High-Tech Medicine, Crappy Products, and Evidence

Yesterday I blogged about companies (and witch doctors!) selling things without sufficient reason to believe they actually work. Among other things, I said “There are good reasons why drug companies are forced to do randomized, double-blind, clinical trials.”

Some of you may have inferred from that blog entry that I love Big Pharma and Big Medicine (because, after all, they use science) and hate purveyors of “natural” medicines with their reliance on “traditional” and “folk” knowledge.

Not true.

Here’s a story from yesterday’s NYT, slamming crappy practices in high-tech medicine: Regardless of Quality, Medical Scans Cost the Same

When Gail Kislevitz had an M.R.I. scan of her knee, it came back blurry, “uninterpretable,” her orthopedist told her.

Her insurer refused to pay for another scan, but the doctor said he was sure she had torn cartilage that stabilizes the knee and suggested an operation to fix it. After the surgery, Ms. Kislevitz, 57, of Ridgewood, N.J., received a surprise: the cartilage had not been torn after all.

She had a long rehabilitation. And her insurer paid for the operation. But her knee is no better.

The focus of the story is on the use of outdated machines, and on the conflict of interest inherent in physicians ordering expensive (i.e., profitable) tests conducted on machines they themselves own. The neglected angle is the poor state of knowledge about the kinds of ailments such scans are often used for. Note that Ms. Kislevitz’s doctor was “sure” she had torn cartilege, which she didn’t. Sometimes fancy scans just add an illusion of certainty in situations like that.

Now, as to the distinction between high-tech medicine and “traditional” medicine: at least people (and companies) in high-tech medicine don’t (i.e., can’t) deny that having evidence would be good.

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