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

“Integrity in Science” – who’s paying the piper?

UPDATE: The Integrity in Science database is no longer posted on the CSPI website. See ProPublica’s Dollars For Docs: How Industry Money Reaches Physicians site for comparable financial conflict of interest lists.

Looking for a luscious way to noodle away an hour this weekend? Check out the Center for Science in the Public Interest and their Integrity In Science conflict-of-interest project. But before you back away slowly for something more exciting like organizing the sock drawer, consider this: there is strong evidence that researchers’ financial ties to chemical, pharmaceutical, or tobacco manufacturers directly influence their published positions in supporting the benefit or downplaying the harm of the manufacturers’ product.

In other words, as a heart attack survivor whose doctor has prescribed a fistful of meds, I have no clue which of those drugs has been recommended based on flawed research or tainted journal papers that have essentially been bought and paid for by the drug company who made them. And, worse,  neither do my doctors.

So to check who’s taking money from whom, you can now visit the Integrity in Science database and find out for yourself.   Continue reading

Researchers: “Osteoarthritis treated with drugs/surgery instead of recommended guidelines”

When I had arthroscopic surgery on my right knee to repair a torn cartilage, my orthopedic surgeon also found evidence of osteoarthritis in that knee.  Not surprising, really, given my age and family history, but new research says many docs would now be recommending drugs or surgery that they shouldn’t for that new diagnosis.

This month’s issue of the journal Arthritis Care & Research suggests that doctors are disregarding standard medical guidelines to manage the joint inflammation condition of osteoarthritis (OA) through lifestyle improvements (like exercise or weight loss) – and instead relying on drugs and surgery.   Continue reading

British surgeon threatened with lawsuit for daring to question ‘Boob Job’ cream

According to The Guardian, a prominent British plastic surgeon named Dr. Dalia Nield of The London Clinic has been threatened with a libel action by the manufacturer of a cosmetic cream because she publicly questioned whether it worked as the company claimed. Dr. Nield had also told a newspaper reporter: “The manufacturers are not giving us any information on tests they have carried out.” The company, Rodial Limited, claims that its £125 ($192 Cdn) Boob Job cream, if applied regularly, can increase a woman’s breast size by up to 8.4% within 56 days. According to the company’s website, here’s how Boob Job works:

“As your fat cells move around the body after eating, Boob Job ‘blocks’ the fat into the area where the product has been applied, so the bust and décolleté areas. You will see a gradual increase in cup size within 56 days as well as gaining an instant lifting and firming effect.”  Continue reading