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- Jun 12, 2002
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How hard would it be to start preaching to internists how their patients keep dying of heart disease, hypertension, diabetes and from eating themselves to death, from all the futile attempts they make to prevent such outcomes?do you remember when he presented 3-4 years ago at one of our meetings - cna't remember if it was ASIPP or ISIS - still think he was pretty brave for doing that. Although his logic was flawed at multiple steps of his presentation.
He is not a pain doc - but has found a niche where he looks at the literature, writes reviews of the data (with his twist) and resells this to work. comp, to occ health - he is getting paid to do this....
He is not a pain doc - but has found a niche where he looks at the literature, writes reviews of the data (with his twist) and resells this to work. comp, to occ health - he is getting paid to do this....
Multi-society letter already done and sent to Berliner.
Payment drives research, payment changes policy. Research changes nothing.I don't a SISy can help. Integrated health systems are chasing bundled and capitated payments.
Payment drives research, payment changes policy. Research changes nothing.
I like Lobel Doctrine....Henceforth, perpetually, and for all time, that shall be known as the Lobel Axiom...
I think Roger is looking at the cost of the service, the total # performed, and the paltry ROI.
It's hard to argue with his analysis from my experience.
Is it? Compare it to a months supply of low dose narcotic - 4 to 6 a day - with the previously mentioned very poor return to work data when back pain patients use COT.I think Roger is looking at the cost of the service, the total # performed, and the paltry ROI.
It's hard to argue with his analysis from my experience.
Outcome measures: Pain, Function, and subsequent surgery.Is it? Compare it to a months supply of low dose narcotic - 4 to 6 a day - with the previously mentioned very poor return to work data when back pain patients use COT.
By that cost analysis, opioids run roughly $250 for one month supply. That's $750/3 month, combined with low rate of RTW. Vs $600-1200/3 month depending on the ESI...
Ok but, you and I both know that probably half of ESI's performed are for axial pain syndromes in working aged adults. I'm reviewing Rogers analysis and average ages are 40-55.
In my hands these folks would get neither ESIs or opioids
Btw I was not able to read the full article. Was there analysis for quality of life markers? Functioning he mentions shows short term improvement. Are we getting that from COT?
No I'm not. Part 1 of EBM is of course whether an intervention is clinically effective. Chou is stating that there is short term benefit.Outcome measures: Pain, Function, and subsequent surgery.
You are presenting a false dicotomy: ESI or COT.
Large ACO's, academic health centers, and integrated health centers are under pressure to reduce "revenue leak" from bundled and capitated payment. Keeping surgeons busy in the OR is good for business and provides the internal grant money to offset productivity losses from reduced clinical work--as long as the message is congruent with the larger needs of the organization.
And in a similar vein: Guys & gals that do too many ESIs are upset that Roger is calling them out.
I wonder what the data are on the NNT or the NNH for ESI's? I wonder if that data are deduced, imputed, or politically determined...
Why don't you just ask Roger. He's very approachable, humble, and smart.
I think Roger is looking at the cost of the service, the total # performed, and the paltry ROI.
It's hard to argue with his analysis from my experience.
I think Roger is looking at the cost of the service, the total # performed, and the paltry ROI.
It's hard to argue with his analysis from my experience.
And spend a day treating failed back surgery syndrome from all these so-called "day surgeries" requiring "only a small incision" and then be aquatinted with the fusion-industrial-complex and how curative it is. Talk about detached from reality."But advances in spine surgery have made it easier than ever to treat pinched nerves caused by herniated discs, Chou added. These days it’s performed as a day procedure, and requires only a small incision.
“People recover quickly, and it usually works pretty well,” he said. “Most people, if they are told about the expected benefits of corticosteroid shots compared with surgery, I believe would choose not to receive the injections.”
He needs to spend a day in my office to see how well it usually works.
Science is never agenda-driven. To me, it seems like the authors started with the notion that "too many epidurals are given". His analysis doesn't refute, but also don't justify his conclusion....when your underlying agenda is to show esi's are ineffective? It makes perfect sense...
It's interesting in Europe , where epidurals are not paid by the single payer system due to limited data, but the commercial supplementary plans cover this benefit no problem. Irrespective of which country you reside, money and higher end plans will always offer better access to care, independent of the literature... Sad state of affairs. The NIH tried to limit mammography, prostate screening, Pap smear screening, all for cost savings no other reason( ie reduce breast biopsies, turp, cervical biopsies)... That hasn't sat wellEveryone expects academic "freedom" to be balanced by academic responsibility--or, at the very least, intellectual honesty. Still, Deans, Department Chairs and politically appointed policymakers need faculty to stick with a particular message for institutional purposes. Meta-analysis is a tempting way to build a career and get promoted: No messy IRB's, no human subject committee, no lengthy follow-up, etc. In fact, no real scientific expertise in a subject matter required. The typical reader of the medical literature is blind to these dynamics, blind to the politics of policy, and blind to the publish or perish realities of an academic career. Some people walk away from it all with disgust. Others "adapt" to survive and take their marching orders.
I try to tell all my residents and anyone that will listen that meta-analysis is about the most sneaky lie possible.Everyone expects academic "freedom" to be balanced by academic responsibility--or, at the very least, intellectual honesty. Still, Deans, Department Chairs and politically appointed policymakers need faculty to stick with a particular message for institutional purposes. Meta-analysis is a tempting way to build a career and get promoted: No messy IRB's, no human subject committee, no lengthy follow-up, etc. In fact, no real scientific expertise in a subject matter required. The typical reader of the medical literature is blind to these dynamics, blind to the politics of policy, and blind to the publish or perish realities of an academic career. Some people walk away from it all with disgust. Others "adapt" to survive and take their marching orders.
I agree. Especially, considering there's a huge amount of non-published research, negative studies that don't show the predetermined and desired results the investigators were trying show, that is never published, therefore never shows up in meta-analyses and severely skews these compiled results.I try to tell all my residents and anyone that will listen that meta-analysis is about the most sneaky lie possible.
In fact, I have mentioned that on here and people have criticized me - somehow believing that meta-analysis is the highest quality of evidence - when in fact that isn't true at all. The highest quality as deemed by many societies is "Multiple, large, high quality, randomized controlled trials" which is a world apart from a meta-anlaysis - which tries to take data from all the RCT's and combine them somehow.
Why anyone ever even started doing meta-analysis is beyond me.
a meta analysis is the perfect way for a pseudo scientist to get published using a statistics grad student to compile research done by others...
i have seen some professors climb their way to the top of academia on the backs of primarily meta-analysis studies --- they never broke a sweat...
bunch of clowns.
Who is the quote from. Post his name, let's see if he'll stand by it pubically.
Who is the quote from. Post his name, let's see if he'll stand by it pubically.
No. Paul has become a nihilist. He is defending the proposition that nothing works. Lousy methodology? No problem. Dare to oppose his position? You are an evil human being, and your views should be discounted as a result.
Chou's science is indefensible. Paul likes the conclusion, as it confirms his overarching principle. When confronted with a factually superior argument he will attack the people opposing him personally.