Why do doctors call it “practice variation” instead of poor care?

Did you know that your medical treatment may depend on where you live?  It even has a name: doctors call it “practice variation”. A new U.S. study suggests, for example, that a person living in St. Cloud, Minnesota is twice as likely to undergo invasive back surgery as a patient with a virtually identical diagnosis living in Rochester.  There are a number of reasons for this strange disparity, but one might be that Rochester is the home of the non-profit Mayo Clinic, where surgeons are paid a salary. No matter how many surgeries they do, they earn the same paycheque.  But other physicians elsewhere who are paid per surgery may be inclined to do more surgeries.

Such “practice variation” is not just seen at Mayo. Medicare patients in Fort Myers, Florida, are more than twice as likely to receive hip replacement surgeries compared to their counterparts across the Everglades in Miami, according to Dartmouth Health Atlas researchers.

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How to turn a condition into a disease by “selling sickness”

“Selling sickness” means that the line between healthy and sick becomes blurred – and demand for medical treatment increases. If you’re a drug company, it’s a swell way to get consumers to demand treatment that may or may not even be necessary. So says a Dutch study that investigated industry-funded information campaigns around common conditions like restless legs syndrome, overactive bladder and heartburn.

These “ask your doctor” campaigns focused on symptom advertising or disease mongering.

Dutch law, as in Canada (but not, significantly, in only two countries: the U.S. and New Zealand) prohibits “Direct To Consumer” public advertising of prescription drugs. You might well wonder why these two countries are the only ones on earth who still permit this marketing practice. Continue reading

Why there’s no such thing as “clinically proven”

I really like reading the common sense essays of Pennsylvania physician Dr. Lucy Hornstein. She’s also the author of the book, Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.  I like her writing mostly because I agree with almost everything she says. She’s brilliant, really. Last month, Dr. Lucy took aim at one of my own pet peeves: advertising for questionable health products that claim the benefits of such products are “clinically proven”.

For example, she picked on a radio ad for a colon cleanse product that helps remove the ‘five to ten pounds of waste some experts believe are spackled along the inside of the large intestine’:

“But ‘some expertsalso believe the moon landing was a hoax, the Holocaust never happened, and homeopathy is effective medicine. Somehow this colon cleansing stuff helps you preferentially lose belly fat. Not really sure what belly fat has to do with five to ten pounds of stuff spackled inside your intestine. But they’re not selling logic. Call right now for your free sample. Or not.  Continue reading