Why do doctors use treatments that do not work? Doust & Del Mar, 2005

[ME/CFS Science Blog]

Thought this was an interesting editorial. It's from 2004 but is still relevant.

The history of medicine is replete with examples of treatments once common practice but now known not to work—or worse, cause harm. Only because the French surgeon Paré ran out of boiling oil did he discover that not cauterising gun shot wounds with it created much less pain and suffering.w2 Leeches and blood letting were used for thousands of years for almost everything. Attempts to show that they were ineffective were resisted with great passion by the medical profession.w3 More recently, we have had treatment with insulin for schizophrenia and vitamin K for myocardial infarction.1 2 In case we are all feeling too smug about silliness in the bad old days, we have the recent crisis on finding that hormone replacement therapy does not prevent cardiovascular disease.3 Why do we still use ineffective treatments?

Source: http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC351829&blobtype=pdf

 

[alktipping]

Thought this was an interesting editorial. It's from 2004 but is still relevant.


Source: http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC351829&blobtype=pdf

the same answer as always profit people have forgotten that medicine was built on fraud charlatans selling hope and not much else being payed regardless of patient outcomes allows the medical profession to ignore its mistakes .

 

[James Morris-Lent]

The authors' answer:

Reasons for using ineffective or harmful treatments
•Clinical experience
•Over-reliance on a surrogate outcome
•Natural history of the illness
•Love of the pathophysiological model (that is wrong)
•Ritual and mystique
•A need to do something
•No one asks the question
•Patients’ expectations (real or assumed)

I would agree with @alktipping that the the authors have neglected to include pure greed. The opioid crisis is a fine example.

More banal is the special interests forming around job security incentives. Of course we see this with heavy promotion and deployment of psychotherapies with unreliable evidence bases.

Lastly none of their categories adequately encompass the personal political and economic risks of questioning dogma backed by authority, eminence, and/or pure political influence.

i don't disagree with their bullet points but I must say they are insufficiently cynical.

 

[shak8]

Beware the surgeon who gets an MBA in his spare time.

I wouldn't say most, but some to many docs go into medicine to make money. And if they feel they don't make enough (I'm talking USA docs) well, buyer beware.

 

[Hutan]

•No one asks the question

Lastly none of their categories adequately encompass the personal political and economic risks of questioning dogma backed by authority, eminence, and/or pure political influence.

Yes.
An individual doctor takes enormous risks to 'ask the question', that is to question the established practice. Also, someone may actually ask the question, but, if they don't have a medical degree, and especially if they are a patient, they may be ignored.

I think we have to ensure institutions are asking the questions with competence and rigour - institutions like Cochrane, and the offices of the public health services that compare health outcomes by regions and review treatment efficacy research. The WHO should also be doing this at the global level. We, or at least patient advocacy organisations, can hold these institutions to account.

•Patients’ expectations (real or assumed)

This is something we can work on too. Patient advocacy organisations need to be well-informed and ask the questions. They need to provide good information (including statements about the absence of treatments where necessary) so that patients don't accept their doctor recommending, for example, gargling as a treatment for ME/CFS.

 

[Arnie Pye]

Why do doctors use treatments that do not work?

I have many examples, but I'll stick to just one.

Doctors use unjustified assumptions about the cause(s) of a problem, particularly if that problem is common, so of course any treatment they offer (if any) may turn out to be wrong. One example which affected me for nearly thirty years was a diagnosis I got repeatedly - that I had IBS. I did get given some quite unpleasant tests in order to "prove" that there was nothing wrong with me (and none of these tests are likely to be offered to anyone today because IBS is considered to be strictly a mental health issue).

The bowel is a tube, with an inside and an outside. All the testing assumed that if any real problem existed it must be as a result of something going wrong inside the tube. It turned out that the problem I had was caused by something going on outside the tube. The surgeon who reduced my problem by about 95% didn't even realise that he had achieved that because he was looking for something else which he didn't find, so my post-op follow-up was "interesting".