Monday, November 30, 2015

Hsieh Forbes Column: Why You Want Your Doctor To Be Wrong (Sometimes)

My latest Forbes piece is now out, "Why You Want Your Doctor To Be Wrong (Sometimes)".

Here is the opening:
“Mommy, my tummy really hurts!”

Your 7-year old daughter wakes you up in the middle of the night, doubled over in pain. You take her to the local ER. The on-call surgeon, Dr. Smith, performs a thorough physical exam, reviews the test results, informs you that she has appendicitis, and says she needs surgery right away. You sign the consent forms, and he whisks her off to the OR. An hour later, Dr. Smith comes back and says, “I’m sorry. We removed her appendix, but it turned out to be normal. She didn’t have appendicitis, just a severe case of gastroenteritis or ‘stomach flu’.”

Should you be relieved or angry? Did Dr. Smith make a mistake? Did he perform an unnecessary operation?...
I discuss Type 1 vs. Type 2 errors, why they are important, and why certain kinds of diagnostic errors are not merely unavoidable but (in the right context) desirable.

For more details, read the full text of "Why You Want Your Doctor To Be Wrong (Sometimes)".

And my personal favorite example of Type 1 vs. Type 2 errors is below:

Thursday, November 19, 2015

When Unethical Medical Experiments Bear Fruit

I'm not a utilitarian, and the medical experiments described below were truly appalling.

But there is some informative medical history in this piece: "These medical experiments were horrible, unethical — and useful".

People can debate some of the fine points of the current system of IRB (Institutional Review Board) approval and informed consent for medical experiments.  But the current system is far better than what has occurred in the past.

Tuesday, November 17, 2015

Short Story: SMOD 2016

I'm exercising blogger's privilege to post something totally unrelated to health care policy.

Here's my latest short story, "SMOD 2016" (400 words).   FYI, it's a little dark, in the spirit of Frederic Brown.

Here is the opening:
SMOD 2016
A short story by Paul Hsieh

"So, basically you're saying that humanity should be extinct by now." MIT astrophysics professor Linda Tsang furrowed her brow.

"Yes, many times over," replied statistics professor Max Wendt. "Based on the new telescope data you provided me about the asteroid belt, the Earth should have been struck by a 'Dinosaur Killer' rock at least 5 or 6 times in the past 10,000 years."

"So, why haven't we?" asked Tsang.

"Well, there are a few possibilities," said Wendt...

Read the rest at: "SMOD 2016".

["Asteroid Belt", image courtesy Wikipedia.]

Monday, November 16, 2015

The Inadequacy of 15-Minute Medicine

In the Washington Post, Dr. Michael Stein writes: "When medical care is delivered in 15-minute doses, there's not much time for caring".

Dr. Stein's bottom line:
My job, in its barest 15-minute form, is to separate the serious possibilities from the less serious, offer a diagnosis and an explanation, recommend any additional testing and list the possible courses of action. But a hurried, task-oriented approach doesn’t accommodate the meandering, overlapping, widening issues of patients. It undermines kindness. And it prevents doctors from being what our patients hope we will be when they walk in: unrushed explorers on the lookout for the next discovery.
Fortunately, patients and doctors can avoid these problems through a "direct pay" or "concierge" model, as discussed in my earlier Forbes piece, "Is Concierge Medicine The Correct Choice For You?".  Doctors can take the time to give the patients' issues the attention they need.

One excerpt:
In response to this frustrating situation, more doctors are seeking an alternative practice model. They are establishing “concierge” or “direct pay” practices, where patients pay a monthly or annual fee for enhanced services, including same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times. Instead of the usual rushed 10-15 minute appointments, these doctors typically offer 45-60 minute visits allowing them to really delve into their patients’ problems and craft individualized treatment and prevention plans.

The Indianapolis Business Journal described how concierge medicine helped patient Dale Sventeck. Sventeck suffered from a “frozen shoulder” which severely limited his range of motion. Most doctors he saw simply wanted to schedule him for an MRI study and surgery. But concierge physician Kevin Logan was able to take the time to diagnose that Sventeck’s problem was caused by the mercury in his dental fillings. Dr. Logan advised Sventeck to remove the fillings. One month later, his shoulder was back to normal.
(Washington Post link via Dr. Matthew Bowdish.)

Thursday, November 5, 2015

Sissel Lawsuit Update

Matt Sissel has an OpEd in the 11/3/2015 Washington Times on his anti-Obamacare lawsuit: "Taking a stand against Obamacare".

Sissel is being represented by Timothy Sandefur of the Pacific Legal Foundation (PLF).   For more details, see the PLF page on the case.

I wish them both success in their fight for individual rights!

Monday, November 2, 2015

NEJM On Peer Review Fraud

New England Journal of Medicine: "Peer-Review Fraud -- Hacking the Scientific Publication Process".

Fraudulent reviews on Amazon or Yelp are bad enough. Fraudulent peer review in science and medicine could be very, very dangerous to patients.

Wednesday, October 28, 2015

Washington Post Vs. Paternalistic Breast Cancer Guidelines

Washington Post editor Marisa Bellack speaks out against paternalistic mammography guidelines in her editorial, "Don't worry your pretty little head about breast cancer".

She notes that "anxiety" is being increasingly invoked as a (bad) reason to limit screening mammography, especially for women between ages 40-49:
And yet, there was a 19th-century echo in the American Cancer Society’s announcement this past week of revised guidelines for breast cancer screening. Whereas anxiety was once a reason for aggressive medical intervention, it is now invoked to avoid intervention — an argument that is both patronizing and unscientific. There may be good reasons for women in their early 40s to forgo regular mammograms, but this isn’t one of them.

A reference to anxiety appears in the very first paragraph of the harms-and-benefits analysis commissioned by the cancer society: While early screening “reduces breast cancer mortality, there are a number of potential harms, including false-positive results, which result in both unnecessary biopsies and increased distress and anxiety related to a possible diagnosis of cancer.”

But the idea that anxiety is a major harm doesn’t have much scientific support...

There will always be uncertainty in cancer screening. And that uncertainty understandably fuels anxiety. But most false-positive mammograms are quickly resolved by additional imaging. Among the cases that progress to biopsies, 9 out of 10 show no sign of cancer. And even when there is a breast cancer diagnosis, that’s not equivalent to a death sentence. Doctors should be able to respond to anxiety rationally, putting fears in context and expediting follow-up testing and results to limit what can be an agonizing wait.
For more details, read the full text of "Don't worry your pretty little head about breast cancer".

See also this related Washington Post piece, "Why this Harvard radiologist still recommends women get mammograms at age 40".

(Link via Dr. Evan Madianos.)