Medical practices without proven efficacy

 
Medical practices without proven efficacy
When medicine gets sick
Unnecessary "check-ups", avoidable studies, over-medication ... excesses are not only expensive but can be harmful to health.

By Sonia Santoro: History says that the first president of the United States, George Washington, died because he had seven bleedings to cure him of pneumonia, one of the practices that the medicine of the time endorsed. Today no one would think of bleeding, however medicine can cause illness, disability and even death. An investigation concluded that there are almost 400 medical practices whose use is not supported by sufficient scientific evidence. Non-governmental organizations warn of unnecessary "checks", avoidable studies, over-medication and the role of the pharmaceutical industry. Interventions in cardiovascular diseases are among the most questioned categories. "The same patients ask for many studies, nobody wants to die and we want to buy health," says a specialist.

An investigation published in June by the eLife magazine that analyzed more than 3,000 trials published in three medical journals (JAMA, The Lancet and The New England Journal of Medicine) and revealed almost 400 medical reversals or reversals.

The medical reversals, explained by the Argentine Cardiology Foundation, refer to those medical practices, diagnostic tests, medication or procedures of little value, which has been found - through randomized controlled studies - that are no better than an older or lesser practice cost and therefore should be discontinued. Medical practices of "little value" are those that are either ineffective or more expensive than other options, but only offer similar efficacy. Therefore, identifying and eliminating “low value” medical practices reduces costs and improves health care.

According to "meta-research", most studies (92%) were conducted in populations of high-income countries; that cardiovascular disease was the most commonly represented medical category among medical reversals (20%), followed by public health / preventive medicine (12%) and critical care (11%); and that medication was the most common type of intervention (33%).

Why do doctors adopt these practices? Most of these interventions were recommended by medical societies or international organizations. “The problem arises from the process of building recommendations, where information is sometimes inadequately valued and wrong conclusions are reached. On other occasions, there is interest and anxiety to adopt practices that seem innovative and offer great benefits, but then the reality proves otherwise or patients demand to have studies that are not really necessary in order to 'check' their health status, without take into consideration that the excess of studies can harm them ”, explained Dr. Carlos González Malla, clinical physician (MN 114.005) and member of the Argentine Cardiological Foundation (FCA).



Many times before identical evidence, it may be that a doctor decides one thing and another doctor another. There is great flaw in the essential competence of doctors that requires knowing how to interpret the evidence.

The other big problem is economic interests. “Sometimes what is done in the guidelines of recommendations made by scientific societies is done. It should be the best. But there is a big problem with the guides and they are made by a hyperspecialist in a subject that has generally worked for laboratories. There are major conflicts of interest of those who make guides and recommendations. That is why the important thing is that there is a state that regulates. In other countries an agency or a state institute makes recommendations and there is no link with laboratories, ”said Malla.

Against this, some medical associations and non-governmental organizations have a lot of interest in doing “quaternary prevention”, that is, preventing the negative consequences of excess medicine.

In Argentina the non-governmental organization Inter-Specialties Initiative (http://interespecialidades.org) warns of these excesses. On its website it publishes recommendations of the different medical associations to avoid these problems. One of them is, for example, "not to perform a general check-up or periodic health examination in asymptomatic patients", a guideline indicated by the Argentine Society of General Internal Medicine (Samig). As you can see, some popular notions such as “you have to have a general check-up once a year” are not only not true but they can be dangerous.

 “There are issues that are adopted by custom and people believe that it is fine. There is a lot of trade. There are places where people pass by as a sausage machine and do all the studies. The important thing is that your doctor tells you ‘I came in 10 years’ or ‘I came in two’. Sometimes I say it to a young boy and he looks at me like saying "you are crazy" - clarified Malla. That is, if you are 20 years old, you are healthy and you have no symptoms, it makes no sense to have your checkup done. If you are 70 years old it is good that you have a check-up once a year because you can detect diabetes. ”

Nogracias.eu is an international civil organization (Spain, Argentina, Uruguay) that works for transparency, integrity and equity in health policies, health care and biomedical research. In its manifesto it points against the pharmaceutical industry. “The‘ aggressive marketing ’of the pharmaceutical companies is identified as the first responsible. An unacceptable reality when the third world population has difficult access to essential medicines. The investment of the Marketing Industry is huge (31% of the total) compared to the 14% dedicated to research ... The industry pays more than 90% of continuing education: set the agenda, pay the speakers ... and this It is, without a doubt, marketing. ”In addition, the manifesto continues,“ a good part of marketing is 'overvalued' information on new medicines that are more expensive because they are protected by patents (without generic versions) although 80% of these medicines do not contribute nothing new, they are called me too, by similarity with those already existing ”.

–What studies do you recommend not to do? - Page / 12 asked Mesh.

- The study itself is not the problem, in general they are useful studies, the problem is to whom you indicate it. One person can save his life and in another it can complicate his life. For example, a patient wants to make a chest plaque to prevent lung cancer and it is already proven that it does not work. The same patients ask for many studies, nobody wants to die and we want to buy health. The hardest part is disarming the studies that patients want to do. Most diseases cannot be prevented.

- How not?

–Cancer, for example: the only one that can be prevented is that of the cervix, the colon up there, the breast and the prostate more or less.

- Is mammography not useful?

- Yes, it works, but you have to know that there can be false positives. The problem with mammography is that it gives false positives and false negatives. There are many women who are going to have a puncture and probably nothing comes out. You are more likely to generate a problem by being a false positive. Another example of studies that can give false positives is thyroid ultrasound. Imagine the negative consequences on someone who operates thinking that he has a cancer and in the end it was a benign nodule. Another example, in cholesterol, which is the cuckoo of the world. Actually, sometimes lowering cholesterol lowers the risk of heart attack or stroke by 1 percent and for that the patient has to take a pill every day for ten years. That is why each study depends on the person. The important thing is to identify the benefit and the risk and that the decision is taken jointly by the patient and the doctor.

- But the professionals do not usually give as much information to the patient nor let him decide ...

- There is an idea of ​​empowering the patient, we have to go to that, although we still have to work in social and medical maturity.