The hubris of medicine has to end

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat.

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at the white board to explain, I often find myself pausing for a moment to think: Is this really the right course? Does the evidence support doing it this way? Do I know the science, or is it “just the way things are done?” I have the same problem in the hospital—perhaps worse, as there, dogma permeates most of what we do.

What keeps popping into my head is the hubris of medicine. As I grow older, the excessive pride and confidence of the medical establishment becomes more obvious. Why didn’t I see it before?

In many cases, medical and surgical treatments that were once thought to be beneficial turn out to be not so. Often, these therapies were backed by expert guidelines and taught to young students as law. Think of that for a moment. We do things to people; we monitor, we medicate, and we even cut, all with the aim of helping. But then further study proves that we were actually providing no benefit and in some cases, causing harm.

This is sobering.

recent article, published in Mayo Clinic Proceedings, provides chilling evidence that many well-established medical practices are wrong. Researchers from the National Institutes of Health looked at 10 years of clinical investigations from the New England Journal of Medicine. Over the past decade (2000-2010), they found 363 published studies that evaluated an established therapy.

In 146 of the 363 studies (40%), the scientific evidence caused a reversal of established medical practice. That’s a sterile way of saying that nearly half the time the prevailing wisdom was wrong. It is worth going over some examples. Not one branch of medicine was spared a reversal.

In my field, electrophysiology, the AFFIRM trial revealed that the strategy of using rhythm control drugs to maintain sinus rhythm in elderly asymptomatic patients with AF did not reduce stroke, hospitalization and death rates. To this day, nearly ten years out, I still see AF patients on rhythm drugs because a doctor thinks this strategy will prevent stroke or reduce the risk of death.

In interventional cardiology, the idea that coronary blockages need to be ‘fixed’ is ingrained. Fueled by favorable reimbursement, intense marketing from industry and an insatiable public demand for being ‘fixed,’ stent implantation has soared. Then the COURAGE trial showed that implanting stents in patients with asymptomatic coronary disease was no better than optimal medical therapy and lifestyle modifications. Again, to this day, wide variations in cardiovascular care suggest too many doctors ignore scientific evidence.

Preventative cardiologists also took their share of lumps. Hormone replacement therapy for women was perhaps the most famous reversal. Millions of women were treated with hormones under the guise that manipulating female hormones would be “cardio-protective.” But HRT was based only on observational studies. Randomized clinical trials proved the concept wrong.

In pediatrics, therapy of inner ear infections set the stage for a huge medical reversal. Doctors were fearful that recurrent otitis media would cause long-term hearing loss. Guidelines recommended early intervention with surgery (tubes) to prevent complications. But then two major trials showed no benefit. One of the most commonly done procedures in all of pediatrics — wrong!

In ICU medicine, the pulmonary artery catheter (Swan-Ganz) was thought to provide invaluable data on a patient’s heart and lung function. You just couldn’t manage a sick patient without one. Surgeons, too, thought the balloon-tipped catheter was necessary for major operations. Then, when it was studied systematically, no benefit was found. A generation of doctors toiled over those pressure tracings — all for naught.

Cardiac surgeons do not like bleeding after they close a chest. An almost magical (procoagulant) drug called aprotinin was found to decrease post-op bleeding. Not until after the use of aprotinin became established practice did four studies refute its benefit. Here the story gets worse. Aprotinin increased mortality.

In anesthesia, one of the more feared complications is patient awareness of surgery. It’s a terrible outcome, which, in some cases leads to PTSD. It was no surprise then that anesthesiologists jumped at the chance to use a nifty little monitor stuck on a patient’s scalp. The bi-spectral index monitor quantifies the deepness of a patient’s sedation during surgery. Despite only one industry-sponsored study, use of the monitor surged, and it nearly became a standard of care. Then in 2008, a large randomized trial showed no benefit.

Medical reversals in oncology were especially sad. Thousands of women with advanced breast cancer were exposed to unnecessarily aggressive surgery or chemotherapy (with stem-cell transplantation) before careful clinical trials showed no benefit. Metastatic breast cancer is bad enough; heaping this therapy on at the end of life was tragic.

In diabetes care, we learned the hard way that strict control of blood glucose in hospitalized patients worsened outcomes. I remember the medical staff meetings where protocols designed to micro-manage blood sugars were presented. The experts were sure. Blood sugar had to be strictly controlled. Wrong again. Too much action caused harm.

I could go on. There are many more examples. A total of 146 similar narratives are available. Reversals included medicines, procedures, diagnostic tests, screening and medical devices. If an intervention was not based on solid scientific evidence, there was a nearly 50% chance it was wrong. What’s more, some of the most striking reversals came when therapy was aggressive.

The authors emphasize three reasons why medical reversals are so serious.

First, millions of humans were harmed.

The second issue is continuing harm. Some estimates suggest it takes ten years — on average — to change entrenched medical practice. Believe me, ten years may be an underestimate.

Third, medical reversals cause harm because they erode trust in the patient-doctor relationship. Patients expect doctors to be either correct, or transparent about uncertainty. You have seen how the erosion of trust can lead to patients refusing beneficial therapy. (Think vaccines.)

Four important messages stand out:

1. Doctors must strive to be better judges of science. When we intervene, especially in an aggressive way, with procedures, or surgery, or potent chemicals, we must be sure the science backs us up. Our interventions should never be eminence-based, but rather, evidenced based.

2. Hubris has to go. Though there is a role for ‘assess and decide’ in the practice of medicine, we must become more honest and skeptical with ourselves. Let’s get comfortable with uncertainty. This way, we can better communicate with our patients. When a prescribed therapy merely makes sense (or is just a good idea), all involved parties should proceed with caution.

3. This data should reset the default of American medicine. Currently, most everyone expects action, intervention and monitoring. Do something doctor! This needs to change — immediately. Our default should be to intervene and monitor only when the evidence supports doing so. These findings call us to share decisions with patients and default to a culture where less is more.

4. This is not just important information for doctors. Patients seeking medical treatment should not assume a prescribed therapy is beneficial just because a doctor says it is. The era of paternalism in medicine is over. Patients should be able to ask their doctor whether the evidence supports the intervention. It’s okay if the doctor is uncertain. In fact, doctors who are too sure of things worry me.

Make no mistake, the fury of modern medicine is a beautiful thing. It’s a great time to be a patient and a doctor. Whenever it comes time to act, however, it seems healthy to consider what the next generation of caregivers will think of our plan. I’m sure prescribing good food, good exercise, good sleep and good attitudes will stand the test of time. I’m not so sure about a lot else. If ear tubes and tight control of diabetes don’t stand up, what will?

John Mandrola is a cardiologist who blogs at Dr John M.

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  • Ron Smith

    In reply to:

    “In pediatrics, therapy of inner ear infections set the stage for a huge medical reversal. Doctors were fearful that recurrent otitis media would cause long-term hearing loss. Guidelines recommended early intervention with surgery (tubes) to prevent complications. But then two major trials showed no benefit. One of the most commonly done procedures in all of pediatrics — wrong!”

    I’m assuming you mean middle ear infections. There are more than one reason to do tubes, but the most important one is to relieve recurrent painful battles with them. You can have hearing loss from the conductive effects of recurrence just as I have seen persistent fluid itself. Having a 25% hearing loss in one ear and coming from a circa 1958 era where you just didn’t go to the doctor like today, I can tell you that there is concern that we wouldn’t be seeing more hearing loss had we not become more aggressive.

    That said, I’d like to comment about your article in general. I think after 30 years, I’ve become ultimately suspicious, even cynical, when I hear the latest, greatest study results. You know the one that I’m talking about where its the ‘Oh my word, I can’t believe we didn’t see that before!’ faceplant.

    I remember when the 5 studies came out about the sleeping position of babies and the relationship to SIDS. All of those studies were done outside the US. Still I was hopeful. SIDS is so tragic. We still have not solved SIDS and the sleeping position has done little more than create the craniofacial clinics where we have to fit malshaped occiputs with the helmut prosthetic.

    I personally believe that SIDS is probably a conductive cardiac thing like long QT. We’d probably have been better off doing routine ECGs on kids that spending on that money on their head shape.

    The point though that I’m making is that doctors act like lemmings all to often. We walk right over the cliff of the latest study results. We need to be much more skeptical. Think what a difference it would have made in children’s health when Wakefield’s infamous study relating MMR to autism. Now my exam time has a significant slice calming parent fears about something that is still a problem. Did you see the recent outbreak in 21 children in a group of probably well-intentioned church folk in Texas recently who didn’t want to vaccinate?

    Gone it seems are the days when we waste time on confirmation follow-up studies. We just accept a study at face value. I’m assuming that research dollars are all too tempting these days maybe? I’m an old dog hear, and I demand better. Also, if you notice, the word ‘probably’ is a healthy inclusion for me.

    We, the primary care docs who have to implement some response to these ‘studies,’ face both the fronts of fraudulent or misguided studies and the skeptitude of patients who have some sense that something ‘ain’t’ right in Denmark.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Jean Oliver

    All the more reason to follow my chosen “health care” path: visit a doctor only when symptomatic and then only if symptoms have persisted for a good length of time. Let the body heal itself, which in my experience works more times than not. I am a big proponent of “preventive” care, but not of the medical kind. Eat a healthy diet, stay active, reduce stress, don’t smoke or drink to excess. These things will go a long way to keep you healthy and out of a doctor’s office, thus reducing your likelihood of exposure to questionable treatments, including screenings and pharmaceuticals. I think advances in medical treatment are outstanding for those with life threatening disease or for victims of accidents but for all other reasonably healthy individuals it makes little sense to be meddled with on a regular basis. Just my opinion.

    • Guest

      Many doctors feel the same way, when it comes to them and their families.

  • Suzi Q 38

    Thank you for your article.
    Sometimes it is better for the physician and patient to “sit on their hands and wait (for more symptoms or information).”

  • Margalit Gur-Arie

    So if the “evidence” turns out to be wrong half the time, why is it imperative that it propagates quickly and that everybody follows said evidence to the letter?

    • azmd

      Furthermore, one wonders, what exactly is “evidence-based medicine?”

    • LeoHolmMD

      Even worse…why should anyone be forced to buy in to such a polluted structure?

      • Margalit Gur-Arie

        That’s easy… Look at the incredible amounts of cash on the table…

        • Michael Rack

          The academic-pharmaceutical monster must be fed.

  • guest

    If you notice most if not many of these examples, the treatments are with pharmaceuticals or medical devices. Since there have been several well known studies that have been corrupt (such as infuse was with bone fusions for orthopedics) that many physicians are skeptical of studies.

    On top of that patient and doctors wish for a cure. Between that and Big Pharma and medical device companies readiness to gain financially, I have a hunch that they have a role to play in these so called “standardized treatments” and new cures and techniques. Only to find out later that they don’t work.

  • Anthony D

    “I used to think medicine would get easier over time. It makes sense,
    right? You see patterns, you learn how treatments work, and you just get
    to know stuff. Experience should make it easier to diagnose and treat.”

    “That’s not been the case for me. In fact, it’s closer to the opposite.”

    The Downgrading of the Medical Degree: The new world order under Obamacare will see a paradigm shift wherein government-empowered administrators and other non-physicians make de facto medical decisions effectively ruling over the practice of medicine by physicians. Through the abuse of “standards” imposed by the Feds, the AMA, and the pseudo-independent
    accrediting body, the “Joint Commission” (JCAHO), doctors are
    increasingly losing the freedom to exercise independent thought and the
    independent practice of their profession. By utilizing peer review
    practices which would not stand muster under standard constitutional
    law, hospital and health systems can label anyone a “disruptive,”
    “unruly” or “uncooperative” physician and destroy their ability to work.

    • southerndoc1

      That “paradigm shift” has been underway for the past 25 years. No need to give Obamacare all the credit.

  • Mengles

    Blame academic medical center residencies who have every reason to promote them in the attempt of “graduate medical education” due to monetary gain.

  • Chiked

    Doctors today remind of the aging football player. Sure as a rookie, he dazzled everyone with exceptional speed and agility.
    But as he got older, the same gifts don’t seem to measure up. Now the great players learn to play a smarter game combining innate ability with head smarts. The never to be heard of players keep trying the same thing until they are eventually replaced.

    So the smart doctors, the ones that will be here for another generation will start incorporating timeless initiatives (nutrition, sleep, exercise) into their practice. The bad ones, the ones who will soon be replaced or at best relegated to computer monitors, will keep reaching for the next wonder pill or procedure in desperate hopes of maintaining an era long gone.

    • a dn

      I don’t believe it will ever happen. Doctors are not being trained in medicine but polypharmacology.

  • karen3

    Awesome article.

    • Suzi Q 38

      I agree.

  • Danny Long

    As a 24/7 caregiver for an unfortunate medical blunder.. and also aware of just how in danger every patient is even considering medical care/advice/opinion.. I am VERY please to see a little more naked honesty come out from the doctor side. I do hope the seed of thought takes root in other providors hearts, and less focus on the checkbook.

  • morebuzzkills

    This piece raises a good point. Many physicians certainly are guilty of hubris. The media also contributes to this by their portrayal of physicians. However, I must add that many patients are not guilt free in this story. Many patients put their bodies through a lifetime of abuse and then look to the medical field for a magical solution that simply does not exist. Physicians subsequently feel the pressure to treat. The situation is like buying a brand new Mercedes Benz, never changing the oil, running it at high RPMs, filling it with 50 octane gasoline and then wondering why it doesn’t run so well 40 years later. Most auto mechanics would laugh in your face if you brought this car to them and wondered why he couldn’t tune it up in one visit and have it running perfectly. It is also important to remember that medicine is an inexact science. There will always be “standards of care” that are subsequently refuted or rebuffed by better studies and advanced science. With that said, I think many of the problems you point out on the physician side could be solved with better medical education (and I am typically very hesitant to offer medical education as a solution to anything). Teaching medical students to be better students of science and better research appraisers definitely has merit. I also think more could be done to temper down the pre-MD and subsequent MD haughtiness during medical school and residency. One of my most memorable medical school moments was during morning report when I simply asked the nurses to monitor a patient’s PO fluid intake and the senior resident jumped in and said they had already done an excellent job of monitoring this and that we just wanted them to keep up the good work. I am usually pretty perceptive but I didn’t even realize that simply asking the nurses to continue to monitor something could be taken as a slight on their work or appear arrogant on the part of the lowly med student.

    • rbthe4th2

      Thank you! I would love to see a lot less treating the “paper” labs rather than the patient. All too often, as someone who shows symptoms long before the issue hits the fan, I get sick and stay sick longer, because “your labs are fine”. I have a couple of docs who do treat me based on common sense. I do anything for them, even making sure their admin people know how valuable I see them and how helpful they are. I’m a patient, a person, not a lab value.

    • a dn

      Since when did physicians respond to “pressure” from their patients? If they did, they would counsel and guide to health. They practise a profession that responds only to industry, and have become employees of pharma and device industry. This has come about because we the voter, taxpayer, hand our medical schools over to corporate funding. They are planned and run on a business model, not healthcare.

      • morebuzzkills

        I wrestled with myself over whether to even qualify your statement with a response…but I’m bored so why not? Physicians “counsel and guide” patients to health all the time. Unfortunately, patients rarely heed the advice. We live in a culture of excess and over-indulgence which has health consequences. Also, fast food offers the most calories per dollar of any food in our society. These are both big problems. The attitude that this type of culture breeds is unfortunately not congruent with counseling and guiding patients to health. Physicians counsel all the time, but few patients listen. Also, it doesn’t take a mental giant to realize that diet and exercise are pretty important…If you need a physician to tell you this, you have issues. If you’re looking for looking to blame industry alliances, you should look to the fast food/junk food/tobacco/alcohol/everything else that is terrible for you and congress. People have to be unhealthy in the first place for all these dollars to be spent, but for whatever reason it’s easier to blame the docs and big pharma. The pharmaceutical industry makes drugs in response to demand. Physicians also treat in response to demand. Where does the demand come from? Unhealthy people. How did the people get unhealthy? Was it the doctors or big pharma that made them that way? No. If you want to blame someone, at least place blame where it might make a difference.

        • Chiked

          I disagree. Physicians should always practice what is right regardless of the demand from anyone. When I am on a plane, I hate putting on my seatbelt. But I know that it is either the seatbelt or I find another plane. Doctors should exert the same autonomy and stop practicing the “customer is always right” fast food type of medicine.

          • morebuzzkills

            You’re missing the point. Let’s use a little scenario to help drive it home. A patient comes in who has high blood pressure. The patient is relatively young and moderately overweight. The physician says to the patient, “You know, I think your blood pressure could be controlled with weight loss, proper diet, and exercise.” The patient responds by saying, “You know Doc., I just don’t think I can do that. I’m busy and I just find that I can’t ever take the time to cook or exercise. Isn’t there something else you can do?” The doctor might even be so brazen as to suggest that the patient at least give these recommendations a try for a month and then come back to have his/her blood pressure checked. The patient returns in a month and his/her pressure is even worse than before because he/she hasn’t done what the doctor recommended! The doctor, realizing that the patient won’t comply with the initial recommendations and knowing the potential consequences of chronic hypertension, decides to use medical therapy to treat the patient’s hypertension. This is the “demand to treat.” We can call it “pressure to treat” or “increased patient compliance treatment option” if you would be more comfortable with that language. A lot of what gets labeled as the “customer is always right” fast food type of medicine that you speak of is actually just poor patient compliance with non-pharmacological recommendations. Ultimately, doctors have a duty to at least try to keep their patients alive. I’m not sure if you’re a physician, but try telling a patient who is chronically hypertensive and has metabolic syndrome that is inching towards type 2 diabetes that you’re not going to treat because you refuse to practice the “customer is always right” fast food type of medicine. You can say bye bye medical license and hello lawsuits!

          • Chiked

            So the customer is still always right. He said he is too busy to lose weight and whether true or imagined, you and 99% of doctors will give him a pill.

            If I were a doctor, in that scenario, I would give the patient a 90 day prescription for his high blood pressure on condition he loses a certain amount of weight in that time period. Nothing crazy…say 5 pounds or 10 pounds. Just enough to demonstrate that he is serious and committed to reversing his weight problem. After 90 days, if he did not meet his targets, I would encourage and eventually force him to seek another doctor who may be better than I am at treating his condition.

            If every or even half of doctors took this approach, patients would start taking some responsibility. Right now there is absolutely no incentive to do so.

          • morebuzzkills

            Not only is your scenario considered unprofessional, it is grounds to sue. As a physician, you have a duty to “do no harm” or “do the least amount of harm” to the patient. What would make the doctor to which you referred the non-compliant patient more capable of motivating the patient to lose weight? I am not saying that physicians should dole out pills to cure every illness…but it often reaches a point where you have to prescribe in order to do the least amount of harm to non-compliant patients. If you want to go lobby to congress to protect physicians from being sued who do not prescribe medications to patients that miss weight loss goals (or whatever the case) then be my guest…but it’s a slippery slope. Until then, focus your efforts on what created these problems in the first place. And here’s a hint, it wasn’t physicians!

          • Chiked

            “but it often reaches a point where you have to prescribe in order to do the least amount of harm to non-compliant patients.”

            Let me give you an example of why your approach is harmful. My Aunt is grossly overweight (by choice) and now diabetic and hypertensive. Her doctor gives her Lisinopril amongst others for her Bp but it is apparently responsible for her cough which is so bad at night, it can wake up someone next door. To help her sleep they gave her Ativan except now she coughs and does not remember it. One night she fell out of bed in a coughing fit and fell to the floor except she was too drowsy to get up and lay there till morning. In 5 years no one has ever confronted her about her weight despite checking it on every visit.

            So you say prescribe to do no harm. I say you are doing harm. You are just protected by law.

          • morebuzzkills

            I’m not saying that every physician out there prescribing meds is the best doctor in the world. Certainly your aunt should have been counseled on weight loss. From your limited description, her high blood pressure could have been much more appropriately managed with more appropriate meds. It could have been MOST appropriately managed with weight loss and meds. Her MD dropped the ball by not counseling on weight loss. Many MDs drop this ball. This MD also used medications to treat side-effects from other medications. Although this is in rare cases necessary, it can more often be solved by using different classes of medications or reducing the number of meds a patient is on. However, it does not mean that all MDs are horrible and don’t do their jobs…just like all patients aren’t terrible people and don’t do what their doctors tell them. It’s dangerous to apply blanket statements. Unfortunately, all meds carry some risk of harm…so it might be time to rephrase “do no harm” to “do least amount of harm.” Maybe you should suggest to her aunt that it might be time to search for a doctor who can be more involved and proactive in her care. They are out there!

          • a dn

            As I said, and you’ve proven, the doctors is only willing to work for the pharmaceutical company, NOT practise medicine, not guide the patient to health.

            In Finland and Sweden the doctors have a PDR which sets out exercise and diet counselling for each of the major western conditions that can be treated by diet and exercise. In the back of this PDR (which hasn’t, as has ours, been written by pharma) are tear out prescription pages where the doctor writes down 2 sets of 5 reps etc, and the time for the next appointment, to monitor and adjust as needed.

            Throughout your posts, all you talk about is prescribing drugs.

            Who sets the numbers at which you treat? We know it’s pharma.

            You’re working for pharma, not your patient. What do the reps give you for your loyalty?

          • morebuzzkills

            Finish and Swedish cultures are completely different from American culture. Physicians do not get anything for loyalty to pharma. The numbers at which to treat are generally set by consensus among professional societies of physicians. You are honestly missing the boat. This is exactly why change occurs at a snail’s pace in this country. People pseudo-educate themselves about issues, draw comparisons between the US and other countries which are completely irrelevant, and then are unwavering about their desire for change which is ultimately rooted in complete fallacy.

          • a dn

            I’m not missing the boat, I refused to get on it as are many others of your colleagues, and your patients.

            Finnish and Swedish medical professionals are not owned by industry.

            That would be the relevant difference.

          • morebuzzkills

            Well, go there the next time you need care!

          • a dn

            I did, twice, and saved myself an early death. I have also written about it to the thousands and thousands of Statin injured who have NOT recoverd as pharma keeps saying is what happnes when their “rare” killer side effects occurr.

            Oh no I didn’t travel there, Statins having disabled me (I was lucky, as the death toll rises among the Statin injured I was only disabled by them) and impoverished me.

            Email is free. I highly recommend consumers fed up with medical predators who masquerade as physicians give it a try. Even some American doctors are trying to find their way off the pharma gravy train, as evidenced by this post.

            What a pathetic response: Well go there next time. Actually the only illness or disease conditions many people experience are itatrogenic, which the med profession calls: cause unknown.

            The majority of us would have been better off without medical interference. The best doctors do nothing. The rest treat the harm they’ve caused with one drug after another treating the previous drug’s side effects until the patient is murdered.

            Cause unknown? No, we know the cause. And call a spade a spade.

          • morebuzzkills

            Good for you! If you reference my first comment, you will see that I did indeed agree that many physicians were guilty of the hubris that the author speaks about in this piece! However, some people tend to fixate on certain statements/arguments/opinions and put the blinders on all the way to the martyrdom that they so desperately crave. I was merely raising the point many patients (just like the many physicians the author speaks of) are also guilty of hubris! So to put this in very simple terms for you, on the one hand I was agreeing that there are many guilty physicians out there…but I was also raising the counterpoint that there are many patients out there who are guilty of the same thing. They abuse their health to the point where science has justified the efficacy of these radical pharmacological interventions in these patients and then look to physicians for a quick fix. Complicating matters is the fact that a large segment of American society is not motivated to do physical activity and other therapeutic lifestyle interventions. Judging by the fact that you sought medical care in other countries and actively write, I would hazard to guess that you do not fall in this category. However, you must realize that just because something worked for you does not mean it will work for everyone. I will again try to break this down for you in very simple terms. Should we hand out statins (indeed all medications) to everyone? NO! Are there harmful side effects from statins (indeed every medication)? YES! Are there certain people who can benefit from statins? YES! Could the vast majority of people benefit from lifestyle modifications? YES! Is the vast majority of people in America going to follow through with lifestyle interventions? NO! Should physicians preach lifestyle interventions until they’re blue in the face? YES! Are there physicians out there who over-prescribe? YES! Does the former mean that all physicians are bad? NO! Should physicians also weigh the risks and benefits of pharmacotherapy in patients who are unwilling, unmotivated, or stand to benefit substantially from pharmacotherapy? YES! Should highly motivated people such as yourself spend time and energy going after some of the things in our society that are causing people to be unhealthy in the first place? YYYYYYYYEEEEESSSSS!!!! I highly recommend that consumers who are fed up with the medical profession also beware of predators who have their own agenda and fixate on a one-size-fits-all solution.

          • a dn

            Good analogy. And, when you’re on a plane the pilot has a lot of incentive to get you safely where you paid to go, because if s/he hurts you, chance are she gets hurt too.

            Unlike the doctor ahd his patient.

  • drjoekosterich

    Great article. Now we need to get governments and insurers to drop their beliefs in “one size fits all medicine”. And lets get back to treating the person not the target

  • meyati

    I find it a horrible time to be a patient. Yesterday I finished an antibiotic-that’s not unusual for anybody. I had strep throat for close to 3 months. Back in the 1990s and earlier they would have run a strep test. I finally found an 80 year-old doctor at an Urgent Care that ran a strep test. I’ll be honest, I have been tested by the Air Force and at Ft. Bliss to see if I was carrier. I’m not. Nobody but the old doctor listened to me. I sent messages to my PCP via my EHR.
    I have statin toxicity. I was nagged into taking statin as a preventive med. I just felt bad about it, but finally took it. The third month black urine, seizures, rhabdomyolysis, back spasms, myopathy, peripheral neuropathy, sinus problems, foot and leg cramps hit me. 7 months and two weeks after I started taking it, my Achilles tendons went out.
    Then the FDA keeps trying to stop the use of Armour thyroid hormone supplement. It’s getting hard to find a doctor that will prescribe it. I can’t handle the hormones in synthetic thyroid meds. I’m not the only one-because the FDA had to allow Armour to start producing thyroid again.

    I do not like modern medicine at all. I do not like the way that modern doctors are trained at all. To me the height of American medicine was between the 1950s and the early 1990s.

    • Suzi Q 38


      I have had problems with the statins. I have tried 3 or 4.
      I felt very achy and sore all over my body.
      I felt that this type of drug compounded my nerve problems.
      I had leg cramps that were extremely painful.
      I didn’t need the side effects of a statin along with my symptoms of spinal stenosis in my neck.
      I gave it a try. My doctor had pit me on 3 different ones.
      He agreed to remove this from my list.
      When I stopped it my BP is much lower. My blood sugar is not bad (100 fasting AM) I have yet to find out what my cholesterol without it will be. I too, was concerned about all of the side effects.

      • meyati

        Don’t compare yourself to me. I don’t have concerns- my life was ruined by statins. I can’t hardly walk. I need physical therapy again. I urinated black and have been told that my kidneys will go out. The black urine is caused by dead body cells, and it causes kidney failure—I am well past concern. If your Achilles tendons haven’t gone out within 9 months of starting your last statin course, you shouldn’t have problems. Do you hurt so bad that you want your legs amputated? I do— I don’t have concerns, I have fear of meds, loathing on how doctors are now trained, hate for the FDA and pharmaceutical companies. I hope that you get better medical care than I do.

        • Suzi Q 38

          I am so sorry. No way are my side effects a comparison. You are right.

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