An epidemic of unnecessary and unhelpful medical treatments
theatlantic.com
theatlantic.com
A sibling comment mentions that lobbyists worked to get the 21st Century Cures Act passed, but a potentially bigger issue with the act is that it transfers $3.5 billion of public health spending to medical research.
I would like to see much more public funding going towards medical research, with the stipulation that the results must be open and cannot be patented.
In mentioning this I just had an idea that I don't remember seeing before. I wonder if there should just be a sort of medical treatment lottery for pharma companies. They come up with a treatment, get a patent, and prove it works as normal. Instead of allowing the monopoly however, the FDA could buy out the patent and make it public domain. The pharma company gets a guaranteed and immediate profit (say 50% of the projected total profit over the life of the patent). Meanwhile any company can then produce the drug/device/etc. competing on the quality and price of the treatment, separate from the cost of the research that led to it.
I read once about a prize based on QALY gained (quality adjusted life years) over current best practices. One of the best parts about this is you could give it for unpatentable advanced like diet/exercise/herbs.
Lots of money is wasted trying to take an unpatentable ideas like intermittent fasting/curcumin and turn them into patentable drugs.
Taking funds away from public health to do medical research is highly questionable.
I'm not sure people realize how much the public health labs do that would simply never pay, yet saves lives: who's going to speciate and sequence rare, but highly contagious or virulent organisms (like MDR TB) isolated from some one homeless person, who, by virtue of their unfortunate circumstances, serves as a canary in the coalmine of the modern city.
I can think of a number of ways it could go wrong.
The kicker is that doctors will often refuse these same treatments when offered, which is not a good reflection on their efficacy (again covered in How Doctors Think). This is not an indictment of modern medicine (which is often very effective on acute care), just a recognition of the limitations.
This leads to people saying that those lifestyle interventions are more effective in general, but that's due to them being appropriate for more patients, while there's a smaller population for which these interventions won't work well. Good doctors/psychologists will identify which patients are which over time.
SSRIs frequently create their own problems. They are sometimes effective because of their effect on the neuroactive steroids:
https://en.wikipedia.org/wiki/Neuroactive_steroid#Role_in_an...
Depressed people frequently have a metabolic problem, where they don't make enough ATP. This is caused by thyroid imbalances, poisoning with excess Omega-6 polyunsaturated oils, etc.
Prior to that, I'd been depressed since I could remember. In hindsight, I may have had mild aspergers like symptoms, mostly related to reading social cues. This wasn't "just growing up" despite shrinks for years telling me it was.
Finding the right anti-depressant changed my life for the better. Absolutely changed my life. After college, I went off them for a year just to see if I "needed them" any more. Within 6 months, I noticed my thoughts slip into old patterns of hopelessness, counterproductivity, loneliness, and general loops of existential pain, and this outlook effected everything and everyone around me. I do need them, it turns out.
So I wish people around me hadn't been so against drugs. In my case, they should have tried them earlier in treatment. That would have saved me some years of suffering.
Also, I tried prosac, lexapro, and effexor before buproprion. If I'd listened to the many drug critics, I'd have stopped looking after prosac (side effects there included sexual disfunction and mania). I notice no notable side effects with my current cocktail.
Also, I've exercised and been in good shape both pre and post taking anti-depressants. I feel better if I'm exercising than not, but it's not even in the same ballpark as what the drugs do for me. Everyone should exercise, not everyone benefits from anti-depressants. No exaggeration, I'd be dead without them.
I guess Wellbutrin has mild stimulating properties. SSRI drugs were approved on the basis of fraudulent science. The MAOIs were reasonably effective, but caused high blood pressure when the patient also ate fine cheese.
I will say some weird side effects have been cigarettes taste like shit and aren't addictive, cocaine doesn't work quite right, and MDMA doesn't work at all. Something about Wellbutrin binding strongly to the same receptors and blocking the others. Probably for the best though...
Certainly. Well-said, thanks.
> cigarettes taste like shit and aren't addictive
I learned from a hacker news comment that current thinking is that tobacco is addictive because of the combination of nicotine and chemicals that have an MAOI effect.
timrpeterson@wustl.edu
I ran, not walked, to this thread without reading the article just to talk about back surgeries.
It is stupefying and outrageous that people allow themselves to get butchered up (yes, butchered up - go read about spinal fusions, etc.) for an outcome that could easily be achieved by merely walking a few miles a few days per week.
Or that you are taking so much painkillers (from all ranges, up to opiates) that you just have the side effects and not the benefits.
I just completed a huge app to educate and prevent diabetic foot amputations. It costs $70,000 to remove a foot and the government is really trying to cut down on these if they are preventable. Patient gets to keep their foot, government doesn't have to spend money - win win!
In the US, a hospital would be stupid to make an app like this. Why would you want less foot amputations? You don't get the $70k from the surgeries and you also don't get to subscribe them to a lifetime of therapy and prosthetics. Chop off more feet, I say!
I applaud the work you are doing, but I question your confidence that the US system is the only system with these issues.
publicly-funded health care has the opposite problem - constant pressure to reduce the budget
In the USA:
if riskFromTreatment <= riskFromNoTreatment: doTreatment
In most public systems:
if (treatmentCost <= someThresholdPerBenefit) && (riskFromTreatment <= riskFromNoTreatment): doTreatment
In practice, treatment outcomes are pretty similar, but more treatments are preformed in the USA system. Being a for-profit system is one cause, but so is the litigation culture. Not doing every possible treatment and test can lead to the physician being accused of being negligent.
if profitFromTreatment <= profitFromNoTreatment:
doTreatment
It is easier to sue for not treating than for over treating, and treating generates a profit. Therefore the default is excess treating EVEN THOUGH health outcomes are equivalent to worse.
(If you think this might be absurdly expensive, you are right. A glance at the costs and outcomes in the US vs other countries verifies this.)
It would be nice if most of those tests were usually 'effective' (fairly accurate, or really cheep with rarely a false negative and a better confirmation test if warranted).
It would be nice if the goal was to /prove/ someone was healthy, just like how burn-in tests 'prove' that built systems function within the desired parameters.
My Uncle died a few years ago when a tree fell on him while working in his back yard. While trying to stabilize him, a doctor put in a request to have a surgeon amputate his leg to prevent complications once he was stabilized. My uncle died that day, and a day later a surgeon and anesthesiologist came to amputate his leg. When he wasn't found in his hospital room, they went down to the morgue, amputated his leg there, and billed the insurance company for the procedure... including the cost of anesthetizing the dead man.
Ridiculous stories like this abound in the American system of healthcare.
https://www.qualitymeasures.ahrq.gov/summaries/summary/48831...
This is complete nonsense and I'd like to see the source of this. Do you really think the state has any incentive to prevent health insurance and treatments from costing a lot? Spoiler alert: It doesn't. The state never has any incentive to save, it grows and grows. The more socialised and rigid your healthcare system, the more bloated it gets, and the more doctor and insurance mafia you get.
The strongest incentive to save is if the customer is free to decide. We see this time and time again. We do not have to force the people to save money, the market forces do a wonderful job all by themselves.
Now, what's got to happen is that patients inform themselves and diversify diagnosis. The crux of the problem is that patients seek advice from the exact same people who can make large financial gains if the patient opts for a certain treatment. Now, this is really just a beginner's mistake in negotiation and not something you can fix at the state level (since if you try to do that, the costs are socialised, but the poor judgement of the patient remains)
What needs to happen is that if doctors say "Don't inform yourself about your condition and don't read on the internet", get up, tell them to fuck off and get informed - like you would about every other service you like to buy. NEVER tolerate being taught ignorance. Nothing good comes out of ignorance, ever.
I'd like to see your source for this. Many reports have demonstrated that the US spends dramatically more on healthcare to get equal or worse results than the majority (almost all?) of developed countries. Those countries don't have one system, they have a variety - state run health care, state-paid health care, state heavily regulated health care...and they all work better than our system.
1) My understanding is that Medicaid/Medicare has consistently spent less money on overhead than private insurance.
2) Have you TRIED to get pricing information from a hospital? The market has done a terrible job.
3) Or, in simply talking to my doctor, if I need a second opinion from someone who has no incentive to mis-state the risks/benefits, AND is knowledgable enough to give me accurate opinions, exactly to whom should I turn? Or should I become a subject matter expert on every service in my life, so that I know that the non-FDA drugs I'm using actually work (which assumes that there is actual public evidence one way or the other in the absence of govt requirements), that the food I eat is safe, that my medical treatments are necessary and helpful....
> NEVER tolerate being taught ignorance.
Here, however, we are in agreement.
She would have loved to have an app like this.
So in my anecdotal experience at least, doctors are at least trying to do the right thing.
Perhaps, but in this example, shouldn't you be considering the insurance company as the entity with the motive to prevent expensive treatments?
If they're increasing rates because their costs have gone up, they're not making more profit. And other insurance companies that have done more to control costs are likely to start taking their customers over time.
Isn't the prognosis something like 2 years after foot amputation for people with diabetes?
Better early treatment keeps them alive for longer and thus buying all the test strips and injecting pens plus needles plus etc.
Example: Thyroid disease diagnostic and treatment problems are so common, that there are organizations made solely to support thyroid patients, including having lawyers specialized in suing doctors to force them to start treatment...
The reason for that, is that although there is plenty of research showing that the 80s blood tests are too conservative (they only show positive to people that are usually too damaged beyond any repair), many doctors insist in using solely those tests, and ignore symptoms and newer blood tests.
This does have to do with pharmaceutic industry though, some of the organizations pushing for the 80s tests are all supported by pharma companies, and the same companies also have lobbists that try to get in the way of allowing research of treatments that would skip such companies, for example many patients only improve when using "alternative" but centuries old methods that were known to work for centuries, yet lobbists and pharma companies try to convince doctors and politicians that these ancient methods are "wrong because they are old", and don't allow even research to proceed properly, the leading manufacturer of thyroid medicine that works is in Thailand, because in most other countries their business is considered shady or sketchy.
Same thing happen in psychiatry, problems that are popular in the public mind are overdiagnosed, specially when they have expensive medication, yet when the problems aren't popular, psychiatrists refuse to treat sufferers. I found a strange case with ADHD: kids are being pumped full of meds due to the fact that they keep disrupting classrooms and ADHD is a "popular" disease with kids, but all adults I know that are actual sufferers from ADHD to the point of disrupting their adult lives, struggle to find treatment, with the usual excuse from doctors being that the meds are "too dangerous" (then why give it to the kids by the boatload?) or that people in their 20s seeking meds must be some kind of junkie looking to boost academic performance, nevermind if non-academic symptoms are there too.
Not that I'm excusing this, but aren't most ADHD drugs powerful stimulants that are similar to street drugs? Adults would have the autonomy to abuse them, but most kids would not, and that might one way that they're "dangerous" for adults but not children.
It shows again that we will not have sane healthcare system when there are thousands of lobbyist working to keep it insane.
[1]http://www.advicegoddess.com/archives/2017/01/11/the_fda_pro...
The overall picture of beta-blockers is complex. For example, some beta-blockers have been shown clearly to reduce the chance of a stroke or heart attack in patients with heart failure. But the latest review of beta-blockers from the Cochrane Collaboration—an independent, international group of researchers that attempts to synthesize the best available research—reported that they “are not recommended as first line treatment for hypertension as compared to placebo due to their modest effect on stroke and no significant reduction in mortality or coronary heart disease.”
"the latest review of beta-blockers ... reported that they 'are not recommended as first line treatment for hypertension as compared to placebo due to their modest effect on stroke and no significant reduction in mortality or coronary heart disease.'"
We've frequently discussed on HN the idea that sky-high evidentiary standards for new treatments may have passed the point where they are doing more harm than good. While I'm sure there are disagreeable details in the new bill, the broad strokes of the bill are things that the HN gestalt has at least been talking about for a while. It's not like it's a sudden out-of-the-blue idea that nobody's ever heard of before.
A patient with a serious condition should not be denied a possible treatment, as long as it's proven that it won't hurt him.
"No thanks, grandma. We don't want none of your 21st Century cures here."
Because it was supported by many lobbyists? Or because it lowers evidentiary standards?
I'm fairly sure this kind of thing ends up with patients asking/pressuring doctors for treatments they don't need.
> Other highlights of the surveys include:
> Most physicians agreed that because their patient saw a DTC ad, he or she asked thoughtful questions during the visit. About the same percentage of physicians thought the ad made their patients more aware of possible treatments.
> Many physicians thought that DTC ads made their patients more involved in their health care.
> Physicians thought the ads did not convey information about risks and benefits equally well. Seventy-eight percent of physicians believe their patients understand the possible benefits of the drug very well or somewhat, compared to 40 percent who believe their patients understand the possible risks, and 65 percent believe DTC ads confuse patients about the relative risks and benefits of prescription drugs. In addition, about 75 percent of physicians surveyed believed that DTC ads cause patients to think that the drug works better than it does, and many physicians felt some pressure to prescribe something when patients mentioned DTC ads.
> Eight percent of physicians said they felt very pressured to prescribe the specific brand-name drug when asked.
> DTC ads help patients have better discussions with their physicians and provide greater awareness of treatments. The study demonstrated that when a patient asked about a specific drug, 88 percent of the time they had the condition that the drug treated. And 80 percent of physicians believed their patients understood what condition the advertised drug treats.
> Doctors believe that patients understand that they need to consult a health care professional about appropriate treatment. Eighty-two percent responded either "very well" or "somewhat" when asked whether they believe that their patients understand that only a doctor can decide whether a drug is right for them.
https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm14356...
Folks can argue that the FDA is biased in favor of drug companies at the expense of consumers, but then this would be a huge problem with the central mission of the FDA. It's not clear why we would trust it for approving drugs/treatment, but not trust it for considering the affects of adverisements.
For things on patent protection, the argument would be that companies are better positioned than the government, for the same reason that most net-positive ads for non-medical goods are made privately.
If our drugs, for all intents and purposes, are the exact same, then there is no point in a doctor prescribing drug x or y when the patient specifically asked for drug z.
Even when two drugs use the same mechanism of action (an agonist or antogist toward the same receptor active in the synthesis of a target protein), different generations of drugs often produce significantly different pharmacodynamic profiles of efficacy and toxicity that affect people differently. A good example are the diabetes drugs Actos vs Avandia -- same MoA (glitazones), but the latter has proven to be toxic.
Fact is, no two drugs are the same, unless they both do nothing.
This include the above. The point was that the drugs are the same in every way possible. Although this is most certainly not the case for drugs x, y and z, our example hinges on them being the same. Otherwise the doctor always should prescribe the best medication for the given situation.
They also may not have sufficient incentive to care about whether a non-life-threatening condition is actually cured.
The article mentions how one patient googled his condition and sought a second opinion. I imagine that this direction is common among patients.
I am afraid that once I get old I will also be pushed to have unnecessary treatments.
However, there's still a long ways to go in terms of UX, interoperability, adoption, etc.
https://www.propublica.org/article/when-evidence-says-no-but...
So one way to avoid unnecessary treatments is to seek out doctors who are willing to discuss treatments in similar terms. They may lack the information to build such a precise estimate, but they should still be willing to talk in a clear way about the risks and benefits of a given treatment.
NNT is a great idea, but not as practically useful for individuals as for policymakers, IMHO. I suspect few primary care clinicians can discuss current and precise NNT figures. More likely they will rely on standard of care advice from the AMA or their subspecialty board that itself was shaped by NNTs.
I'll repost my second paragraph too:
So one way to avoid unnecessary treatments is to seek out doctors who are willing to discuss treatments in similar terms. They may lack the information to build such a precise estimate, but they should still be willing to talk in a clear way about the risks and benefits of a given treatment.
Yes, it will be difficult for providers to have detailed information. They should still be open to discussing downsides and tradeoffs. It's a red flag if they hesitate to talk in terms of tradeoffs or to take the time to discuss the expected benefits and potential downsides.
Yes - exercise and a simple diet.
Michael Pollan speaks of it in the 21st century and the greek philosophers spoke of it in the negative-fourth century.
And every thoughtful person in-between.
Go look - every philosopher you've ever heard of has taken some amount of time to pontificate about health and diet and has concluded the same thing.
> In 2012, Brown had coauthored a paper that examined every randomized clinical trial that compared stent implantation with more conservative forms of treatment, and he found that stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. In general, Brown says, “nobody that’s not having a heart attack needs a stent.” [...] Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure. [emphasis added]
(This comment recycled from the earlier submission of the propublica version this story: https://news.ycombinator.com/item?id=13705761 )
Just because something works doesn't mean it's not a broken system.
Suprised that no one else has commented on this article.
Didn't refresh
And it just goes to show you, that Dr. Brown might have saved the executive a stent procedure, but they are still promulgating the myth that cholesterol causes CHD. It's a side effect not the cause. There are plenty of people that have high cholesterol and don't have blocked arteries.
<sigh>
If it were, treatment with anti-cholesterol drugs such as statins (the most used) or even a new class of drugs called PCSK9 inhibitors wouldn't have such a clear cause-and-effect on reducing cardiovascular events and mortality.
Since removing cholesterol from circulation reduces cardiovascular disease, you can view it as a cause and not as a mere marker of disease.
I've read that studies show it only has an effect for men > 50 yrs, but that the effect isn't due to reducing cholesterol.
I have notice a huge increase in the last 10 years in the number of researchers reporting no causal link between cholesterol and CHD.
On the first page of a Google search:
https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines...
Evidence abounds that there is no link.
None of the 4 other doctors even considered dealing with my carpal tunnel first, which, combined with stenosis causes what's called a 'double crush' scenario. Only one surgeon recommended the least invasive and risky procedure for me! Even though a fusion in the future is likely, for now the risk - reward for such a procedure does not warrant immediate action.
I also think it's worth noting that that 5th doctor is the only female of the group. She was the only one that didn't seem gung-ho about the fusion. I'm not saying gender plays a role but...
>Public health researchers at Harvard found that elderly patients were less likely to die or be readmitted to the hospital within 30 days if treated by female doctors rather than male. The study doesn’t explain why this happens, but prior studies have found that female doctors tend to spend more time with patients, communicate better, and follow clinical guidelines more often than their male colleagues.
So although it is widely known that doing angiograms and inserting stens in patients with stable coronary artery disease is a waste of time, perverse incentives in a fee for service model result in these outcomes. As such it isn't a good example of evidence-free medicine. In Australian public hospitals, the cardiologists are paid the same salary regardless of whether they do zero or 1000 angiograms a year. They are very happy not to do unnecessary angiograms in line with the current evidence. If anything, this introductory example shows that a health system needs to be set up to facilitate and encourage evidence-based practice.
Otherwise this article rehashes many points about clinical trials and interpreting medical evidence, without a really coherent theme, except maybe to (yet again) criticise doctors.
Things have improved in the last 10 - 15 years. Clinical trials come under more scrutiny, trial pre-registration has become more common (although not strictly enforced), health systems gather more and more data about patient outcomes outside of clinical trials and manipulative marketing practices by pharmaceutical companies have been curtailed drastically.
In my opinion, the challenges for evidenced based medicine in the next decade are:
1. Getting some decent data about nutrition. There are really remarkably few useful things we can say about how nutrition relates to health.
2. Reducing unnecessary interventions towards the end of life in an ageing population. Healthcare and healthcare research is not well suited to de-escalating care.
3. Transitioning from a one-size-fits-all approach doing clinical trials in 1000s of undifferentiated patients, to collecting 1000s of data points about each individual patient (blood and metabolic variables, genome sequencing, immune profiling, microbiome etc) and using that data to get them healthy and keep them that way. Needless to say, the difficulties in doing this will make doing a randomised controlled trial look like a walk in the park.
4. Fighting pseudo-scientific diagnostic tests and treatments. Examples of this are everywhere - Theranos, gene therapy clinics in undisclosed locations in South America, quantified self services that have no proven health benefits, virtually every supplement ever sold, multivitamins...
5. Fighting the politicisation of health care. This is a very worrying trend that can easily render all our scientific efforts irrelevant - eg anti-vaxxers, far-right intolerance of harm minimisation measures like abortion and decriminalising drug use.
I am thinking of the example mentioned in "The Power of Habit" where one group of knee surgery patients was given a brochure about post-surgery treatment, like PT, exercise, etc. The other was give the same brochure with blank pages to write out a specific plan for following the recommendations. Of course, the second group fared much better.
My wife is an ophthalmologist in private practice. Recently, we were looking at the economics of buying a laser to do a common treatment for patients with glaucoma, called a Selective Laser Trabeculoplasty (SLT).
Even with a decent understanding of medical reimbursement models in the United States, I was still kind of shocked by what I found.
The laser to perform the procedure costs about $30,000 to purchase.
The Medicare allowable for a physician performing the procedure in a standalone surgery center is about $315. There's really no reason that the procedure needs to be performed in a surgery center, and Medicare does let the physician bill about $30 more if they bought a laser for their office, and performed the procedure there. But, at an increase of $30/procedure, you'd have to be doing a ton of SLTs to make buying your own laser financially attractive vs. just using the local surgery center's.
Where things get crazy, is in terms of facility fees.
If a physician performs an SLT procedure at an ambulatory surgery center, the physician's medicare allowable is about $315, and the surgery center can bill a separate facility fee of about $290, making the total procedure cost medicare just over $600.
If my wife's practice were bought by a hospital tomorrow, and they brought an SLT into her office, every time she performed an SLT in the exact same office that was now hospital owned, they'd be able to bill the $315 physician fee, plus a "hospital outpatient department" (HOPD) facility fee of $443, bringing the total cost of the procedure to over $750.
So, to recap the total costs to medicare:
Physician does the procedure in their privately owned medical practice: $345
Physician does the procedure in a surgery center: $600
Physician does the procedure in a hospital-owned medical practice: $750
You want to know why independent medical providers are getting bought up by hospitals and large health systems at an alarming rate? That's why. Because for doing the exact same thing, they get paid by medicare and private insurance companies (whose rates are largely based off of medicare reimbursement rates) 2x what a provider can on their own.
You hear a lot in the healthcare market about the efficiencies of scale, and how large integrated healthcare organizations are doing amazing things. You don't hear a lot about the potential for independent practitioners to reduce costs, but it's absolutely there, and largely ignored.
That said, medicare is (or at least was under the ACA) moving toward a "pay for performance" model, where instead of getting paid more for doing more angiograms, cardiologists will get paid more for keeping their patients from needing angiograms in the first place. There are still plenty of issues, but I think broadly that's the right direction for healthcare reimbursement to be going.
That can be a problem if you are trying to test a new antibiotic for a very rare drug resistant strain. You need 100 patients in your trial to hit statistical significance, but only 50 cases happen in the US each year.
So you run a smaller trial, get the best data you can and the FDA gives you conditional approval. You agree to a patient registry to collect post approval data where in time you get full FDA approval.
Fundamentally, you have not "done the research and weighed the risks" unless you went to medical school.
I think sensible people can choose to procure FDA approved treatments through conventional providers. It's a jump to assume that, just because alternative treatments are available, everybody will be lining up to purchase them.
Doctors absolutely know more about your body than you do. Obviously they don't know everything, and patients should be active and involved, but that doesn't mean you can cut out the doctor because you read a few papers. Letting drug companies sell anything to anybody would be immensely damaging to society.
Legalization of drugs, including opiates, has been successful (or at least not disastrous) in many societies. What makes you think it would be a disaster here?
Also, it's a straw man to argue that random people would be opening up doctor's offices. I'm not advocating that we remove the MD from anybody's name.
When I talk about unlicensed doctor's offices, I don't mean someone posing as an MD, I mean a well-meaning individual opening a cheap clinic and offering medical advice for non-emergency issues. Or maybe more likely, WebMD adding links to order drugs on their results pages. Why go to the doctor if you can just look up your symptoms in 5 minutes and have pills arrive at your door the next day?
But what part of the pain management patients actively abuse their meds. It's a real issue, but is it a commonplace issue where we absolutely have to devout resources to solving it?
Imagine the numbers if patients didn't need a prescription and didn't need to talk to a doctor about safe usage.
And why not allow the OTC treatments and clinics you describe? They may not (probably should not) be covered by medical insurance, but I see no reason not to allow someone to open up a medical advice clinic of their own volition. Is that even illegal today?
Yeah, medical licensing does nothing to prevent that.
I'm not arguing, just wondering what exactly is the problem that this act is trying to solve.
> If you want to use an unapproved drug, you can do so
This is not true in general. Where do you get it? A doctor won't prescribe it, you can't get it from a pharmacy without a prescription, you certainly can't just order it directly from the drug company. Sometimes it might be more easily available in another country, but that won't always be the case.
Sam Peltzman in "Regulation of Pharmaceutical Innovation" provides statistical evidence that the "safe and effective" 1962 Amendments reduced the development of new effective treatments as well as new ineffective ones, for a net decrease in positive results.
Let me start by saying that I think that whenever we have a problem in this country, one of the things we should do is look at how other countries handle it to see if there is anything useful we could learn.
That being the case, we need to know how other countries handle the over-treatment problem. Are there studies on this? Perhaps the authors could write a follow-up article.
My way of life dictates adequate exercise, healthy diet and normal sleep patterns.
I come from a family of strict vegans. No, I’m not here to promote either veganism or non-veganism. I’m in my early 40’s and have been exercising since I was a teenager. My routine includes running, cycling, strengthening exercises, lifting light weights, and I do one or two of these a couple times a week. IMO, any and all physical activity is a form of exercise. Usually, my day starts in the early hours. And, as I’m getting older, my endurance levels have been getting significantly better now than during my schooldays, 20’s, or 30’s and with regard to my work I’m getting more productive, too.
I also think that those who are not predisposed to any genetic conditions are in a league of their own. Even those who inherit a predisposition can benefit from delayed onset of a condition by practicing a healthy lifestyle. I’m not a medical professional, so my assumptions may or may not carry any weight.
All I’m trying to do is keep such treatments as are being discussed here at bay and I will keep at it as long as I possibly can :)
It's concerning that the vaccine was approved despite the problems with the study, but they also can't have people agreeing to die in order to increase the statistical power of their results.