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> An interesting development is that there is generally an increased acceptance for psychiatric diagnoses. Psychiatry is the only medical specialty that has a

> An interesting development is that there is generally an increased acceptance for psychiatric diagnoses. Psychiatry is the only medical specialty that has a resistance movement and survivors groups. I think psychiatrists do okay with diagnosis, but commonly-used treatments frequently make the patients' condition worse. Ref: Whitaker's Anatomy of an Epidemic > More are accepting that just as the pancreas may stop delivering insulin, the brain may fail to uphold the proper seretonin levels. The MAOIs were reasonably effective as anti-depressants, but fell out of favor as newer & less-effective patent medicines were approved. The SSRIs are slightly better than a placebo, for some patients. I think the Paxil hawkers recently lost a lawsuit over a lawyer who rapidly became suicidal after starting that drug. He threw himself in front of a train: https://www.madinamerica.com/2017/05/change-in-chicago-playing-go/ https://www.madinamerica.com/2017/05/change-in-chicago-playi...

gforge 9y ago
I agree, there are serious issues with many of the drug treatments and psychiatry has some dark history - but so does orthopaedics (e.g. the pseudotumors associated with hip resurfacing). Even if anti-depressants are no more effective than placebo, I still think a knife may be an even worse alternative and I've seen patients spiraling down into an abyss of pain after repeated failed surgeries. My hope is that if we are able to correctly identify the cause we can start getting somewhere with the treatment. This said, there are indications that there is a subset of cases where the pain actually is triggered by the spine. The SweSpine register has some interesting numbers that show the results after surgery over time (http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf page 37, DDD). There is also the very fascinating study by Arlbert et al (https://www.ncbi.nlm.nih.gov/pubmed/23404353 https://www.ncbi.nlm.nih.gov/pubmed/23404353) that show that antibiotics may help. As always LBP is most likely a mix of diagnoses where we need to identify the correct subgroups before we even start to test treatments.
- tcj_phx 9y ago
  Thanks for responding, and for the links. > I've seen patients spiraling down into an abyss of pain after repeated failed surgeries. I think surgery is commonly seen as better than doing nothing. Someone I know has some deterioration from cortisone medications. He just heard that his neck implant didn't fail, now the next joint down is gone. He'd rather not have surgery again, but is rather miserable currently, and some doctors make their money by doing surgery... Do you have any comments on Inertia in Medicine? Doctors try to stay up to date, but... well, cardiologists seem to resist acknowledging that statins don't actually help many patients, and psychiatrists are very resistant to admitting that antipsychotics prevent their patients from recovering from their psychotic episodes... What does medicine do well, and how can use of practices and procedures with limited benefit be curtailed?
  - gforge 9y ago
    There is an inertia but I would say that it is often of benefit to the patients. The problem is that I as a surgeon love to operate (note that we don't even have a monetary incentive) and I truly want to help my patients. This makes me biased and the inertia has saved me quite a few times for starting performing new cool procedures. The biggest problem is that we often have a big problem with discontinuing treatment s, see my post on clavicle fractures http://gforge.se/2017/08/clavicle-gate/ http://gforge.se/2017/08/clavicle-gate/ I am not a cardiologist so I don't know the full details on the statins, but I would be careful not to skip them. Cardiovascular mortality has decreased hugely the last decades and this one of the major treatments - they must be doing something right. Also be careful of flat-earth arguments, there are plenty of people who want to disprove medicine - some of us are researchers but others are just writing blog posts after finding a single article contradicting a treatment. It is incredibly hard to do medical research, it takes years to recruit patients and collect data. You always think that there is a ton of patients with this condition and then you find that the inclusion and exclusion criteria that you believed to be so brilliant (others had forgotten about them in their studies) actually get in your way of being able to finish the study. If this wasn't enough, once you are done with disproving the treatment, you will find that the person that a few years ago popularized it is no longer doing it... They would never do that, now they're doing treatment B, a completely different thing. It's a game of whack-a-mole.
deleted 9y ago
[deleted]

gforge 9y ago

I agree, there are serious issues with many of the drug treatments and psychiatry has some dark history - but so does orthopaedics (e.g. the pseudotumors associated with hip resurfacing). Even if anti-depressants are no more effective than placebo, I still think a knife may be an even worse alternative and I've seen patients spiraling down into an abyss of pain after repeated failed surgeries. My hope is that if we are able to correctly identify the cause we can start getting somewhere with the treatment. This said, there are indications that there is a subset of cases where the pain actually is triggered by the spine. The SweSpine register has some interesting numbers that show the results after surgery over time (http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf http://4s.nu/pdf/Report_2014_Swespine_Engl_ver_141204.pdf page 37, DDD). There is also the very fascinating study by Arlbert et al (https://www.ncbi.nlm.nih.gov/pubmed/23404353 https://www.ncbi.nlm.nih.gov/pubmed/23404353) that show that antibiotics may help. As always LBP is most likely a mix of diagnoses where we need to identify the correct subgroups before we even start to test treatments.

tcj_phx 9y ago
Thanks for responding, and for the links. > I've seen patients spiraling down into an abyss of pain after repeated failed surgeries. I think surgery is commonly seen as better than doing nothing. Someone I know has some deterioration from cortisone medications. He just heard that his neck implant didn't fail, now the next joint down is gone. He'd rather not have surgery again, but is rather miserable currently, and some doctors make their money by doing surgery... Do you have any comments on Inertia in Medicine? Doctors try to stay up to date, but... well, cardiologists seem to resist acknowledging that statins don't actually help many patients, and psychiatrists are very resistant to admitting that antipsychotics prevent their patients from recovering from their psychotic episodes... What does medicine do well, and how can use of practices and procedures with limited benefit be curtailed?
- gforge 9y ago
  There is an inertia but I would say that it is often of benefit to the patients. The problem is that I as a surgeon love to operate (note that we don't even have a monetary incentive) and I truly want to help my patients. This makes me biased and the inertia has saved me quite a few times for starting performing new cool procedures. The biggest problem is that we often have a big problem with discontinuing treatment s, see my post on clavicle fractures http://gforge.se/2017/08/clavicle-gate/ http://gforge.se/2017/08/clavicle-gate/ I am not a cardiologist so I don't know the full details on the statins, but I would be careful not to skip them. Cardiovascular mortality has decreased hugely the last decades and this one of the major treatments - they must be doing something right. Also be careful of flat-earth arguments, there are plenty of people who want to disprove medicine - some of us are researchers but others are just writing blog posts after finding a single article contradicting a treatment. It is incredibly hard to do medical research, it takes years to recruit patients and collect data. You always think that there is a ton of patients with this condition and then you find that the inclusion and exclusion criteria that you believed to be so brilliant (others had forgotten about them in their studies) actually get in your way of being able to finish the study. If this wasn't enough, once you are done with disproving the treatment, you will find that the person that a few years ago popularized it is no longer doing it... They would never do that, now they're doing treatment B, a completely different thing. It's a game of whack-a-mole.

deleted 9y ago

[deleted]