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


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