you and for your employer. Health insurance is a huge burden. Rates rise inexorably and insurers have been allowed to do these “acey-deucey-one-eyed-jack” policies that make it impossible to compare apples with apples when shopping. When the change is made no one ends up happy except the salesperson for the ‘winning’ provider.

            I hate ACA, not for what it is so much as for what it isn’t but could have been. That said, when it kicked in I gave everyone a raise equivalent to what I had been paying for their health insurance and cut them loose to choose the ACA package that best suited them.

            Strip the American health care system of its world class heroics and it would be a laughingstock. We can sometimes save an 800 gram baby by focusing an expensive arsenal of technology and the skills of a small army of clinicians and technicians but we can’t provide good routine prenatal care to at-risk mothers? Cuba provides better routine care for its people than the United States – at least those in the US without high quality insurance. ACA doesn’t fix that. Deductibles on many ACA policies leave working people declining medical care in favor of keeping the lights on and the kids in school. We spend a fifth of the nation’s entire economic output on health care and that is the best we can do?

      3. ThomasT says:

        Wow, breast and chemo. You obviously haven’t got The Cure and Prevention of All Cancers, 2007, Clark,H R PhD ND.

        Plus all the new ‘stuff’ on papaya leaf tea, tumeric, nano-colloidal silver, vitamin D3 etc..

        Neither elevated blood cholesterol nor dietarty cholesterol cause arterial calcifiction. The causes are high blood homocysteine, LDL, and high triglycerides

        1. Nell on Wheels says:

          You’re joking, right?

        2. Windriven says:

          Hey- Thomas Turdbrain – In one sentence you say that elevated cholesterol doesn’t promote arterial calcification and in the next sentence you say that it does. What do you think LDL is? LDL has been understood to contribute to arterial calcification for decades. Maybe witch doctors have only just gotten the message, hmmm?

          1. Andrey Pavlov says:

            In one sentence you say that elevated cholesterol doesn’t promote arterial calcification and in the next sentence you say that it does.

            Well to be fair and pick a nit, he did say dietary cholesterol (though then did not distinguish that from synthesized LDL). So technically it isn’t necessarily an oxymoronic sentence. Though it still isn’t entirely accurate either. Yes, it is true that the contribution of dietary cholesterol to cardiovascular disease is much lower than we once thought, it is certainly not zero either.

            1. Windriven says:

              ‘Drey, I was keying on the ‘elevated blood cholesterol’ rather than the dietary. Wrong is wrong even if the added dietary phrase is much less wrong.

            2. WilliamLawrenceUtridge says:

              My understanding is it is not dietary cholesterol that is a health risk, it is dietary fat intake that raises LDL cholesterol that is the problem. Which makes sense – eating a blood transport complex wouldn’t change the amount of whatever it’s transporting.

              Anyway, if Thomas is citing Hulda “I died of cancer” Clark seriously, he’s not worth giving any respect to.

              Thomas is also remarkably certain about an incredibly complex set of conditions which genuine experts, expert bodies and the world at large views as still far from settled. It must be nice to be so certain, particularly if it means you eat a better diet as a result. Comforting lies are, of course, comforting.

            3. Nell on Wheels says:

              Whether we’re talking about dietary or serum cholesterol, diet plays an important role in in controlling LDL levels, particularly in familial hypercholesterolemia where the body has a decreased capacity for removing LDL. Eating a low fat vegetarian diet high in fiber, especially soluble fiber, can reduce LDL serum levels. Even if you’re not willing to become a vegetarian, cutting back on saturated fat and increasing your consumption of soluble fiber can help keep you from needing medication.

        3. Chris says:

          “You obviously haven’t got The Cure and Prevention of All Cancers, 2007, Clark,H R PhD ND.”

          A couple things that you should learn about spotting pure nonsense:

          1. The title. Anytime something says it can cure all, it is 100% bogus.

          2. Just for your information, the degree “ND” stands for “Not a Doctor.”

          3. The author of that book actually died from cancer and was a well known quack.

          4. This blog does mention her a few times, like in this article:

          Compare this to the view of many practitioners of unscientific medicine. My favorite example of a vastly, hugely, mind-bogglingly simple pseudo-explanation for cancer is that of the late Hulda Clark, who claimed to be able to cure all cancers (not just all cancers, but all disease) but who died of multiple myeloma herself. Her idea was that all cancer is caused by a liver fluke, which she would claim to be able to kill (and thus cure the cancer) with device she called her “Zapper,” a cheap little electrical gadget that looked as though it were assembled from spare parts at Radio Shack.

          I suggest you actually read some more articles on this blog to learn what actually constitutes scientific evidence.

  9. Ed Whitney says:

    There is a cautionary tale about following evidence-based guidelines and not automatically ordering a PSA test, suggesting that the malpractice “excuse” is sometimes more than an excuse.

    New national guidelines on pelvic exams suggest that they need not be done annually in healthy women. Will we see similar cases arise?

    1. MTDoc says:

      Probably. Interesting how lawyers use the community standard when it serves their purpose, and turn to a national or even a global standard of care when more convenient. I remind my younger colleagues that it was not always that way. That is why my first malpractice insurance policy only cost $69. I doubt the case sited in your link would have made it to trial in Montana, at least with an endorsement from the state review panel, but once it’s before a jury, all bets are off.

      1. mho says:

        I don’t believe there is consensus on that recommendation.
        I haven’t looked for data yet, but anecdotally, I’d say many young women only see a physician during that annual visit and that may be the first time anyone educates them about the importance of knowing family medical history or pre-natal care. Perhaps the pelvic exam could be skipped, at a physician’s discretion, but I think its the wrong message if women think they have no need to see a gyn. until they have symptoms of something.

        “The American College of Obstetricians and Gynecologists, however, immediately responded in favor of doctors’ continuing to perform routine pelvic screening on healthy women. That group “continues to firmly believe in the clinical value of pelvic examinations,” it said in a statement, which help gynecologists turn up incontinence and sexual dysfunction, and allow them “to explain a patient’s anatomy, reassure her of normalcy and answer her specific questions.” ” http://www.washingtonpost.com/news/to-your-health/wp/2014/06/30/healthy-women-do-not-need-routine-pelvic-exams-influential-physicians-group-says/

    2. Young CC Prof says:

      I’ve heard that claim before, that evidence-based medicine is all about cost-savings, especially when it argues for less cancer screening. It isn’t, of course, it’s about figuring out what works and what doesn’t. Saving money by eliminating ineffective treatments is a side benefit.

  10. MTDoc says:

    Just a couple of thoughts. Doctors are still condemned for “missing the diagnosis” on a routine basis. Perhaps “tests” are replacing the time we used to spend with patients, after all, this is the age of technology. As for technology, why does it cost $100 to stick a drop of blood in a machine and push a button? Oh, and my generation was taught to order tests in order to be “complete”. For example, during my internship, complements of the USAF, we had a written list of 20 tests that we were to order on all patients with hypertension. (To be fair, they were referred for a workup). Anyway, clinical medicine IMHO, is more than a treatment algorithm, and that is what I see more and more. These are just random thoughts, provoked by your as usual excellent presentation. As for your conclusion, I’m on board 100%.

    1. Windriven says:

      “Anyway, clinical medicine IMHO, is more than a treatment algorithm, and that is what I see more and more.”

      I think most everyone would agree. But treatment algorithms based on good science and evidence can improve care and reduce workload. Why reinvent the wheel? When algorithmic treatments aren’t working clinical judgment should come to the fore.

    2. JustaTech says:

      “As for technology, why does it cost $100 to stick a drop of blood in a machine and push a button?” I can’t speak for all machines, but for the AcT5diff CP CBC machine from Beckman Coulter that my lab uses, each test run costs $1.5. That doesn’t include the cost of the machine, the service contract, the calibration or validation materials, the tube for the blood, my time or the blood drawer’s time.

      So maybe part of that $100 is a hint to not do it so often?

  11. Msrk Crislip says:

    I would also suggest personal comfort with diagnostic uncertainty

    i bet interns order more tests than attendings more than specialists for routine diseases as experience makes one comfortable with uncertainty. But then I am too old to incorporate newer diagnostics into my thought process, still can’g figure out when I need a procalcitonin

    when I see a patient I generate three lists in my head: the list of likely diagnoses, the list of diseases I can’t miss as it may kill or hurt them, and the list of cool or unusual diseases. I will order tests for the first two, but for the third it depends.

  12. FredJ says:

    It is a shame if doctors order too many tests for fear of malpractice suits. The belief that there are rampant frivolous malpractice suits is a given, but the facts are otherwise. Malpractice insurance companies made sure over the past 40 years that this fear was instilled in their customers. This way, rising premiums are never blamed on the insurance companies. It’s always that “litigious society” trope that gets the blame. Studies over the past decades have proven that premium increases bear no relation to actual changes in the number of suits or the payouts…including settlements. And they have everything to do with investment losses by the insurance industry.

    1. Stella B. says:

      When I was working we were required by the insurance carrier to go to a quarterly “quality assurance” meeting where malpractice defense lawyers would scare us silly with stories about crazy lawsuits.

      OTOH, I did a Pap on a 3-pack per day smoker. Four years later, when she was diagnosed with lung cancer (surprise!), she sued the 7 PCPs she had seen in the past 5 years for failing to diagnose. To add insult, she had seen multiple family members die during chemo, so she opted for Gerson therapy and we got sued on the assumption that the coffee enemas would have worked had they just been started sooner. Can you blame us, if we were at least a little touchier about ordering x-rays for smokers?

  13. MTDoc says:

    I was unaware that there were still any commercial insurance companies even offering malpractice insurance. In Montana, at least, all the standard carriers dropped these policies all together because of the non-quantifiability of risk circa 1980. Physicians had to scramble to set up our own cooperatives, and because of reserve requirements, were only able to offer a limited product called a claims made policy. (That means you are only covered if a claim is filed within the policy year). Lots of us left private practice at that time (1985). What you say about the insurance industry depending on investment income is certainly true, but they lost enough on medical malpractice to get out of the business. Insurance is a business and will only stay viable, and in business, as long as they can accurately predict future risk. Which makes one wonder how long they will continue to carry health insurance.

    1. Stella B. says:

      Maybe not in Montana, but we have them here in California.

      1. MTDoc says:

        Thanks for your reply. I wonder if they offer “real” coverage, i.e. “occurrence” coverage or the “claims made” scam we were subjected to. I am sure, however, that the premium is several times what I made in my practice. Lest you think I am some rustic eccentric , I did spend three year in CA at an Air Force base, and an additional two years in a truly fine residency. That served me well over the next two decades in Montana. I loved your climate, but Melvin Belli’s home state was not where I felt I could best serve my patients, even in 1967.

        The “quality assurance” remark brought to mind my corporate years, 1985-1997, when we were subjected to cultural change efforts. What a waste of money, although I did get a free trip to Singapore. Quality is part of professional (medical) culture, at least it was in my day. Marketing, on the other hand, would never understand the concept.

        1. Stella B. says:

          Actually, in the 1970s we had “tort reform”. If you are injured in California and you are low-income, you can forget a law suit. Since “pain and suffering” have been capped at the same amount for 40 years, you (also the lawyer) can only receive a big settlement for economic losses based on your loss of income.

          I suspect the real reason that there are no for-profit malpractice insurance carriers in Montana, though, is the size of the risk pool. MT has a total population of 1M. San Diego, where I live, is three times that size and the statewide population is 38M. Higher insurance prices are one of the costs of living in a low population density state.

  14. James says:

    The use of computer assisted diagnostic tools could help reduce unnecessary tests.

    If used properly it can to a lot of those excuses on their head.

    “To be complete” – Can turn to we are going to focus on the most pressing need.

    “they say”
    Can turn to the computer says you do not need it.

    “if we don’t order everything at once, it won’t get done”.
    Can be turn to would be ordered when it is needed.

    “we’ll get in trouble if we don’t”
    Can turn to we’ll get in trouble if we do

    “As long as he is in the hospital, we might as well”
    Can turn to we can schedule if then they need it.

    “academic”
    Can turn to keep with the standard practices we just run these tests.

    “malpractice” – Can turn to we have proof we followed the most up to date practice that we know of.

    “protocol” – Following the software recommendation is the protocol

    “if it were my mother or father, I’d want it done” – Can turn to If it were my X I would want the to have the most current care.

    “how do we know he doesn’t have it” – This can still happened hopefully less.

    “knowledge is good” – My mind is blank here

    “fishing expedition” – Can turn to let go over your history and symptoms again

    One can dream

    1. Windriven says:

      ““knowledge is good” – My mind is blank here”

      Knowledge is good – but sometimes it costs more than it is worth.

      1. KayMarie says:

        And sometimes the bliss of being ignorant of the inevitable quirk of biology lurking in your body is priceless.

  15. Irreducibly simplex says:

    Thank you for the interesting article, I wonder if acupuncturists throw in an extra needle sometimes ” hey I might discover a new meridian”

    1. Serge says:

      Brilliant!

  16. Sullivanthepoop says:

    Here is a problem they didn’t address. I have a single antibody autoimmune disorder that causes a graves-like thyroid disease . My primary keep ordering thyroid peroxidase and thyroid stimulating hormone antibody tests which I have never had. It is frustrating because we have talked about this extensively.

    1. Sullivanthepoop says:

      So this would be a “standard of care” excuse even though I do not have standard thyroid disease.

  17. Lost Marble says:

    I actually really appreciate all the times my doctor told me a mild symptom didn’t warrant testing and would go away on its own. I find it odd that the people who rant against over-medicalized society are the same Pete who complain when a Dr won’t run such and such test that they read something about on google university.

    1. Bryan says:

      True, those rants are very widespread and very odd.

      However, I am still glad I decided to enter Google University when I was trying to persuade my doctor to check my vitamin B12 level. I was experiencing progressive weakness and pins and needles in my legs for a good six months. Couldn’t be B12 deficiency, the doc said, because I didn’t have anemia or macrocytosis.

      Armed with a couple of pubmed references I managed to convince him you can indeed suffer neurological symptoms from B12 deficiency, pernicious anemia even, without having anemia. Turned out I had a very low B12 level, very high gastrin, and antibodies against intrinsic factor and parietal cells. In other words: classic pernicious anemia, without anemia.

      In fact, not even pernicious, ever since Minot and Murphy found a cure in 1926 :)

      1. WilliamLawrenceUtridge says:

        Part of your success is probably because you went to pubmed rather than google though. Google probably would have turned up a whole bunch of suggestions to, I dunno, chant or get an enema or something.

        If more patients started on pubmed, I’m guessing doctors would have fewer headaches. Not none, since people still probably don’t appreciate that humans aren’t rats or test tubes.

  18. nutrition prof says:

    My husband has gotten sucked into the PSA roller coaster. At a routine physical at 58, his PSA doubled, from 1.2-2.4. Not knowing better (and being scared,, b/c we trusted our providers and did what they said), he went on antibiotics, had a biopsy, all negative. Then one year later, PSA goes from 2.4-4.3-once again, antibiotics, biopsy,negative.
    His gut health appears to have changed after this experience (though his father developed lots of intolerance as HE aged, so perhaps we’re just seeing some genes turning on). I feel like we stuck our foot in the door and it has slammed on us. We have a big trip this winter, so no follow ups til we get back.

    1. Windriven says:

      Even a PSA of 4.3 isn’t anything to get jacked up about. Normal is anything under 4 ng/ml and that is, as I understand it, pretty squishy. All of this presuming an asymptomatic man with no family history of aggressive prostate disease. According to the Urological Sciences Research Foundation, age adjusted normative values would place your husband’s 4.3 in the normal range.

      What was with the biopsy at 2.4? Somebody need to do one more biopsy to win the all expense paid trip to Buffalo?

      And just to be clear I am NOT a physician so the above information is based on general knowledge and physician input on my dangly bits and those of my friends.

      1. Dave says:

        It’s not that simple. A “normal” PSA level varies with age. The velocity of change of a PSA level also has significance. Here is a discussion of PSA velocity from UpToDate:

        “PSA velocity — Another approach has been to assess the rate of PSA change over time (the PSA velocity). An elevated serum PSA that continues to rise over time is more likely to reflect prostate cancer than one that is consistently stable [60]. In one study, a PSA velocity cutoff of 0.75 ng/mL per year distinguished patients with prostate cancer from those with either BPH or no prostate disease with a specificity of 90 and 100 percent, respectively [61]. A further study from the same group found that when PSA was 0.35 ng/mL per year measured over several years was associated with a high risk of death from prostate cancer 15 years later [62]. Similarly, another series of studies from a different group found that among men with prostate cancer, a PSA velocity >2 ng/mL per year in the year prior to diagnosis was associated with an increased risk of death from prostate cancer after radical prostatectomy or radiation therapy [63,64].

        A community-based study examined PSA velocity in 1851 men with a normal DRE who underwent prostate biopsy for an elevated PSA [65]. In this study, very high PSA velocities (above 3.0 ng/mL per year) were associated with prostatic inflammation as the etiology of the elevated PSA, and thus a reduced risk of prostate cancer on biopsy.

        In practicality, the clinical usefulness of PSA velocity is in part limited by intrapatient variability in the serum PSA; at least three consecutive measurements should be performed [66]. A longer time over which values are measured can help reduce the general variation (ie, “noise”) in the PSA measurements. Depending upon the magnitude of the abnormal serum PSA, it is likely that a patient with an initially abnormal level would undergo prostate biopsy before waiting for a second measurement to be performed one year later. Said in a different way, a rapid PSA velocity will quickly result in an abnormal PSA level, which would be further evaluated due the PSA elevation alone even in the absence of a rapid velocity. Furthermore, men with cancer often have a PSA velocity of less than 0.75 ng/mL per year, especially those with lower PSA levels [67,68]. Multivariate and receiver operator characteristic (ROC) analyses as well as a systematic review suggest that calculation of PSA velocity and PSA doubling time are of limited value in screening [69-72], though some studies do suggest they may be useful in detecting the most aggressive cancers [62]. (See “Screening for prostate cancer”, section on ‘PSA velocity’.)”

        The whole PSA issue is controversial. If it were simple it would not be controversial.

        1. Windriven says:

          “The whole PSA issue is controversial. If it were simple it would not be controversial.”

          Understood. And thanks for multiplying my knowledge of the subject. I was aware of the age confounder but was clueless to the importance of rate of change.

  19. James says:

    * Disclaimer controversial topic ahead.

    Not every doctor can be diagnostic genius.
    However I do believe by having the right tools most doctors can help reduce their mistakes and unnecessary tests.
    This is why I believe doctors should software to assist them in diagnosing patients.
    There are many good reasons why doctors should use software to diagnosis patients.
    One of the biggest in my mind it can help them reduce their cognitive load and reduce the impact of a doctor’s own cognitive biases on diagnosis.

    Most people are blind to their cognitive biases.
    Constantly expecting doctors to be perfect all the time is counter productive.
    Providing doctors with better tools and systems to help reduce mistakes is a much better approach.

    A even bigger benefit to move to software is about social justice.
    It is known the minorities will get worse care than whites.

    Using software can reduce the consequences of the racial empathy gap that people have and are not even aware that they have.

    A few articles to look at.

    Computer-Assisted Diagnostics Systems Help Doctors Get It Right
    - http://www.darkdaily.com/computer-assisted-diagnostics-systems-help-doctors-get-it-right-may-help-improve-utilization-of-clinical-pathology-laboratory-tests-12313#axzz36KfRsYzI

    For Second Opinion, Consult a Computer?
    - http://www.nytimes.com/2012/12/04/health/quest-to-eliminate-diagnostic-lapses.html?pagewanted=all&_r=0

    Well-dressed women are dying because GPs assume they are healthy.
    - http://www.dailymail.co.uk/health/article-2410151/Thousands-dressed-women-dying-heart-attacks-strokes-GPs-assume-healthy.html

    Racial Bias in Perceptions of Others’ Pain
    - http://www.plosone.org/article/info:doi/10.1371/journal.pone.0048546

    Racial differences in pain treatment and empathy in a Canadian sample
    - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659010/

    Racial Empathy Gap
    - http://www.huffingtonpost.com/2013/10/17/racial-empathy-gap_n_4118252.html

  20. Russell Welch says:

    A few years back at our national society meeting, I attended a lecture by one of the premier national plaintiff’s malpractice attorneys His lecture was on how to avoid a lawsuit, to quote “if you do not order every possible test, I will get you”, enough said.

  21. agitato says:

    Dr. Hall,
    I enjoyed this blog entry. Are you or any of your colleagues going to the Preventing Overdiagnosis conference in September in Oxford? http://www.preventingoverdiagnosis.net

  22. moriyah says:

    The article and comments are just one more reason for me to avoid doctors and hospitals like the plague.
    The 2 million malpractice deaths each year in the USA is the primary reason.

    1. Harriet Hall says:

      I certainly agree that visiting doctors and hospitals can be hazardous to your health. But I think avoiding them is likely to be far more hazardous. I had hoped the take-home lesson from my article would be that both patients and doctors should clearly understand why they are ordering tests and what difference the test results will make.

      I don’t believe there are 2 million malpractice deaths a year. What was your source for that number?

      1. moriyah says:

        There are many studies, this is an important one;
        http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm
        For various reasons I will not reveal my exact sources.

        I have seen many, many medical error results and attended the aftereffects. Many of them life threatening. No one that I have attended has died within 14yrs of my working with them. Very few doctors can say the same.
        The fact that doctors are still ‘practising’, rather than performing as competent artists, is significant. Ha, ha.

        How many doctors would use common cayenne to stop a stroke or heart attack? How many would advise vanadium, chromium and zinc for diabetes mellitus? Less than 1% if that.
        The biggest killer in America is ignorance, number two is pride.

        1. weing says:

          “How many doctors would use common cayenne to stop a stroke or heart attack? How many would advise vanadium, chromium and zinc for diabetes mellitus? Less than 1% if that.”

          So what you’re saying is that less than 1% of doctors are responsible for these examples of malpractice?

          “The biggest killer in America is ignorance, number two is pride.”
          You mean on the part of the lay public? I’ll agree to that.

          1. moriyah says:

            Ignorance and pride of doctors is what I clearly meant.

            Doctors of medicine know next to nothing about nutrition in the context of human biology.
            If the true number of malpractice deaths was known doctors would be hanging from trees.

            How about pedophile doctors who rape little boys and girls for decades? That’s really great if you want to produce walking dead.
            How about doctors who cross prescribe incorrectly and the evidence of such is buried with none the wiser?
            How about doctors who prescribe addictive opiates for pain they caused and create lifetime addicts?
            The average doctor could not pass a veterinary school exam. Some of the ‘best doctors’ are the worst witch doctors?
            Mercury was/is the god/goddess of medicine, commerce, thieves and escorting souls to hell. Welcome to the real world NEO.

            1. weing says:

              And your humility and wisdom are so, so much greater. A doctor can’t even begin to comprehend it.

            2. Andrey Pavlov says:

              Wow. What an absolutely insane screed. Yes, let’s indict the entire profession of medicine by the single digit number of physicians that rape children.

              Get a flippin’ grip!

              1. moriyah says:

                I don’t claim humility or wisdom by a long shot, however, the only thing you have going for you now or in the future will be humility. When you get humility you will get some wisdom.
                In the meantime, you get me.
                -As Arnie said, ‘I’ll be back’.

              2. Windriven says:

                “As Arnie said, ‘I’ll be back’.”

                Great! Dullards like you provide immense entertainment and at the same time are useful object lessons demonstrating the perils of sloppy thinking and empty claims. You’re welcome anytime:-)

              3. WilliamLawrenceUtridge says:

                When you get humility you will get some wisdom.

                Doctors get a lot of lessons in humility when their patients die, and when those deaths are reviewed, in brutal detail, at morbidity and mortality boards which are a part of all medical training. At these boards they are grilled for the evidence-base for their decisions. And if they responded to this grilling with anecdotes, they would probably get kicked out of medical school.

                So maybe step up your game a little there champ.

            3. WilliamLawrenceUtridge says:

              Doctors of medicine know next to nothing about nutrition in the context of human biology.

              …except how individual macro and micro nutrients move through the body, the biochemical loops and feedback cycles which cause them to be consumed, stored, catalyzed or act as catalysts. Y’know, except for that, learned as part of every single medical curriculum, doctors don’t know anything about nutrition in the context of human biology. Frankly, if my doctor wants to spend his day writing out a diet for me, he’s wasting both our time, and a considerable amount of money to boot.

              How about pedophile doctors who rape little boys and girls for decades?

              How about pedophile plumbers? Or priests? Or scout masters, or teachers, or assshole arrogant internet commentors? What does this have to do with anything?

              How about doctors who cross prescribe incorrectly and the evidence of such is buried with none the wiser?

              So…if the evidence is buried with none the wiser, how do you find out about it?

              How about doctors who prescribe addictive opiates for pain they caused and create lifetime addicts?

              How about patients who seek out addictive opiates?

              The average doctor could not pass a veterinary school exam.

              Well duh, just like the average vet could not pass a med school exam – they work on different species. The average doctor could also not pass the HVAC certification exam, or flight school, or sommelier training. What’s your point?

              Mercury was/is the god/goddess of medicine, commerce, thieves and escorting souls to hell. Welcome to the real world NEO.

              That must have been very therapeutic for you, but one must note that doctors do not currently pray to or worship Mercury or his Greek incarnation of Hermes. They assess evidence as published in scientific journals, an approach which has been far more successful than prayer.

        2. Windriven says:

          “For various reasons I will not reveal my exact sources”

          Reason 1: you are a liar

          Reason 2: you are delusional

          Reason 3: you are breathtakingly ignorant

          Reason 4: many of your exact sources are nut job websites of conspiracy theorists, halfwits with scrambled ideas about human physiology, and altie types who couldn’t get into med school but still want to play doctor.

          Did I miss any?

          1. moriyah says:

            Yeah, I don’t want me or others to get firebombed by the AMA like they did to the ANA back in the days.

            However, it does not matter.
            When the plagues start rolling along, you gutless gutters will have a heart attack at treating the victims.

            I will keep my potions and lotions.

            Dr, Thomas Willis named Diabetes 300yrs ago. He blamed sugar for that as well as for the high mortality of the plague.
            Hospitals today make sugar a mainstay at every meal.
            Idiots!

            1. Windriven says:

              “Yeah, I don’t want me or others to get firebombed by the AMA like they did to the ANA back in the days.”

              Oh, don’t worry about being ‘firebombed’. You aren’t remotely worth the effort.

            2. WilliamLawrenceUtridge says:

              However, it does not matter.
              When the plagues start rolling along, you gutless gutters will have a heart attack at treating the victims.

              Meanwhile you’ll sit down to a nice vindaloo presumably?

              I will keep my potions and lotions.

              Well we certainly don’t want them.

              Dr, Thomas Willis named Diabetes 300yrs ago. He blamed sugar for that as well as for the high mortality of the plague.Sure, but they also blamed the plague on witches, comets, the stars and the vapours rising from marshes. So picking one area where there’s success at the expense of all the failures is a little deceptive, don’t you think? And what was Dr. Willis’ treatment for diabetes? My understanding is way back then all they had available was exercise – have a nice big meal, go for a jog, die blind and crippled at 30. Now type I diabetes can be treated with daily doses of insulin, no blindness, no crippling. Seems like an improvement, doesn’t it?

              Hospitals today make sugar a mainstay at every meal. Idiots!

              Well, to be fair to hospitals, they don’t treat plague every day. Also, are you talking about the packet of sugar you get with your coffee or tea? Or like, a bowl full of sugar and a big spoon? Also, is this sugar given to type I and II diabetes patients, who are actually harmed by sugar intake? Or are their diets controlled a little more carefully perhaps?

        3. Andrey Pavlov says:

          How many doctors would use common cayenne to stop a stroke or heart attack?

          Sweet jesus I hope none of them! That is the most ridiculous thing I’ve ever heard!

          If you ever have a heart attack and decide to take cayenne for it I’d love to hear your story, but I know I won’t. Dead people don’t write profoundly ignorant and blazingly stupid comments on the internet.

          1. moriyah says:

            ‘That is the most ridiculous thing I’ve ever heard!’
            Yeah, probably so, but, before you say it again you would display some intelligence by doing a brief search online or in the medical databases.
            You just stuck your foot, up to your hip, in your mouth.
            Are you choking yet?

            It is that kind of pride and ignorance that is systemic to the medical profession.

            Look it up if you dare. Same goes for the rest of the dumb, unable to speak, med pros on here now.

            1. AdamG says:

              Actually, I did look it up in the medical databases. It turns out Cayenne can actually cause heart attacks.

              http://www.ncbi.nlm.nih.gov/pubmed/22264348

              Oops!

              1. moriyah says:

                Yeah, especially if you are taking warfarin (rat poison) prescribed by your doctor.
                Please, Adam, don’t you go taking cayenne if you prefer rat poison.
                On the other hand, I can provide thousands of testimonies from those who are very thankful for cayenne.
                You have to remember, Adam, there is a lot in a name. Was it not Adam who ate the apple when coddled by his wife.

              2. weing says:

                “On the other hand, I can provide thousands of testimonies from those who are very thankful for cayenne.”
                Testimonies are worthless. You need actual studies. Not quack or self-diagnosed ischemia either. BTW, warfarin is not used to treat MIs. Do you mean you advocate patients with atrial fibrillation and CHADS2 score 3 or higher, use capsaicin cream instead of warfarin or the newer factor X or thrombin inhibitors?

              3. AdamG says:

                Was it not Adam who ate the apple when coddled by his wife.

                Well I happen to be gay, so you don’t have to worry about that!

              4. WilliamLawrenceUtridge says:

                Yeah, especially if you are taking warfarin (rat poison) prescribed by your doctor.

                It’s funny, because you promote cayenne pepper and castigate warfarin for its presumed toxic effects. But while warfarin, which is a potent anticoagulant is toxic in high doses, so is capsaicin. What’s the therapeutic index for cayenne pepper given an acute myocardial infarct? What’s the lethal dose? What’s the minimum effective dose? Did the Mayans, who had chili peppers available to them, ever die of heart attacks?

                Please, Adam, don’t you go taking cayenne if you prefer rat poison.

                Again, cayenne contains capsaicin, which is itself toxic in high doses (or lower doses if you have allergies, lung conditions, etc.). In fact, nearly anything is a poison given appropriate dose – water can cause hyponatremia, salt can cause hypernatremia, and if you drop a ton of sugar on someone it can kill them!

                On the other hand, I can provide thousands of testimonies from those who are very thankful for cayenne.

                So…you run a cooking class then? Oh, you mean medically. Oh, that’s different. How many testimonials do you have from people who died of a heart attack after attempting self-treatment with cayenne? And do you collect testimonials from heart attack patients successfully treated with warfarin? How do you determine which is better, based purely on anecdotes?

                You have to remember, Adam, there is a lot in a name. Was it not Adam who ate the apple when coddled by his wife

                That’s…completely irrelevant to anything. Shiva has a frisbee that can destroy the world, so that means I win the argument, right?

            2. weing says:

              “How many doctors would use common cayenne to stop a stroke or heart attack?”
              You mean because a quack herbalist, self-styled Dr. J.R. Christopher said so? Only those that are willing to commit malpractice.

              1. moriyah says:

                Ahh, ignorance does reign here at science based medicine.
                Remember, pride comes before a fall.
                Bunch of quacks and cracks.

                It appears some very heavy hitters who do science based medical research would disagree with your position, Weing, Adam, et al.

                New research just published in the journal Circulation concludes that a common, over-the-counter pain salve containing capsaicin rubbed on the skin during a heart attack could serve as a cardiac-protectant – reducing or even preventing damage to the heart. The researchers found an amazing 85 percent reduction in cardiac cell death when capsaicin was used. This is the most powerful cardioprotective effect ever recorded, according to Keith Jones, PhD, a researcher in the UC department of pharmacology and cell biophysics.

                Dr. Jones and his research team applied capsaicin to specific skin locations in mice that caused reactions in the nervous system. Specifically, sensory nerves in the skin were triggered to activate what the scientists call cellular “pro-survival” pathways in the heart. The result? The heart muscle was protected from injury.
                I can go on and probably will. Must be some other stuff to critique around this sad site.

              2. weing says:

                “Dr. Jones and his research team applied capsaicin to specific skin locations in mice that caused reactions in the nervous system. Specifically, sensory nerves in the skin were triggered to activate what the scientists call cellular “pro-survival” pathways in the heart. The result? The heart muscle was protected from injury.”
                I ignore animal studies when it comes to applying treatments to patients. Come back when you have human studies demonstrating this. I will gladly adopt it.

              3. MadisonMD says:

                New 5 year old research you mean? That cite is here. It is mouse study reporting the interesting finding that a surgical wound or capsaicin rubbed onto a mouse prior to 45 min coronary occlusion, then infarct size is markedly reduced. However it says nothing about eating chili peppers, nothing about human studies, and even if you are in the business of treating murine myocardial infarction and place your full trust in one unreplicated study, then you better have precognition so you can start rubbing it on the shaved mouse belly before it squeaks with chest pain.

                Your deceit (“New research just published”) and dissimulation (failure to identify cite or link a specific study) marks you as an individual who engages dishonestly. Your assertion that this study trumps clinical data on aspirin, beta blockade, and revascularization for MI marks you as a rube afflicted by Dunning-Kruger.

              4. WilliamLawrenceUtridge says:

                Dr. Jones and his research team applied capsaicin to specific skin locations in mice that caused reactions in the nervous system. Specifically, sensory nerves in the skin were triggered to activate what the scientists call cellular “pro-survival” pathways in the heart. The result? The heart muscle was protected from injury.

                Does it work in humans?

            3. Andrey Pavlov says:

              It is that kind of pride and ignorance that is systemic to the medical profession.

              Then by all means don’t seek medical care! Nobody is forcing you to. Take all the cayenne for strokes and heart attacks you want.

              Use all the powerful tools available to humanity a couple hundred years ago. Let us know how that goes for you.

              In the meantime, the patient whose COPD exacerbation I just stabilized with some BiPAP, IV steroids, and nebulizers is probably happier with those than some loon chanting spells and throwing peppers at her.

              1. moriyah says:

                Yes, I did want to mention how I appreciate medicine and its ability to stabilize traumatized victims. It really is wonderful.
                Its after the patient is stabilized that irks me incredibly.
                When they roll in those trays of sliced and diced, minced and mashed concoctions they call food. Then let the patient eat all they want causing great havoc with every organ.
                On top of that giving them so little water, from city taps at that, we find most all patients in a hospital dehydrated. Some to extreme degrees. Some to death.
                If they were given enough of that water for the dehydration they might die from the toxic heavy metals or free floating pharmaceuticals poisoning city water supplies.
                Sorry Doc, you get no kudos from me.
                Oh, and isn’t it doctors that have both the first and second rankings for early death as measured by profession?
                What a stupid system of medicine.

              2. weing says:

                Oh, and isn’t it doctors that have both the first and second rankings for early death as measured by profession?

                If you factor out suicide?

              3. WilliamLawrenceUtridge says:

                Yes, I did want to mention how I appreciate medicine and its ability to stabilize traumatized victims. It really is wonderful.

                What about it’s ability to prevent infectious diseases through immunization? The ability to drive smallpox to extinction? The ability to detect and repair congenital defects in utero? The ability to re-attach severed limbs? Recognition of the genetic cause of Huntington’s disease? Proto-giant mecha? Seems like there’s a bit more to medicine than merely stablizing trauma victims. One could even point to the frequently-ignored advice to patients to eat a lot of fruits and vegetables, not smoke, exercise and get enough sleep. But patients rarely follow such advice.

                Its after the patient is stabilized that irks me incredibly.

                Why? You prefer burn victims without skin grafts? Compound fractures set but not casted so they can be rebroken? You have something against rehabilitation?

                When they roll in those trays of sliced and diced, minced and mashed concoctions they call food. Then let the patient eat all they want causing great havoc with every organ.

                Oooooh, you’re one of those idiots who thinks everything can be cured with food…that’s great. Because if there’s anything they didn’t have in the past, it’s food. Yeah, all we need to do is send stablized trauma victims home where they can have a nice bowl of chicken soup, and they’ll just spring back to life.

                On top of that giving them so little water, from city taps at that, we find most all patients in a hospital dehydrated. Some to extreme degrees. Some to death.

                [citation needed] there champ. Can you provide even one example of a hospital patient dying of dehydration?

                If they were given enough of that water for the dehydration they might die from the toxic heavy metals or free floating pharmaceuticals poisoning city water supplies.

                You do realize that they test city water supplies for these things, don’t you? And that the levels of medications found reflect the improved technology for detection rather than massive doses of drugs in the water?

                Oh, and isn’t it doctors that have both the first and second rankings for early death as measured by profession?

                I don’t know, is it? Can you provide a citation? And how could they have the first and the second? That seems physically impossible, what do they die twice?

                What a stupid system of medicine.

                Considering your alternative seems to be a grocery store, I think the problem might be one of comprehension.

            4. WilliamLawrenceUtridge says:

              Look it up if you dare. Same goes for the rest of the dumb, unable to speak, med pros on here now.

              Courtesy, not to mention credibilty, normally requires the claimant to provide the citations. Why don’t you do so? PMIDs are fine, I can look those up myself quite easily. Unless you want to keep stroking yourself to your own brilliance and find it hard to type with only one hand? Human studies, randomized, controlled trials ideally, comparison with standard care is also acceptable, but best would of course be systematic reviews, meta-analyses or a Cochrane review. The thing is, there’s a lot of potential search terms that could be used (heart attack, myocardial infarct, stroke, cayenne, Capsicum, capsaicin) and rather than get into a long, turgid debate, I’d rather save the time by having you provide us with the best references.

        4. WilliamLawrenceUtridge says:

          For various reasons I will not reveal my exact sources.

          Good idea, it makes your case far more convincing.

          I have seen many, many medical error results and attended the aftereffects.

          Yeah, that’s why M&M conferences are a routine thing, as is monitoring medical errors for trends and ongoing efforts to reduce them. It would be great if we had perfect robots to conduct medical care, but we don’t, and humans make mistakes. For instance, patients will often eat excessively for decades to the point where they have a heart attack. Big mistake.

          How many doctors would use common cayenne to stop a stroke or heart attack? How many would advise vanadium, chromium and zinc for diabetes mellitus? Less than 1% if that.

          Thank Dog it’s less than 1% since that would mean a significant portion of doctors are committing medical malpractice given the vast number of proven treatment options for these conditions and the utter dearth of good evidence supporting them.

          The biggest killer in America is ignorance, number two is pride.

          Funny that. Given your comments, I’m assuming you are some sort of naturopath? Yeah, it’s easy not to kill people when you see and treat medically stable, worried well customers. Also, are you contacted by hospitals when your customers go into diabetic comas or die of a heart attack? Well, why would you be? You’re not a doctor, you have no privileges, and you don’t treat acute issues. So realistically, how would you ever know if one of your patients died of a sudden, massive heart attack brought about by untreated diabetes? Incidentally, which type of diabetes do you treat with these compounds? And, of course, what is the research base? I’m guessing rats and pancreatic cells in petri dishes.

    2. WilliamLawrenceUtridge says:

      The article and comments are just one more reason for me to avoid doctors and hospitals like the plague.
      The 2 million malpractice deaths each year in the USA is the primary reason.

      Take that approach with chest pain or night sweats and you’re asking for an early grave. Better to seek out preventative care – exercise, proper diet, appropriate weight, adequate sleep. But of course, one can’t avoid accidents, and eventually we all get sick. Simplifying things according to the number of malpractice suits is an error for many reasons.

      1. moriyah says:

        Fact; Doctors as a profession are probably more ignorant than any other profession concerning the realities of ‘exercise, proper diet, appropriate weight, adequate sleep’.
        American medicine, as a whole, is the laughing stock of the planet.
        The recent VA debacle is only the icing on the cake. Or, if you like, the tip of the surgeons scalpel.
        To reiterate and respond; if I had ‘chest pain or night sweats’ I would reach for cayenne and not rat poison.
        The AMA is in bed with the drug companies, the mortician, the insurance companies, etc. It is a business, not a service.
        The Cadeusus is what Mercury carries to conduct souls to hell; not that Aescalupius or Hippocrates would have it that way.
        I would argue that every Doctor who signs a death certificate has failed his patient in some way. Not the least in failing to refer his ‘client’ (someone under his protection) to someone skilled. Nurses are riding in the same boat.

        1. weing says:

          Ahh. Thank you for demonstrating ignorance and pride. I hope no one is ever injured by following your stupid advice.

        2. Andrey Pavlov says:

          Doctors as a profession are probably more ignorant than any other profession concerning the realities of ‘exercise, proper diet, appropriate weight, adequate sleep’.
          American medicine, as a whole, is the laughing stock of the planet.

          I did part of my medical education in Australia. Guess what? They learn the same things we do. The system in the US sucks. But the science and medicine are the same no matter where you go.

          1. moriyah says:

            Exactly. Thank you for making that point. The whole system of medicine sucks worldwide.
            But, if you want to talk about healing then we have a whole other situation.
            A healer, of any persuasion, does not need any tests at all. They know what the symptoms are and what they mean. They do not have to guess or test. Invasive surgery is rarely considered an option and poison is not used to treat what nature can directly.
            The ‘healing’ profession was wiped out during the inquisition and has now barely regained a tenth of what was lost then.
            The ‘medical’ profession was born out of the inquisition and is still today controlled by the church and not by rational healers.
            Any doctor that cares truly for his patients will study the earth and the biological processes at the cellular level to know how to interface plants and people.

            1. Andrey Pavlov says:

              Exactly. Thank you for making that point. The whole system of medicine sucks worldwide.

              The only way I could possibly make your point is if I suffered horrible brain trauma. Systems suck. The science and practice of it is a different stories. Our science is pretty darned good actually.

              A healer, of any persuasion, does not need any tests at all. They know what the symptoms are and what they mean. They do not have to guess or test.

              Well… almost right. Tests are properly used only to confirm a diagnosis, to track a particular marker for response to treatment, or to discriminate between diagnoses that are tough to tell apart.

              We don’t guess but we do, at times, need to test.

              Invasive surgery is rarely considered an option and poison is not used to treat what nature can directly.

              Such a cornucopia of tired old tropes you are!

              The first thing you learn doing surgery is that the key thing to learn is when not to do surgery.

              Oh, and guess what? Nature has all sorts of poisons! Belladonna, amanita, aristolochia, tobacco, foxglove…

              The ‘medical’ profession was born out of the inquisition and is still today controlled by the church and not by rational healers.

              Hmmm…. well, I am rather an atheist and even an anti-theist so that is news to me. Not sure where you even grabbed that piece of class A nuttery.

              Any doctor that cares truly for his patients will study the earth and the biological processes at the cellular level to know how to interface plants and people

              Phew! Well, I am glad you and I can be buddies then. I did my post-grad research in molecular pharmacognosy. You know, the study of bioactive molecules in plants. And we all do biochemistry and molecular biology.

              So…. what other completely incoherent ramblings will you come up with next?

              1. moriyah says:

                Really? And you know nothing about cayenne?
                Or curcumin, thymol, pascalite, goldenseal, echinacea, cats claw…..

                That is amazing! How much did you pay for that license to bury people without risk, I mean, to ‘practice’ medicine? Maybe you should ask for your money back.

                It is a charter, a warrant, a permit; that is all. It does not convey godlike qualities or protection.
                You know very little when you start to practice except, as evidenced by your insurance which your patients pay for, cover your ass ets.
                The rest you learn as you go. If you learn at all. Then you die an average of 10yrs younger than your patients.
                I though about being a doctor but decided I would rather have the extra ten.

              2. WilliamLawrenceUtridge says:

                Jesus mary, do you back anything up with citations? Simply saying stuff doesn’t make it true – I can say you area chicken pecking at a keyboard, but that doesn’t mean you are actually a chicken. How about some citations or evidence to back up the massive death rates of doctors? For instance, this one says doctors actually live longer than average.

                In other words – I’m calling bullshit, you may type out a lot of crap, but I doubt any of it is true. Please substantiate your claims with references to reliable sources, because tracking down citations to show you are wrong is time-consuming (but hilarious).

              3. Windriven says:

                “I though about being a doctor but decided I would rather have the extra ten.”

                Or, more likely, didn’t want to go all the way to Bangladesh for a medical school that would accept you.

              4. Andrey Pavlov says:

                Or curcumin, thymol, pascalite, goldenseal, echinacea, cats claw…..

                Actually I did post-graduate research on goldenseal. It was pretty interesting stuff. Seemed to show a pretty clear effect of increasing life span without any obvious side effects, specifically no changes in reproduction, vision, congential anomaly changes, etc. in an anti-oxidant independent pathway (part of which was my work). In Drosophila melanogaster. I actually had to sleep in the lab over the weekend because my assay ran 48 hours and I had to log it every 4 hours. And that was after 2 weeks of prep. And I replicated it 5 times.

                It is interesting stuff. But there is no evidence it is useful in humans or what the interactions there may be. But it seems that there may be some compounds in it that, if purified and perhaps modified, could prove to be beneficial for people in some way. But it won’t be anything that ever stops heart attacks or strokes or cures cancer. Things are just a lot more complicated than that.

            2. WilliamLawrenceUtridge says:

              But, if you want to talk about healing then we have a whole other situation. A healer, of any persuasion, does not need any tests at all.

              Question – in the era before scientific medicine, what was the average life expectancy? What was the child mortality rate? Did they have “doctors” back then?

              They know what the symptoms are and what they mean.

              Fun fact – before the germ theory of disease, they categorized illnesses according to symptoms rather than etiology. How did that work out?

              Invasive surgery is rarely considered an option and poison is not used to treat what nature can directly.

              So…what part of “nature” can treat stage IV breast cancer? And tobacco is part of nature, what is its role in the creation of lung cancer? What part of nature treats cystic fibrosis? Or type I diabetes? Or paralytic polio? Are fava beans part of “nature”? What is their link to G6PD deficiency?

              The ‘healing’ profession was wiped out during the inquisition and has now barely regained a tenth of what was lost then.

              What, like midwives and shit? Currently midwives responsible for low-risk births kill proportionately more babies and mothers than high-risk births in hospitals. But that’s probably the inquisition’s fault.

              The ‘medical’ profession was born out of the inquisition and is still today controlled by the church and not by rational healers.

              Actually, in the US the current medical profession was born out of the Flexner report.

              Any doctor that cares truly for his patients will study the earth and the biological processes at the cellular level to know how to interface plants and people.

              What plant will provide insulin to a type I diabetic? Also, is deadly nightshade a plant? What about deadly nightshade? And also, you know warfarin, that rat poison you hate so much? You know where they get it from? Plants. Plants are assholes. They want to kill us so we don’t eat their leaves, or so that after we eat their seeds, we poop them out in a nice nutritious pile of diarrhea (or even better, simply die with them in our stomachs, turning us into fertilizer).

              But yeah, plants are great.

              1. WilliamLawrenceUtridge says:

                Damn, the second deadly nightshade should be mandrake root.

              2. mouse says:

                WLU “Damn, the second deadly nightshade should be mandrake root.”

                Yes – It’s important to be very careful with your ingredients when mixing a potion(?) Just ask Harry Potter.

                Okay I didn’t read this thread. But I the comment taken out of context is so delightfully whimsical I’m afraid to. I suspect it the point is much more mundane.

            3. Frederick says:

              “The ‘medical’ profession was born out of the inquisition and is still today controlled by the church and not by rational healers.”

              euh.. what? Maybe on planet wakkado but not here. You should go out more, read news, talk to people, reality is there waiting for you. Medicine is regulated by government agency, and unfortunately for US people, by Private company a little bit too much ( Private insurance, for profit hospital etc) but the church? wow. did you travel to the future from the 1500′s?

              “…will study the earth and the biological processes at the cellular level to know how to interface plants and people”

              It’s called SCIENCE! biology, microbiology. And with it, they can find super cool molecules that can heal ailment and we call it drugs. welcome to the world of Humans, it called planets Earth!

        3. Sawyer says:

          I would argue that every Doctor who signs a death certificate has failed his patient in some way.

          Wow. I have to hand it to moriyah and others that share her philosophy. They always seem to possess a unique talent for revealing a tremendous amount about their beliefs, values, and experiences with a single sentence. Silly as they may appear, I am in awe of this particular writing skill. It would take most of us pages to express the ideas that she’s managed to get across in under 100 characters.

          I hope others here have thought through the logical consequences of this statement, as they are quite entertaining.

          1. Andrey Pavlov says:

            @sawyer:

            I may be opening myself up to some vitriol from our trolls, but I just woke up from my afternoon nap after my first overnight call. I had one patient on my service die last night. It was a patient that I did not admit and had not seen before. I was called over because the nurse had given her morphine and her pressure tanked. I assessed her, gave some orders, and got her stabilized very quickly. Then about 45 minutes later I got the call that she was coding. The ICU team tried to resuscitate her for 40 minutes.

            She was in her 90′s and had gone through some major surgeries with complications, her quality of life was very low, and she and her family was just starting to think about DNR but hadn’t quite gotten there yet. We are thinking it was most likely either an MI or a PE. I called the family on the phone during the code and spoke to them in person after they arrived.

            The family was very grateful and thanked us, including me, for everything we had done. They appreciated me explaining everything that had happened overnight and how much the ICU team had tried to resuscitate her. I spoke to another family member in Hawai’i and he also thanked me very much for our service and taking the time to give them all the info.

            They did not blame us, they were not angry, and they stated many times that they understood and appreciated that we had done everything we could.

            So forgive me if I couldn’t give two $hits about whether moriyah thinks I have failed my patient because I signed a death certificate early this morning. Her family seems to think otherwise.

            1. WilliamLawrenceUtridge says:

              Marion seems to think that you can prevent death perpetually with the appropriate herbs and spices, sort of a Colonel’s secret recipe for immortality. Sadly, this is untrue – people have been consuming these spices for millennia and still died. They just taste good, they’re not magic.

              1. Windriven says:

                “Marion seems to think that you can prevent death perpetually with the appropriate herbs and spices, sort of a Colonel’s secret recipe for immortality.”

                William, who are we to disabuse her of this notion? It brings her peace and happiness. And it reduces the load on an overburdened health care system. While she drinks tincture of unicorn fart, resources become available to vaccinate a few children, replace an aging knee joint, or implant a pacemaker or two. It’s a win-win!

        4. WilliamLawrenceUtridge says:

          Fact; Doctors as a profession are probably more ignorant than any other profession concerning the realities of ‘exercise, proper diet, appropriate weight, adequate sleep’.

          Really? Is that why it’s a standard recommendation for all patients, included as part of the medical curriculum and you can fail medical school if you don’t recommend these lifestyle changes for an at-risk patient? I mean, you can say stupid stuff like this, but that doesn’t make it true.

          American medicine, as a whole, is the laughing stock of the planet.

          Yeah, this is true, but not because of the education of American physicians (whom staff some of the greatest hospitals on the planet). The American medical system is denigrated because it’s not a system, it’s a patchwork of systems, and the US is the sole first-world country to not offer a purely-public health care option. Nothing to do with the actual medical care, a whole lot to do with how it is paid for, the economics involved, and politics. A lot of doctors really hate it too.

          The recent VA debacle is only the icing on the cake. Or, if you like, the tip of the surgeons scalpel.

          Sorry, perhaps you can clarify for me – was the VA debacle based on the quality of the care provided to veterans, or the fact that they didn’t have access to care? Just curious.

          To reiterate and respond; if I had ‘chest pain or night sweats’ I would reach for cayenne and not rat poison.

          So, how does that work then? Because the study you appear to cite (and we have to guess here, because you didn’t actually link to it) suggests one must apply cayenne prophylactically, upon an open wound. Do you just cut your chest open daily and sprinkle some in there, or do you have some sort of port, vent or shunt?

          I would also argue against the use of rat poison, but I would strongly recommend following doctors orders to use a carefully-dosed amount of anticoagulant to prevent the clot from growing and indeed to reduce it in size if possible. I mean what, does your doctor (presumably former doctor) just hand you a box of Cov-R-Tox and say “here, if you bleed out your eyes, take less”? I mean, my doctor specifies a dosing schedule and amount, but perhaps your hatred of the medical system is based on having a really, really, basically Doug Murphy-style incompetent as a physician. That would explain much.
          The AMA is in bed with the drug companies, the mortician, the insurance companies, etc. It is a business, not a service.Somewhat true, though missing out on the ongoing efforts to reduce the pernicious influence of Big Pharma. Of course, a lot of herbal manufacturers are in bed with Rep. Barton to ensure they are not required to demonstrate safety or efficacy of their pills. There’s corruption basically everywhere, but pretending evidence doesn’t matter doesn’t seem to be a valid solution.

          The Cadeusus is what Mercury carries to conduct souls to hell; not that Aescalupius or Hippocrates would have it that way.

          Well thank the FSM that we don’t rely on prayer to Mercury to cure people!

          I would argue that every Doctor who signs a death certificate has failed his patient in some way. Not the least in failing to refer his ‘client’ (someone under his protection) to someone skilled. Nurses are riding in the same boat.

          So…doctors shouldn’t provide medical care unless they can guarantee that they never harm any patient, ever? Wow, that’s quite the standard. Man, we should try that approach elsewhere. GM can never manufacture a car unless they guarantee that nobody ever dies while driving, riding or being struck by one. Boeing can never manufacture a plane unless they can guarantee it never crashes. Grapes can never be grown unless it can be guaranteed that they never choke anyone, or cause them to be an alcoholic.

          This is great, we should make up rules like this for everything!

  23. moriyah says:

    That was fun. We should do it again soon.
    I must admit, medicine has reached a high art in being able to liberate 100′s of thousands of dollars from dying patients. The inquisition was crass compared to today.
    The blind leading the blind right into the grave.
    It is no longer about quality of life. Now it is about quality of death.
    You will all get along fine in Obamacare.
    When that goes bankrupt you can still work for the VA.
    Plenty of walking wounded to go around.
    I’ll be growing herbs at the cabin, and eating them to stay alive.

    1. WilliamLawrenceUtridge says:

      That was fun. We should do it again soon.

      It was amusing for me as well, finding out that you base your recommendations on five year old mous studies and that your claims of doctors dying earlier than average is flat-out wrong.

      I must admit, medicine has reached a high art in being able to liberate 100′s of thousands of dollars from dying patients. The inquisition was crass compared to today.

      It must just kill you that herbalists can only pry hundreds of dollars from individual credulous patients then. Incidentally, if you kill somebody with your herbs, are you required to face a hearing of fellow herbalists to avoid the issue in the future? Or do you not even know about it because the customer just stops showing up one day and you don’t do a follow-up?

      The blind leading the blind right into the grave.

      That does sound like your approach indeed. Thanks for your honesty.

      You will all get along fine in Obamacare.

      Most people here are quite disappointed with Obamacare actually, it’s at best a band-aid solution for a genuine health care system.

      I’ll be growing herbs at the cabin, and eating them to stay alive.

      Throw in a deer once in a while, otherwise you’ll die of kwashiorkor. Make sure you don’t bring a laptop, because, y’know, magnetic fields.

      1. Harriet Hall says:

        The capsaicin for heart attack claim is about as ridiculous as they come. A study shows that using it BEFORE experimentally inducing a heart attack in rodents reduces myocardial tissue damage. Even if that were applicable to humans, there would be no way to know when a heart attack was about to happen and when the treatment should be applied. And there’s no reason to think capsaicin would do anything for complications of heart attacks like ventricular fibrillation. As for the “thousands” of testimonials, it would be interesting to know how many of them were actually having a heart attack and how many had chest pain for other reasons. Since this “healer” doesn’t do any tests, how is the diagnosis made? Even the best cardiologists rely on EKGs and blood tests to diagnose heart attacks. The vast majority of chest pain would probably resolve equally well with capsaicin, fairy dust, or tincture of time. By the same reasoning, capsaicin is probably highly effective for resolving symptoms of the common cold in a week or so. :-)

        1. WilliamLawrenceUtridge says:

          Of course, we’re all assuming maryola even was aware of the actual study and not merely repeating something she read in, oh, say, Natural News then copy-pasted the text verbatim.

          One notes that Dr. Jones actual interests are in molecular signal transduction. Capsaicin was merely used because it was a topical irritant, not because it has any magical heart-healing properties. You could probably get the same effect by punching the mouse with a tiny boxing glove. I wonder how moriariaha would think of that drug-free alternative to cardiac surgery – a quick sock to the jaw. “Suck it up buttercup” [pow!]

  24. weing says:

    “I’ll be growing herbs at the cabin, and eating them to stay alive.”

    Proof that some herbs can addle your brain.

  25. Matthew Oaks says:

    I would recommend reading A Physician’s Apology by Tom Schneider. Her writes about his experience as a Dr. and a Patient. He talks about medical myths as he calls them. We just aren’t ever sure about why the dr. prescribes what he does, but we need to know. Makes me want to get completely healthy so I don’t have to go to the Dr. ever! His site is ihealthspan.com, he’s onto something I think. Was an eye opening read for sure.

    1. Harriet Hall says:

      I’ve read it. I was not so impressed. He “apologizes” for medical myths that are not based on evidence, and then proceeds to offer a whole slew of his own recommendations that are not evidence-based. I’m planning to write a review of the book for SBM,

  26. This is a very interesting topic
    What kind of those regularly tests and procedures done as a “check-up” are evidence-based?
    Dealing with specific examples: cardiac stress test. what about those regularly blood tests ordered?
    Should we check liver enzymes once a year? Since many liver diseases are “silent”, can be argued that this is a good thing. However, How many of the patients that is diagnosed with any hepatitis were detected in a full-check up?

    1. Andrey Pavlov says:

      @felipe:

      Funny enough, that has been written about right here on SBM.

      Specific examples have specific answers. You need to look them up and see the indications and recommendations yourself. You can start with the USPTF and go on to the specialist and professional societies relevant to each test.

      No we shouldn’t check liver enzymes every year. A screening test must be something that can catch a disease process early, with a high sensitivity (and as high a specificity as possible), with the ability to intervene and improve outcomes by said earlier detection. There are much better ways to check for hepatitis than liver enzymes. And there are groups that are more at risk than others for it and if you are in that group we do indeed test for it. But not for liver enzymes.

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