From: unk...@googlegroups.com   
      
   Magazine    
   Healthy Discourse    
   June 18, 2006    
            
   When my May 29 Cover Story "Medical Guesswork" went to press, I had some   
   trepidations. The story asserts that there's little evidence to support much   
   of what is now common practice in medicine. It questions the value of   
   high-risk procedures such as    
   coronary bypass surgery for many people. As the story's central figure, Dr.   
   David Eddy, bluntly observes: "The problem is that we don't know what we are   
   doing." When Eddy began to push what he called "evidence-based" medicine in   
   the 1980s, the response    
   was mostly hostile. I was bracing for the same.    
      
   Sure enough, there are plenty of critics among the 100-plus letter writers and   
   online commentators who have responded so far. "As a 12-year survivor of Stage   
   IV colorectal cancer, I can attest to the fact that my [doctors] knew what   
   they were doing,"    
   writes Dan Verdirame of Far Hills, N.J. "Your article does them a disservice   
   and provides incentive for those looking to avoid uncomfortable, but   
   necessary, medical treatment."    
      
   One common charge is that the whole "evidence-based" idea was cooked up by   
   insurance companies. "It sounds like a ploy to lower patient access to the   
   latest technologies," complains one online writer. More substantively, readers   
   said that while evidence    
   is lacking that treatments work, firm proof that the treatments are   
   unnecessary is also lacking. Good point.    
      
   Other readers said I'd missed major issues. The threat of lawsuits forces   
   doctors to treat patients aggressively, even when physicians know the   
   treatment is dubious, several wrote. Others wished I had mentioned the   
   importance of diet and lifestyle in    
   keeping people healthy -- and the need for a health-care system that's primed   
   to prevent diseases.    
      
   On the other hand, a great many readers applauded BusinessWeek's willingness   
   to "print the truth about our current health-care system," as one online   
   poster put it. The story won praise from doctors, economists, and patients.   
   And readers provided us with    
   some poignant glimpses of what happens when health care falls short of its   
   promises. "Medical science is nowhere near as exact or insightful as many   
   people have been led to believe," laments one online poster who lost his wife   
   to breast cancer. "There    
   are no magic bullets in medicine, and I am glad to see the story start to   
   bring that idea to light. Perhaps now it will get people to think more   
   realistically about treatments that cost a small fortune, have little or no   
   curative effect, leave families    
   drowning in debt, and have survivors wondering whether it was all worth it."    
      
   The responses show that this subject is far too large to encompass in one   
   magazine story. Here is a sample of what readers said:"    
      
   Having been diagnosed with colon cancer less than three months ago, I have   
   experienced the predicament posed by Dr. David Eddy, i.e., receiving   
   contradictory opinions from physicians. Choosing the right doctor becomes an   
   exercise in guessing and hoping    
   for the best. Fortunately, the oncologist I am working with seems flexible and   
   open to discussing options based on evidence. The glimmer of hope is that   
   medicine is facing several forces that will provoke a change. Dr. Eddy is   
   right on track, and many    
   others will follow in his footsteps. - Carlos A. Valenzuela, Bethlehem, Pa.    
      
   In mental illnesses it is very easy to show that medications can lessen   
   psychosis or block depression and anxiety. But they create a multitude of   
   metabolic problems and cognitive compromises. Just think about virtually every   
   treatment guideline and    
   algorithm issued by cost-conscious insurance companies, prestigious   
   universities, and learned societies like the American Psychiatric Assn. In the   
   name of evidence-based medicine, these academicians have flooded the field of   
   psychiatry with shallow    
   diagnostic manuals, irrelevant brain studies, and treatment guidelines.   
   Instead of painstakingly going into the meaning of patients' symptoms, dreams,   
   and intrapsychic conflicts, they teach how to ask a few rote questions,   
   prescribe the algorithm-based    
   medications, and get to the next patient within 15 minutes. - Surendra   
   Kelwala, M.D., Livonia, Mich.    
      
   "First, do no harm" has been totally replaced by "just do any old thing and   
   bill to the max." - Ron Tripp, Johnson City, N.Y.    
      
   Reevaluation of gold-standard treatments is a good start on the path to more   
   effective and efficient health care. However, your Cover Story overlooked the   
   key reason why we have costly, inefficient health care today: The system is   
   designed for crisis    
   management rather than for fostering optimal health. A top-to-bottom   
   restructuring with changes in incentives is needed for every party, including   
   insurers, health-care providers, employers, and patients. All other changes   
   are like putting duct tape on a    
   leaking pipe. - Candice M. Hughes, Hughes BioPharma Advisers, Darien, Conn.    
      
   Your story was right on the money. Until the "Art of Medicine" becomes the   
   "Science of Medicine," we are doomed to suffer the consequences. - Subash   
   Khadpe, Slatington, Pa.    
      
   John Carey's article blames the failures of medicine on financial   
   self-interest three times. Adam Smith demonstrated that financial   
   self-interest generates a creative-productive economic system. Drop the trite   
   16th century ideology of blaming self-   
   interest, or you will rapidly watch your subscription base move to magazines   
   that aren't stuck with outmoded ideology. - Michael Phillips, San Francisco    
      
   Regarding the suggestion that income clouds judgment, reimbursement is so poor   
   for procedures that I am incentivized to be in the office rather than the   
   operating room. - Daniel A. Spilman, M.D., Santa Cruz, Calif.    
      
      
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