Monday, May 17, 2010

Less is More, Mainstream Goes Alternative

Less Health Care is Better, Not More

by Jeffrey Dach MD

A shocking "medical heresy" was quietly stated in a mainstream medical journal last week.Deborah Grady MD (1)   Less health care is better than more health care.  Dr. Deborah Grady's editorial in the May 10 Annals of Internal Medicine throws a giant egg on the face of mainstream medicine.  It is generally assumed and expected that health care offers some benefit to our health.  Yet, Dr Grady points out that when health outcomes are actually studied, the data shows that more health care leads to worse outcomes. (2,3)  This revelation isn't new, and is actually old news, like a worn and familiar shoe.  The real news story is that this kind of "medical heresy" somehow  eluded censorship by the editorial board and appeared in print in a mainstream medical journal.  Are mainstream doctors getting fed up?  Is this the opening salvo of a medical revolution?

Examples of Harmful Medical Care

Dr Grady cites specific examples of treatments that result in harm, with adverse effects outweighing the benefits.  The first example is synthetic "monster" hormone therapy used by the mainstream medical system, which was found to cause cancer and heart disease in the famous 2002 Women's Health Initiative study. (4)   It seems incredible, but true.  The mainstream medical system used Synthetic "monster" hormones for years until the WHI (Women's Health Initiative) study finally convinced millions of women to switch to safer and more effective bioidentical human hormones.  My previous articles on the safety  and importance of bioidentical hormones discusses this at length. (5)(6)

Egg on the Face of Mainstream MedicineDr. Grady's second example is the discredited practice of arthroscopic surgery for osteoarthritis.  Millions of these useless procedures were performed in the late 90's until it was abandoned after randomized trials showed no benefit.(7) My previous article on the power of the placebo discussed this.(8)
A third example is the case of SSRI antidepressant drugs which have little benefit for patients with mild to moderate depression.  The benefits of SSRI drugs are equivalent to placebo pills.(9)  Dr. Grady points out that in cases of mild depression, the known adverse effects of SSRI antidepressants clearly outweigh the benefits.  My previous article on SSRI antidepressants  discussed this.(10)

A Fourth example is screening mammography.   "The adverse effects of mammography—false-positive findings, biopsies, anxiety, and overdiagnosis and treatment of latent cancers may overwhelm the benefit." (11)  My previous article on screening mammography  discussed this.(12)

Dr Grady's final example is the over-use and misuse of antacid drugs called proton pump inhibitors (PPI's), which have serious adverse effects of increased rates of fractures, Clostridium difficile infection, and increased risk of pneumonia. (13-18) I discussed the harms and benefits of acid blocker drugs in a previous article . (19)

President Obama Signing Health Care BillReducing Medical Care Opposed as "Rationing"

Dr Grady reminds us that the term "rationing" is frequently misused and abused in health care debates.  In politics, those who want more health care oppose those who propose less health care.  Less health care is called "rationing",  a term originating in the wartime practice of rationing food, fuel and other scarce goods, and services, and may not apply to over use of health services which causes harm rather than benefit.

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