The Epidemic of Over-Treatment

[drusso]

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

"Consider the knee, that most bedeviling of joints. A procedure known as arthroscopic partial meniscectomy, or APM, accounts for roughly a half-million procedures per year at a cost of around $4 billion. A meniscus is a crescent-shaped piece of fibrous cartilage that helps stabilize and provide cushioning for the knee joint. As people age, they often suffer tears in the meniscus that are not from any acute injury. APM is meant to relieve knee pain by cleaning out damaged pieces of a meniscus and shaving the cartilage back to crescent form. This is not a fringe surgery; in recent years, it has been one of the most popular surgical procedures in the hemisphere. And a burgeoning body of evidence says that it does not work for the most common varieties of knee pain."

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[willabeast]

yup. and no one to blame except the MD's.

 

[Ducttape]

1. Aren't these studies meta-analysis studies?

2. You to know that one of the linked studies - from Australia - does not support facet denervation, right?


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[jonnylingo]

We've medicalized the human experience. Hence antidepressants for everyone. Even though most "depressed" patients are just experiencing "life".

 

[DrCommonSense]

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

"Consider the knee, that most bedeviling of joints. A procedure known as arthroscopic partial meniscectomy, or APM, accounts for roughly a half-million procedures per year at a cost of around $4 billion. A meniscus is a crescent-shaped piece of fibrous cartilage that helps stabilize and provide cushioning for the knee joint. As people age, they often suffer tears in the meniscus that are not from any acute injury. APM is meant to relieve knee pain by cleaning out damaged pieces of a meniscus and shaving the cartilage back to crescent form. This is not a fringe surgery; in recent years, it has been one of the most popular surgical procedures in the hemisphere. And a burgeoning body of evidence says that it does not work for the most common varieties of knee pain."

Yeah basically what I wrote about in multiple posts being summarized in this Atlantic article. Read that yesterday.

Actually pretty good article but the real question is: Do we have evidence for anything in procedural medicine that is truly level one outside of maybe emergency trauma and appendectomies?

 

[DrCommonSense]

1. Aren't these studies meta-analysis studies?

2. You to know that one of the linked studies - from Australia - does not support facet denervation, right?


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1) No. Most of the evidence given about STENTs for instance came from a single large scale COURAGE study in 2007. Also, there was an interesting discussion about a single study with 7 patients that NEJM published for DBS and memory that was strongly disproven by a much larger study that NEJM wouldn't publish, showing major editorial bias.

2) Must've missed that in this article. Where was that again?

 

[Ducttape]

i think you are missing the jist of the evaluation, that most procedures dont stand up to scientific muster.

In a 2013 study, a dozen doctors from around the country examined all 363 articles published in The New England Journal of Medicine over a decade—2001 through 2010—that tested a current clinical practice, from the use of antibiotics to treat people with persistent Lyme disease symptoms (didn’t help) to the use of specialized sponges for preventing infections in patients having colorectal surgery (caused more infections). Their results, published in the Mayo Clinic Proceedings, found 146 studies that proved or strongly suggested that a current standard practice either had no benefit at all or was inferior to the practice it replaced; 138 articles supported the efficacy of an existing practice, and the remaining 79 were deemed inconclusive. (There was, naturally, plenty of disagreement with the authors’ conclusions.) Some of the contradicted practices possibly affect millions of people daily: Intensive medication to keep blood pressure very low in diabetic patients caused more side effects and was no better at preventing heart attacks or death than more mild treatments that allowed for a somewhat higher blood pressure. Other practices challenged by the study are less common—like the use of a genetic test to determine if a popular blood thinner is right for a particular patient—but gaining in popularity despite mounting contrary evidence. Some examples defy intuition: CPR is no more effective with rescue breathing than if chest compressions are used alone; and breast-cancer survivors who are told not to lift weights with swollen limbs actually should lift weights, because it improves their symptoms.

A separate but similarly themed study in 2012 funded by the Australian Department of Health and Ageing, which sought to reduce spending on needless procedures, looked across the same decade and identified 156 active medical practices that are probably unsafe or ineffective. The list goes on: A brand new review of 48 separate studies—comprising more than 13,000 clinicians—looked at how doctors perceive disease-screening tests and found that they tend to underestimate the potential harms of screening and overestimate the potential benefits; an editorial inAmerican Family Physician,co-written by one of the journal’s editors, noted that a “striking feature” of recent research is how much of it contradicts traditional medical opinion.

Radiofrequency facet joint denervation.
Savigny P, Kuntze S, Watson P,et al. Low Back Pain: early management of persistentnon-
specific low back pain.
London: NationalCollaborating Centre for Primary Care and Royal College of General UK

Also:
Leclaire R, Fortin L, Lambert R, Bergeron YM et al. Radiofrequency facet joint denervation in the treatment of low back pain:
a placebo-controlled clinical trial to assess efficacy. Spine. 2001; 26 (13):1411-1416.
(Canada);Nath S, Nath CA, Pettersson K. Percutaneous lumbarzygapophysial (Facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomizeddouble-blindtrial. Spine. 2008; 33 (12):1291-1297.
(Sweden);van WijkRMAW, Geurts JWM, Wynne HJ, Hammink E et al. Radiofrequency denervation oflumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain. 2005; 21(4):335-
344.(Australia)


There is very limited evidence exploring the use of this technology. Two studies showed some evidence of benefit for radiofrequency facet joint denervation to reduce pain,
whilst one other study found no evidence of benefit. NICE guidance is that facet joint denervation should not to be recommended and that further research is required

especially, if you look back at the Australia data, most quoted more than 1 study.

and then a determination was made about the positive effects of the available data.