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This statistic seems like a useful tool for doctors and others prescribing medicine. However, I don't at all like the insinuations this article repeatedly make

by yzzxy 12y ago

This statistic seems like a useful tool for doctors and others prescribing medicine. However, I don't at all like the insinuations this article repeatedly makes that doctors are keeping information away from patients that could save their lives. Doctors go to med school for years so that they can make medical decisions for the rest of us. It's almost insulting to do armchair pharmacology and assume you know better than the doctor who's trained for years. This is the same kind of thinking that brought us vaccine autism scares and the chronic issue of people not finishing their antibiotic courses.

Alex3917 12y ago
> It's almost insulting to do armchair pharmacology and assume you know better than the doctor who's trained for years. Yeah but doctors in the U.S. basically get fake medical training, which is (partly) the point of this article.
- phren0logy 12y ago
  What are you talking about? Medical training is more rigorous than ever, and requires constant testing, continuing education, and renewal of board certification. All while competing groups have sought independent prescribing privileges with none of these assurances.
  - Alex3917 12y ago
    > Medical training is more rigorous than ever, and requires constant testing, continuing education, and renewal of board certification. - Much of the med school curriculum isn't based on science at all. This article gives several examples of that. - Of the part that is based on science, much of the science is completely wrong for various reasons. - Medical education mostly consists of sponsored content that's paid for by pharma companies rather than students/doctors, at least for continuing education.
    - adventured 12y ago
      You're making extraordinary claims, with zero evidence to support what you're claiming. For example: "much of the med school curriculum isn't based on science at all" Ok, now show me the proof to back up that statement so I can verify for myself that you're not just opining. "Of the part that is based on science, much of the science is completely wrong for various reasons" Ok, which parts, and prove that it's wrong. At least support your extreme claims. "Medical education mostly consists of sponsored content that's paid for by pharma companies rather than students/doctors, at least for continuing education." More truly massive claims. "Mostly" typically implies majority. You've got a lot of proving to do.
      - Alex3917 12y ago
        So basically it's not your job to read books and become well educated, it's my job to do your homework for you. Good luck with that.
- adventured 12y ago
  Doctors on average in the US in fact receive an education and training level that competes with the very best in the world. In regards to doctors and nurses, the US produces a very high quality output. Quality has rarely been the problem in the US (cost is). That has been the case for at least the last 70 or 80 years, going back to or before WW2. That's why America has many of the top rated hospitals: they're staffed by the best doctors. It's not the buildings that make them so good, it's the staff. The US was famous for decades for having the world's best doctors and facilities. The world's rich and powerful would fly to America for treatment. It still possesses that reputation for quality.
pdonis 12y ago
> I don't at all like the insinuations this article repeatedly makes that doctors are keeping information away from patients that could save their lives. I don't think the insinuation is that doctors are doing that on purpose. I think the insinuation is that doctors (a) aren't always up to date on the relevant information, and (b) don't always present the information in its proper context. > Doctors go to med school for years so that they can make medical decisions for the rest of us. I think this attitude, while it is a common one (and it's common with patients too, not just doctors), is part of the problem. Doctors should not be making medical decisions for the rest of us. Doctors should be advising us on the medical decisions that we make for ourselves, taking all relevant factors into account.
- yzzxy 12y ago
  I believe there's a fine line between doctors advising and deciding. So I was probably far too absolute in my previous comment. There's a reason that second opinions exist, for instance. However, I still lean towards ignoring this statistic as a patient. Looking up a NNT number does not make you better than a doctor at a holistic evaluation of your own case. I would hazard to guess it will lead to a poor decision pretty often. Why? Let's assume everybody follows NNT statistics with generally similar cutoff points. Patients generally don't have access to a lot of other empirical evidence on a given drug, because most metrics are meaningless to a person not trained in medicine. Any metric a lay person can understand will probably apply to one patient in the same way it applies to everyone else, because it will almost surely relate to results rather than the underlying medical processes. As a result, every lay person with a given condition will make (roughly) the same decision about a given drug. This essentially throws out all of the other factors involved in the case and all of the doctor's expertise. I would be amazed if this resulted in an improvement to general treatment results. I should note, I am neither a doctor nor an aspiring medical professional. Someone from that world could probably give a great perspective on whether my basic reasoning here is sound.
  - learc83 12y ago
    The problem is plenty of Doctors don't understand statistics. Do I really need this diagnostic test? What's the prior probability I have the disease being checked for? What's the probability that the test will harm me. If I do have the disease, by how much will the test improve the likelihood of a good outcome. Most doctors can't do the math even if they have the answers to all of the questions. There are scores of things a doctor can do that I can't, look at an x-ray and tell me my bone is broken, listen to my breathing and tell me that I have bronchitis. However, I can almost guarantee that I know more about statistics and how to interpret them than your average primary care physician [1]. I want the doctor to tell me everything he knows, do some research on my own, and make an informed decision--taking the doctors advice into consideration. I have to live with the consequences, not the doctor. [1] http://www.jgme.org/doi/pdf/10.4300/JGME-D-12-00161.1 http://www.jgme.org/doi/pdf/10.4300/JGME-D-12-00161.1
jessaustin 12y ago
Different people read differently, but to me the tone of TFA seemed to be "physicians should stop doing things that don't benefit patients" much more than it was "physicians should do more things that benefit patients". Perhaps the difference is subtle, but it perfectly characterizes the challenges of modern medicine. Also please note that Newman, Shreves, Laupacis, Sackett, Mallemat, Saini, cited in TFA, are all actual physicians. (Robin Roberts shares a name with a media personality whose case of cancer is in the news, so I couldn't quickly determine whether he is also.) A sure way to prevent antibiotic noncompliance is to not prescribe antibiotics.

by yzzxy 12y ago

Alex3917 12y ago

> It's almost insulting to do armchair pharmacology and assume you know better than the doctor who's trained for years. Yeah but doctors in the U.S. basically get fake medical training, which is (partly) the point of this article.

phren0logy 12y ago
What are you talking about? Medical training is more rigorous than ever, and requires constant testing, continuing education, and renewal of board certification. All while competing groups have sought independent prescribing privileges with none of these assurances.
- Alex3917 12y ago
  > Medical training is more rigorous than ever, and requires constant testing, continuing education, and renewal of board certification. - Much of the med school curriculum isn't based on science at all. This article gives several examples of that. - Of the part that is based on science, much of the science is completely wrong for various reasons. - Medical education mostly consists of sponsored content that's paid for by pharma companies rather than students/doctors, at least for continuing education.
  - adventured 12y ago
    You're making extraordinary claims, with zero evidence to support what you're claiming. For example: "much of the med school curriculum isn't based on science at all" Ok, now show me the proof to back up that statement so I can verify for myself that you're not just opining. "Of the part that is based on science, much of the science is completely wrong for various reasons" Ok, which parts, and prove that it's wrong. At least support your extreme claims. "Medical education mostly consists of sponsored content that's paid for by pharma companies rather than students/doctors, at least for continuing education." More truly massive claims. "Mostly" typically implies majority. You've got a lot of proving to do.
    - Alex3917 12y ago
      So basically it's not your job to read books and become well educated, it's my job to do your homework for you. Good luck with that.
adventured 12y ago
Doctors on average in the US in fact receive an education and training level that competes with the very best in the world. In regards to doctors and nurses, the US produces a very high quality output. Quality has rarely been the problem in the US (cost is). That has been the case for at least the last 70 or 80 years, going back to or before WW2. That's why America has many of the top rated hospitals: they're staffed by the best doctors. It's not the buildings that make them so good, it's the staff. The US was famous for decades for having the world's best doctors and facilities. The world's rich and powerful would fly to America for treatment. It still possesses that reputation for quality.

pdonis 12y ago

> I don't at all like the insinuations this article repeatedly makes that doctors are keeping information away from patients that could save their lives. I don't think the insinuation is that doctors are doing that on purpose. I think the insinuation is that doctors (a) aren't always up to date on the relevant information, and (b) don't always present the information in its proper context. > Doctors go to med school for years so that they can make medical decisions for the rest of us. I think this attitude, while it is a common one (and it's common with patients too, not just doctors), is part of the problem. Doctors should not be making medical decisions for the rest of us. Doctors should be advising us on the medical decisions that we make for ourselves, taking all relevant factors into account.

yzzxy 12y ago
I believe there's a fine line between doctors advising and deciding. So I was probably far too absolute in my previous comment. There's a reason that second opinions exist, for instance. However, I still lean towards ignoring this statistic as a patient. Looking up a NNT number does not make you better than a doctor at a holistic evaluation of your own case. I would hazard to guess it will lead to a poor decision pretty often. Why? Let's assume everybody follows NNT statistics with generally similar cutoff points. Patients generally don't have access to a lot of other empirical evidence on a given drug, because most metrics are meaningless to a person not trained in medicine. Any metric a lay person can understand will probably apply to one patient in the same way it applies to everyone else, because it will almost surely relate to results rather than the underlying medical processes. As a result, every lay person with a given condition will make (roughly) the same decision about a given drug. This essentially throws out all of the other factors involved in the case and all of the doctor's expertise. I would be amazed if this resulted in an improvement to general treatment results. I should note, I am neither a doctor nor an aspiring medical professional. Someone from that world could probably give a great perspective on whether my basic reasoning here is sound.
- learc83 12y ago
  The problem is plenty of Doctors don't understand statistics. Do I really need this diagnostic test? What's the prior probability I have the disease being checked for? What's the probability that the test will harm me. If I do have the disease, by how much will the test improve the likelihood of a good outcome. Most doctors can't do the math even if they have the answers to all of the questions. There are scores of things a doctor can do that I can't, look at an x-ray and tell me my bone is broken, listen to my breathing and tell me that I have bronchitis. However, I can almost guarantee that I know more about statistics and how to interpret them than your average primary care physician [1]. I want the doctor to tell me everything he knows, do some research on my own, and make an informed decision--taking the doctors advice into consideration. I have to live with the consequences, not the doctor. [1] http://www.jgme.org/doi/pdf/10.4300/JGME-D-12-00161.1 http://www.jgme.org/doi/pdf/10.4300/JGME-D-12-00161.1

jessaustin 12y ago

Different people read differently, but to me the tone of TFA seemed to be "physicians should stop doing things that don't benefit patients" much more than it was "physicians should do more things that benefit patients". Perhaps the difference is subtle, but it perfectly characterizes the challenges of modern medicine. Also please note that Newman, Shreves, Laupacis, Sackett, Mallemat, Saini, cited in TFA, are all actual physicians. (Robin Roberts shares a name with a media personality whose case of cancer is in the news, so I couldn't quickly determine whether he is also.) A sure way to prevent antibiotic noncompliance is to not prescribe antibiotics.