Medical Interventions That Do Not Help You Can Only Harm You
At one point or another a critically thinking medical professional takes a step back and asks themselves, “is this really working”, and, “how good is the supporting data for this intervention?”.
Please understand, “standard of care” is a term denoting pre-established protocols to treat certain diseases generally accepted by most clinicians like doctors, physicians assistants, NPs, and registered nurses, but it changes. Why?
Well, in medicine, turns out interventions we think are helpful, are not. Essentially, a new study could surface showing an intervention is harmful instead of helpful.
Case in point. Aspirin for heart attack. Interestingly, physicians are not allowed to recommend their patients take a daily Aspirin if their past medical history indicates no previous heart attack. The guidance changes because even in pursuit of heart health, Aspirin causes substantial liver, and stomach problems over time. To sum things up, new data reveals benefits of the intervention do not outweigh risks. Hence, the resulting medical reversal.
All things considered, there are clinicians keeping and eye out for safety signals. So, when new information emerges indicating a medicine, treatment, or therapeutic is unsafe, concerns escalate to the appropriate agencies so they can take action.
One of these reporting physicians is Margaret McCartney from Glasgow, Scotland. Some call her the watchdog of medicine. To prove the proclamation made in the previous sentence, a very important Twitter thread by Margaret is listed below as text, then as image. Please read with an open mind.
“I've been writing about medical harms for over 20 years. Always hard to think that what you are doing, with very good intentions, might actually be harmful.
For example, when I was a student, we advised people with a sciatica to lie down for 6 weeks. Bed rest, people often got a wooden board to lie on. Rest the back, sounded sensible. But trials were eventually done: didn't help, caused harm.
A cause of death after myocardial infarction is heart rhythm disturbance; can be fatal. sounded reasonable to try and reduce that risk with specialist anti-arrhythmic drugs; except that when the trial was done, they were found to cause, not prevent, deaths.
Traumatic events - highly distressing. Was thought 'debriefing', a chance to talk, would prevent post traumatic stress disorder. Very good intentions - professionals wanted to help. Not only did it not help, but people who had a debrief did worse.
Osteoporosis, bone thinning which can cause vertebral fractures, can be painful. Medical urge to do something to help - vertebroplasty, where 'cement' was put into the fractured area, was used to stabilize the bone, except it didn't work.
Medical interventions that are not going to help you can only harm you.
Arthroscopy for knee arthritis was thought to be help via a knee washout - beloved especially in private practice for years. But a trial of 'real' vs sham surgery - revealed no difference. Whoops! Another reasonable sounding but ineffective intervention.
Probably most famously, Dr Spock, a beloved US pediatrician, was well intended when he suggested that lying babies on front to sleep would reduce risks of choking on vomit; his books sold 50 million copies globally, and he was wrong; it was estimated that 50,000 infant deaths occurred from 1970s when the evidence was available but wasn't assessed properly; we now recommend 'laying on back to sleep'.
Sometimes our philosophy is at fault. 'palliative care' is often thought of as less 'active' 'giving up' (it's not). randomized controlled trial of early palliative care vs usual medical care for metastatic non-small cell lung cancer; patients in palliative care group had less aggressive care, but longer survival, and better quality of life. 'too much medicine' was harmful.
It is because am so concerned about medical harm of current approach to gender dysphoria that spoke beside @ImWatson91 and @TullipR a few days ago. Their voices so important. The medical profession should listen and hear. Well intended medicine can still do harm.
Many in medicine write to agree but are afraid to speak up. This is bad for evidence-based decision making, for talking about the gaps in evidence, for ensuing we don't do more harm than good. Everyone deserves compassionate, evidence based medical care”.
References:
https://www.nejm.org/doi/full/10.1056/nejm199103213241201
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000560/full
https://academic.oup.com/ije/article/34/4/874/692905?login=false
https://www.nejm.org/doi/full/10.1056/nejmoa1000678
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