Monday, September 19, 2011

Not so fast: Why doctors still know best

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My 17-year-old son wants to backpack across Europe with a couple of friends this summer. My wife and I have been blessed to watch Jack mature into a wonderful young man, with a growing sense of maturity and knowledge about how to get along in the world.

But, we said no. We know our son and know there are challenges and dangers to touring through a foreign land that he can’t appreciate yet. We really want him to have this kind of experience some time, but believe this trip is not in his best interest. Like any reasonable person about to turn 18 who doesn’t get what he wants, he told us he just might do it anyway. As a parent, that thought is a little scary.

Maybe doctors feel the same about their patients ignoring their decisions about what would be best for their health.

There was a recent article in New York Times about the growing interest in a treatment called P.R.P. (plasma rich platelets) to treat injured tendons and muscles. It has become the treatment du jour for professional athletes like Tiger Woods and Hines Ward. The claim is that it gets people healthy and back in the action quicker. Weekend warriors want it and are willing to pay $1,000 per shot. There is a growing commercial effort to exploit this attraction – vendors offering P.R.P. kits to doctors’ offices and articles on P.R.P. (with limited research) appearing in medical journals.

Only one problem. “It is unproven,” says Dr. Steve McCollum, an orthopaedic surgeon with Peachtree Orthopaedic Clinic. Not necessarily bad, says Dr. McCollum, but like so many other treatments that make sense and sound like they should work (i.e., soy to reduce menopause symptoms) there just isn’t a proven clinical benefit yet.

P.R.P. involves injecting the patient’s own plasma enriched blood into the site of the injury. While some people tend to get better after P.R.P., the same outcome might be possible by injecting saline or even just poking the injured site with a needle, says Dr. McCollum.

The New York Times article describes one doctor who doesn’t perform P.R.P. because it is not proven and his patients simply tell him they will go to another doctor who will.

And here is where the growing age of healthcare consumerism runs into problems. On-line information sources dramatically expand our knowledge of emerging treatments. An entire medical products industry, which is appropriately driven by making a profit, wants to further embolden consumers to push for what they want. In the middle stands the physician.

A recent blog in the New York Times describes the concern of some geriatricians if the cholesterol-lowering drug Lipitor is allowed to be sold over-the-counter, as the federal Food and Drug Administration is considering. Lipitor’s patent expires soon and the best way for Pfizer to maintain profitability is to make it available over-the-counter. However, people who use Lipitor, typically older adults, simply don’t know enough yet to be able to use it without physician supervision. Safe and effective use requires actively monitoring patients’ blood cholesterol levels. Otherwise mild-mannered doctors are begging the FDA to say no.

While there may be some exceptions, I believe that appropriate caution in a physician is a good thing, although probably underappreciated by patients.

“I am a second-wave kind of guy,” says Dr. McCollum. He spends his Sundays reading medical journals to stay current with what works. He says that he doesn’t jump on the bandwagon with new treatments, but “as soon as it is safe and effective, I’ll be on it.”

I wonder if Jack will finally thank us when we tell him that we are second-wave kind of parents.

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One Comment

  1. Leigh Hamby
    Posted September 21, 2011 at 4:10 pm | Permalink

    There are several “unproven” technologies, screening tests, etc that are more “mainstream”. For example PSA for prostate cancer screening. I recommend Gil Welch’s new book “Overdiagnosed” for anyone who wants to review “current practice” with a critical, evidence-based eye.

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“Hi, I’m Ed Lovern, the executive vice president and chief administrative officer for Piedmont Healthcare in Atlanta. I created this blog to share my thoughts on the healthcare revolution and how we can all be part of the solution. Feel free to comment or email me your thoughts – I would love to have your contributions and feedback.”
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