May 19, 2009

Medical Malarkey: ABC Gives Space to Doc Who Claims Common, Beneficial Procedures ‘Do No Patient Any Good’

Nortin Hader, M.D. is a “professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals.”

He also thinks that a number of procedures commonly thought of as beneficial have no or very minimal benefit.

The fact that ABC is carrying Hader’s exhortations may be a clue that the network is in the tank for anything that would appear to promote government intervention in the medical system. That appears to be where Hader is ultimately going.

Judge for yourself when you see the list of procedures Hader believes are either not beneficial, or are very minimally so:

We all know about medical malpractice. That is when a physician does something necessary but does it inexcusably poorly. I call that Type I Medical Malpractice.

Type II Medical Malpractice is when a physician or surgeon does the unnecessary, even if it’s done well. Type II Medical Malpractice is a scourge in America.

We’re in for a shock if we ask if there is either no evidence for benefit, or when there’s evidence for benefit, is the benefit is too trivial to care about. Here’s a partial listing of tests and procedures that, in my opinion, we must re-examine:

1) Oral hypoglycemic drugs for Type 2 Diabetes do not spare one from heart attacks, strokes, kidney failure, skin ulcers or anything else you might care about, including death before your time.

2) If you think coronary artery bypass surgery or angioplasty with or without stents can save your life or improve your angina, think again.

3) No one should submit to a screening test unless: the test is accurate, the disease is important and we can do something about the disease. Screening mammography, PSA, HbA1c and cholesterol all fail by at least one criteria.

4) The argument that arthroscopic surgery for your knee will do something good for you in the short or long term is an example of the power of belief over science.

5) Anyone who thinks that any form of surgery can benefit isolated low back pain has been fooled.

6) Any well woman who thinks treating a low bone mineral density will result in anything meaningful for them has been sold another old wives’ tale. Since this is so, bone mineral density screening of well women is foolish.

And that’s just for starters. The menu of Type II Medical Malpractice is long, high-priced, counter-intuitive, and incontrovertible.

It is outrageous that we Americans are asked to share the cost of providing this for each other. Refusing to do so is the rallying cry for rational health care reform, and it’s long overdue.

ESPN and other sports outlets must be in on the conspiracy relating to Item 4, arthroscopic surgery. The parade of athletes whose careers were interrupted by serious knee injuries, but then extended by arthroscopic surgery, is surely too long to enumerate here. Hader wants us to believe that they’ve all been duped. Or is the benefit of continuing to be able to play sports “too trivial to care about”?

The idea that bypass surgery and angioplasty are totally unnecessary also seems particularly suspect, especially given that many of these procedures are done when a patient is near death.

Mammograms a waste of time? I suppose women aren’t supposed to worry about breast cancer until it’s too late to treat it.

Something’s not right about Hader’s stridency, and it may have something to do with an organization that he champions. “The Cochrane Collaboration” claims to be “The reliable source of evidence in health care,” and prides itself on not accepting “conflicted funding.” By making such a claim, it flogs the deeply mistaken belief that commercial donations are evil, and donations from governments, government-affiliated, and government-dependent organizations are pure as the driven snow.

Cochrane’s contributors would seem to lean towards favoring state-run healthcare. The organization’s agenda has a distinct Luddite, anti-progress, anti-technology aroma that is particularly off-putting. Dr. Hader’s outrage that “we Americans are asked to share the cost of providing this for each other” tells me that if were in charge of a state-run system, he’d be denying a lot of procedures he considers unnecessary. I suspect that patients who would like to stay alive or who would like an improved quality of life would take issue with his conclusions.

Oh wait — I just described the UK’s National Health Service.

At a minimum, ABC should have provided a rebuttal opportunity. As it is, commenters at the article have done a pretty good job of that on their own. One of the better ones was this:

Seriously? If we’re supposed to suddenly believe this doctor that these 6 things are foolish, the maybe he should have spent some time explaining the “why”s to us instead of blowing hot air. He only listed the procedures- he did not bother to point out what it is about them that makes them so foolish. Personally, I’m glad my grandfathers doctor found bypass surgery to not be pointless, or christmas of ’07 would have been spent burying him, not bringing him home from the hospital.

The lack of any evidence from Hader is indeed odd coming from someone who touts an organization that supposedly prides itself on being “evidence-based.”

Cross-posted at

Lucid Links (051909, Morning)

Filed under: Lucid Links — Tom @ 9:53 am

Noteworthy Net-Worthies:

Arthur Laffer and Stephen Moore, at the on-a-roll Wall Street Journal, reinforce one of three points yours truly has been making for four years in their “Soak the Rich, Lose the Rich” column. Some chilling stats for high-tax states: “…. we found that from 1998 to 2007, more than 1,100 people every day including Sundays and holidays moved from the nine highest income-tax states such as California, New Jersey, New York and Ohio and relocated mostly to the nine tax-haven states with no income tax, including Florida, Nevada, New Hampshire and Texas. We also found that over these same years the no-income tax states created 89% more jobs and had 32% faster personal income growth than their high-tax counterparts.” Ouch. Sadly, the authors’ inclusion of Ohio further proves the contention I made here last fall and here two weeks ago that the Buckeye State has been governed economically like a blue state since the mid-1990s. In light of Laffer’s and Moore’s stats, and as we in Ohio continue to watch the moving vans depart, John Kasich’s apparent intent to phase out Ohio’s income tax starts looking ever more reasonable with each passing day.

Besides taxes, the other two key elements in the “voting with your feet” equation are lousy schools and crime. All three — taxes, lousy schools, and crime, in different order in different places — serve to retard economic growth or cause it to contract, often leading ultimately to urban job losses, and an even further reason to leave. Focusing on metro areas instead of the states, you will usually find that the cities that have experienced the biggest population declines, including those in Ohio, didn’t start losing jobs until well after people started leaving to flee taxes, lousy schools, and crime. In fact, you may even find that a one or more of the Ohio cities involved has higher employment within its borders now than it did during the 1970s, when their population was much higher; I believe that this is the case in Cincinnati, where the population has declined by about 30% since 1970. But yes, eventually, a lot of jobs did migrate to the suburbs. These businesses ended up fleeing the same problems, but they have been last in the chain of flight because relocating a business with employees is a relatively costly proposition. In the affected areas, you’ll find that metro-area employment continued to grow through most of the 1970s, 1980s, 1990s, and 2000s, while the core cities’ populations consistently plummeted. In a given metro area, within a reasonable commuting distance, where to live and where to work are usually separate decisions. Even if the jobs had left for the suburbs independently, most of those who fled the core cities for the reasons identified wouldn’t have done so if they thought urban living conditions were acceptable.

The constitutional case against Sarbanes-Oxley will be heard by the Supreme Court“Specifically, the lawsuit brought by free-market think tanks challenges the Public Company Accounting Oversight Board (PCAOB), which was created by Sarbox to police the auditing of public companies.” Congratulations to the Competitive Enterprise Institute and the Free Enterprise Fund for their persistence, and brickbats to the Wall Street Journal for failing to name them in their editorial. Even beyond the billions in mostly unnecessary out-of-pocket costs for accountants and lawyers, the sand Sarbox throws in the economy’s wheels on a daily basis has cost us probably a half-point of growth each year during the six-plus years it has been in effect. All the conditions were there from early 2003 to late 2007 for a prosperous economy’s 3.5%-4.0% growth, yet it came in at just under 3.0% for the 19 quarters ended 3Q07. The economy grew by hundreds of billions of dollars less than it should have during that time, in my opinion primarily because of Sarbox-imposed busywork. In the POR (Pelosi-Obama-Reid) Economy, now known as the POR Recession As Normal People Define It, that we have had to endure since June of last year, Sarbox is literally a fixed-cost millstone around struggling public companies’ necks.

We’re supposed to be soooooo impressed that Barack Obama’s speech at Notre Dame’s graduation ceremony, and his call for “dialogue” on abortion, got a standing O. How many people in the audience even knew that Mr. Reasonable’s real documented position is, as Rush reminded us yesterday (link will be available until next Monday or Tuesday), that “a baby that survives an abortion is fair game to be killed, and the doctor should have legal protection”? And that “(Obama’s) excuse at the time that he advanced this barbaric argument (in the Illinois legislature) was that it was necessary to protect a woman’s right to choose”? Andrew McCarthy’s recap of the infanticide saga last year provides the supporting proof (“Infanticide is a bracing word. But in this context, it’s the only word that fits. …. When it got down to brass tacks, Barack Obama argued that protecting abortion doctors from legal liability was more important than protecting living infants from death.”). The fact that most voters knew nothing of this last fall, thanks to the lapdog establishment media (Michelle Malkin dissects the worst single example, what many consider to have the potential “Game Changer,” here), is yet another in a long list of reasons why last year’s presidential election was a referendum on almost nothing. The fact that an evil practice has on its side a skilled teleprompter reader who gets cheered at yet another compromised Catholic institution doesn’t make it good. The truth and natural law aren’t up for a vote. No amount of “dialogue” will change them. Abortion is, and always will be, objectively evil.

William McGurn at the WSJ recounts the history of previous Notre Dame proabort speakers, observing that “It seems that whenever Democratic leaders find themselves in trouble over their party’s abortion record, some Notre Dame honor or platform will be forthcoming to provide the needed cover.” True enough. The Obama invite and honor are only the latest and most outrageous stains on a university that has so clearly lost its way that it doesn’t mind periodically serving as an accessory to an objectively evil practice.

Positivity: Alex Boehme’s long journey to physical and mental recovery

Filed under: Positivity — Tom @ 7:11 am

From Northern Virginia:

Published: May 16, 2009

Alex Boehme stood on the Forest Park soccer field under the lights awaiting the start of the Bruins’ first game of the year.

It was a moment he’d been anticipating for more than two years. He played the scenario in his head for months, wondering what his reaction would be—whether he’d cry or smile, or whether it would register that it was actually happening.

Boehme’s presence on the pitch was nothing short of a medical miracle and a testament to both biolomechanical repair and personal perseverance. Just 28 months and 21 surgeries ago, Boehme lay in a Maryland hospital, his right leg as shattered as his soccer career appeared. …..

Go here for the rest of the story.