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Tuesday, January 17, 2012

Magical Medical Thinking Might Be Killing You

Simple Check Lists Dramatically Reduce Surgical Errors
I have written quite a bit about medical issues and "big pharma."

One of the interesting aspects of "big pharma" (and in parallel the "big government FDA" that rules over it) is how the placebo affect comes into play with what they do and do not do.  (See this as a good source of thoughtful material.)

For one thing, the placebo effect (which is that the mere suggestion that something might provide aid) is pervasive.  What I mean by that is there are many studies (as linked above) that show the effect for placebos by themselves.  What's I find interesting is how much you can separate placebo effects from supposedly "legitimate" medications and their effects.

One supposes that these effects are accurately measured but imagine the "placebo effect" of something like Lipitor.  You tell someone this is "good for your heart" and then you proceed to measure "risk" as opposed to something concrete, as in "Lipitor reduces your risk of heart attack."

But does it?  Or does the "effect" of you taking Lipitor reduce and/or affect this risk as well?

Another thing that is troubling is the concept of what I would call a "reverse placebo" effect.

Suppose I tell you that you look really bad today - peaked, pale, dark circles around your eyes...

Does that have an effect on you?  How about on your mood?  Are you now worried that something might be wrong?  Maybe that headache was really a symptom of something more serious?

So I see the "reverse placebo" as you reacting to the suggestion that you are "less well" than you were.

I wonder if, for example, these ads for things like Lipitor have the reverse effect on people.

Making them question their health in the first place.  While there is a correlation between cholesterol and heart attacks there isn't a causal link.  So you are informing someone about a risk to their health, but its not a certainty.

Then we have articles like this one (I am not picking on the WSJ's health coverage - its just a handy source of material).

Medical science discovering unknown relationships between brain and digestive system.  Personally I wonder if they know this little how can they say for sure that the "purple pill" is really doing the right thing as far as your health is concerned?

What if these pills are simply treating some part of what is really a larger problem?

Based on this article its really hard to believe that medical science really knows...

Now let's mix this in with this article.

This talks about a lot of things but one of the quotes that stood out for me was this one: "... as many as 25% of patients who arrive at the center with diagnoses for certain cancers such as lymphoma may receive a different diagnosis".  The discussion here is about patients arriving at a particular medical center with cancer.

When you think about this that's a pretty significant error rate.

What if 25% of everything you bought at the store was wrong?

What if 25% of your house was built incorrectly.

What if 25% of your car was broken?

What if even 25% of all your car repairs (or dental work) was done for the wrong reasons?

To me this is pretty scary.  Would you shop where 25% of the groceries were mistakes?

Is this even really a "science?"  Or is it just ritual?

Quite honestly this does not even seem like engineering.  After all one would expect that given the same series of tests two doctors ought to come to the same conclusion about what the results mean... but they don't.  They have "opinions" instead.

(Like when your brother-in-law shows up and says "oh, that's the alternator" when looking at your car that's not running right...  he's probably right about as often unless he's a mechanic... and even then...)

If your body's correct function is linked to your brain and what your brain does - which among other things is thinking - then if we don't understand your brain how can we understand what its telling the rest of your body to do?

At the end of the day this seems to me to be the real problem with "medical science."

While we can study chemical and biological reactions, DNA, RNA, etc. we really are just using a microscope to examine an oil refinery - there is a "big picture" as in what's controlling the oil refinery - which is going to be fairly hard to discover with the microscope.

Certainly we can see chemicals, reactions, knobs turning, electricity flowing through wires to operate values, and so on.

But how do we understand its purpose and what's controlling it?

Modern medicine has become too irresponsible and arrogant.  And yes, we have less typhoid, we live longer, and so forth.

Advances in disease, for example, have been concrete, as with the creation of vaccines.  Vaccines continue to work if they are specific - but look at the CDC flu shots - just mumbo jumbo about how they might be working or not (see "Flu Shots and Magical Thinking").  Is this science?  Should people rely on this data?

On the other hand, the microbes are out-smarting us in the areas of antibiotics - our gains were relatively short-lived.

I think that we are missing the big picture here.

Minds are responsible for the much of how the body operates.

And medical "science" does not appreciate this nor does it account for this, e.g., placebos.

My guess is that "medical ads" drive a lot of what people think about (there were none until the last 35 or so years) - like the last explosion of catheter ads.  (Catheter ads?  With smiling young women explaining how they don't have to touch it?)  My guess is is that the ads at least in part drive up revenue because people see the ads and believe they need catheters even if they don't - can't pass up a good deal can we?

Mostly modern medicine from the "user's" perspective (you and me) is to a large degree simply "magical thinking" on the part of those who purvey it.

Don't believe me? See "Ritual Surgery or Surgical Ritual."  Huge reductions in surgical errors just by using a simple "check list."  Probably another post worth of stuff on how this old post relates to Kahneman and his "Thinking, Fast and Slow" - the surgeon's mind making him believe he's on top of it and the fact that a check list reduces mistakes substantially telling the rest of us he's not...

Our minds deceive us and we don't even know it...

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