Mortality patterns for patients hospitalized during cardiology meetings (2016)
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
"To start with there is a significant problem with the article. Cardiac surgeons don't go to cardiology meetings and don't perform the type of interventions mentioned in the article. Interventional cardiologists are not cardiac surgeons. The recurrent mislabeling of the specialty involved is yet another example of the slipshod treatment and lack of understanding of science and medicine in the lay press which makes for an ill-informed public."
https://marginalrevolution.com/marginalrevolution/2023/08/86...
"the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits."
Not sure if they accounted for delayed surgeries in the study.
That's sort of what I am wondering. Perhaps it just delays the inevitable - the patient is gravely ill is is going to die if they don't perform _potentially_ life-saving surgery. The surgery, is of course risky.
The conference delays the surgery, so the patient's surgery or other high risk procedures are delayed. This gives the patient a few more days of being ill, but doesn't probabilistically change the outcome of actually undergoing the procedure.
My understanding from listening to the author’s podcast, is that this is the proposed mechanism. There is a percentage of patients who were going to get better on their own anyway. But if they receive urgent care, it may cause harm.
The conclusion seems to be that there is a measurable percentage of patients who got surgery but didn’t need it and thus suffered greater harm than if they had been left alone. Because heart attacks are so critical, medical staff errs on the side of action instead of waiting. This seems reasonable, but may in fact be bad.
it’s a good podcast: https://freakonomics.com/podcast/what-happens-to-patients-wh...
1) The first date (and then-current surgery schedule) at the point when the conference dates where announced.
2) The date (and then-current surgery schedule) at the point, when the doctor booked his/her travel plans.
Both lists and dates will help you understand if changes in information also resulted in the changes of mortality (by rescheduling hard cases to a later date, for example).
Note: I said most, there are obvious exceptions.
This isn't to say outcomes are always good our knowledge is imperfect, people are imperfect, and not every situation has a good answer.
“Complete and utter nonsense” also ignores many inconvenient truths about medical care today and of course in the not-so-distant past. Medical history should temper the tone.
This says that most medicine is harmful full stop. This is conspiracy theory thinking. It is not far off from I've been thinking maybe the earth really is flat.
Most medicine is setting broken legs, dispensing antibiotics for infections, prescribing insulin for diabetes. In other words interventions that are straightforwardly positive. It is only when the situation is already dire and outcomes are already poor that intervention is sometimes negative and even then we are often discussing whether an intervention at 72 resulted in the person dying then instead of 74 wherein the person would have died thrice over between 60 and 72 and been crippled between.
Yes I too read about both the era where we thought bad smells caused disease and disdained hand washing AND modern end of life care which is oft pointless this doesn't mean medicine is mostly harmful. Words have meanings and the posters are nonsense as you know.
I suspect given that the rarity of many serious ailments until much later in life simply no intervention would suffice in any reasonable epidemiological sense.
2. Your hypothesis presupposes that serious medical care is commonly necessary enough to significantly improve public health.
I know of young people that have been harmed by medical science, and not many come to mind whom I would consider having been in absolute need of medical intervention.
Given that medicine often harms patients demonstrably, with mistakes and opiates contributing majorly to human fatalities, it occurs to me that I can more commonly produce anecdotes where medication or medicine harmed rather than helped where it would have been absolutely necessary.
Of course more things go wrong as people get older but accident or illness can happen at any age and without intervention in the overwhelming majority of cases in which we intervene the outlook isn't great and many people have 40 or more years left when they need help.
Just as a singular for instance people become diabetic. No intervention means they die soon.
People break their bones. No intervention means people experience weeks to months of screaming agony and are far more likely to experience ongoing pain and permanent decrease.
People get pre-cancerous growths or trivially treatable early cancers. No intervention means they die decades early.
People get a bad chest infection and their lungs start to fill up with fluid. Non-intervention means someone who could have lived to 80 dies at 40.
People break their hip in their 50s with decades of life back. What is the chance of walking by just lying abed and drinking tea. It's negligible because certain kinds of breaks don't actually get fixed without surgery.
Here is some data on hospital admissions and emergency department visits per 1000 by age. You will note that even among the relatively young visits are not particularly uncommon. Young people are less likely to have something go wrong with their body but more likely to have something go wrong with their judgement and have an accident.
These people aren't all morons marching in lockstep to get snake oil they are going to the emergency room because they did something stupid and broke their legs or 1000 different other legitimate interventions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133481/
Here is the mayo clinic talking about what they do with a broken leg.
https://www.mayoclinic.org/diseases-conditions/broken-leg/di...
The truly strange thing is that the word epidemiological is in your vocabulary and not only do you know absolutely nothing about the world around you but you are aggressive in your ignorance. Defending the complete fantasy you have erected with vigor if not ability.
It's like talking with a true believer about the "theory" of evolution
https://www.hopkinsmedicine.org/news/media/releases/study_su...
He said his doctor (an internist) was attending a medical conference for allergists, in the Bahamas. About 500 doctors attended.
This doctor was fearfully allergic to peanuts. Like, anaphylactic allergic.
He had an anaphylactic reaction to something he ate, during the main speaker banquet.
He died.
Surrounded by 500 allergists.
It's a bit like expecting a hacker to hack a network without their laptop.
(bit weird if HE didn't have his epipen on him though ...)
Maybe they should.
> It's a bit like expecting a hacker to hack a network without their laptop.
A real hacker can break into a network with some bubblegum, a pen, and a corgi.
I saw someone feel unwell at a party, nothing serious, just a drink too much, but half of the room happened to work in healthcare, and half of the room came to help. As expected it went all over the place, until a relative (also a doctor) came in, ousted the crowd and took proper care of the poor guy.
Modern medicine is a miracle but struggles to evolve beyond many immediate hurdles. In an extreme minority of cases it can be better to avoid traditional intake methods.
Does this mean percutaneous coronary intervention [PCI] is over-applied, or something else?
There's other possibilities though. Like if the timing of other interventions is being delayed until the cardiologist is able to see the patient instead of deferring to a less specialized physician.
Interestingly, there were no differences in the number of procedures performed on meeting and nonmeeting days (it's not the surgeries that are killing people).
The hypothesis that I find most interesting is that the cardiologists who are at the meetings spend less time caring for patients and more time doing research, hence they aren't as good at caring for patients.
A couple of years ago some friends of ours invited us to lunch with a couple of their relatives who were in town for a cardiology conference. They (the relatives) were both stout* people, technicians of some kind rather than doctors, and the husband was super hung over from the previous night.
Anyway, they told us all about how the sessions at these things were pretty dry, but the after party was always a drunken, hours long slurry of alcohol and aorta-clogging food, and it was so ludicrously un-heart-healthy that it was a running gag.
So I'm wondering if the people who opt to go to those things tend to perform differently in their work than the ones who stay home and live quieter lives?
(*I only mention this because a few days after we had lunch, the husband apparently had a heart attack while he was driving, pulled off to the side, and died.)
source: https://freakonomics.com/podcast/what-happens-to-patients-wh...
> In teaching hospitals, mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting dates (P < .001) No mortality differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals [or high-risk patients with AMI in teaching hospitals]
So in the specific case of teaching hospitals with high-risk patients with heart failure or cardiac arrest, the normal treatment is making things worse.
Outside of that special case, the cardiology meetings don't seem to have any effect (positive or negative). This could mean that the normal treatment is useless. Or it could mean that the hospital is doing a good job of planning around the cardiology meeting -- e.g. delaying non-urgent treatment until the next day, while ensuring there are still enough doctors on staff for the urgent cases.
A rare case of meetings proving beneficial? But why?
I'm always struck by how young the attendees are. They look like kids. It may be that meetings are more of an attraction for people trying to build their careers, make connections, and have a free vacation, whereas the senior doctors are happy to stay at home and man the fort, plus they have the usual obligations of older workers, such as families.
This is also the case at my techie day job: Most of the interest in attending meetings is among the junior engineers.
To even suggest a causal link we would need soooo much data that nobody has right now
What happens when you have an acute cardiac issue surrounded by hundreds of cardiologists?