Opinion: Facts don’t support medical assumptions

February 8, 2014


— Swedish researchers report that antioxidants make cancers worse in mice. It’s already known that the antioxidant beta-carotene exacerbates lung cancers in humans. Not exactly what you’d expect given the extravagant — and incessant — claims you hear made about the miraculous effects of antioxidants.

In fact, they are either useless or harmful, conclude the editors of the prestigious Annals of Internal Medicine: “Beta-carotene, vitamin E and possibly high doses of vitamin A supplements are harmful.” Moreover, “other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.” So useless are the supplements, write the editors, that we should stop wasting time even studying them: “Further large prevention trials are no longer justified.”

Such revisionism is a constant in medicine. When I was a child, tonsillectomies were routine. We now know that, except for certain indications, this is grossly unnecessary surgery. Not quite as harmful as that once-venerable staple, bloodletting (which probably killed George Washington), but equally mindless.

After “first, do no harm,” medicine’s second great motto should be “above all, humility.” Even the tried-and-true may not be true. Take the average adult temperature. Everyone knows it’s 98.6 F. Except that when some enterprising researchers actually did the measurements — rather than rely on the original 19th-century German study — they found that it’s actually 98.2.

But if that’s how dicey biological “facts” can be, imagine how much more problematic are the handed-down verities about the workings of our staggeringly complex health care system. Take three recent cases:

Emergency room usage. 

It’s long been assumed that insuring the uninsured would save huge amounts of money because they wouldn’t have to keep using the emergency room, which is very expensive. Indeed, that was one of the prime financial rationales underlying both Romneycare and Obamacare.

Well, in a randomized study, Oregon recently found that when the uninsured were put on Medicaid, they increased their ER usage by 40 percent.

Perhaps they still preferred the immediacy of the ER to waiting for an office appointment with a physician. Whatever the reason, this finding contradicted a widely shared assumption about health care behavior.

Medicaid’s effect on health.

Oregon allocated by lottery scarce Medicaid slots for the uninsured. Comparing those who got Medicaid to those who didn’t yielded the following stunning result, published in the New England Journal of Medicine: “Medicaid coverage generated no significant improvements in measured physical health outcomes in the first two years.”

To be sure, the Medicaid group was more psychologically and financially secure. Which is not unimportant (though for a $425 billion program, you might expect more bang for the buck). Nevertheless, once again, quite reasonable expectations are overturned by evidence.

Electronic records will save zillions.

That’s why the federal government is forcing doctors to convert to electronic health records (EHR), threatening penalties for those who don’t by the end of 2014. All in the name of digital efficiency, of course. Yet one of the earliest effects of the EHR mandate is to create a whole new category of previously unnecessary health workers. Scribes, as they are called, now trail the doctor, room to room, entering data.

Why? Because the EHR are so absurdly complex, detailed, tiresome and wasteful that if the doctor is to fill them out, he can barely talk to and examine the patient, let alone make eye contact — which is why you go to the doctor in the first place.

Doctors rave about the scribes, reports The New York Times, because otherwise they have to stay up nights endlessly checking off boxes. Like clerks. Except that these are physicians whose skills are being ridiculously wasted.

This is not to say that medical practice should stand still. It is to say that we should be a bit more circumspect about having central planners and their assumptions revolutionize by fiat the delicate ecosystem of American health care.

In the case of EHR, for example, doctors were voluntarily but gradually going digital anyway, learning through trial and error what best saves time and money. Instead, Washington threw $19 billion (2009 “stimulus” money) and a rigid mandate at the problem — and created a sprawling mess.

This is not to indict, but simply to advocate for caution grounded in humility. It’s not surprising that myths about the workings of the fabulously complex U.S. health care system continue to tantalize — and confound — policymakers. After all, Americans so believe in their vitamins/supplements that they swallow $28 billion worth every year.

— Charles Krauthammer is a columnist for Washington Post Writers Group.


Ron Holzwarth 4 years, 3 months ago

Clipped from the above article:

"Electronic records will save zillions."

"Yet one of the earliest effects of the EHR mandate is to create a whole new category of previously unnecessary health workers. Scribes, as they are called, now trail the doctor, room to room, entering data.

Why? Because the EHR are so absurdly complex, detailed, tiresome and wasteful that if the doctor is to fill them out, he can barely talk to and examine the patient, let alone make eye contact — which is why you go to the doctor in the first place."
-end clip-

I am absolutely stunned at that fantasy world. Well, I suppose it is possible that the doctors are not intelligent enough to operate a computer keyboard or read a chart on a computer monitor, but then I have to wonder how in the world any of them ever got through medical school.

Every veteran that's enrolled in the VA health care system knows all about electronic records, because that's how it's done.

Often, the first step is for a nurse to collect a blood sample from you. Then lab technicians work their magic and input the results of your blood work (cholesterol, white cell count, lipids, etc.) into the system. And, maybe you'll get an EKG too. Or a heart stress test which takes some time, but it's not done very often. For that matter, an X ray can be done also. And then, shortly before you see the doctor, a nurse takes your blood pressure, weighs you, and gives you your flu shot if it's time and you want one.

And guess what. By then, all of the results of the work done for you that day are already in the system!

Time to see the doctor. Your chart is pulled up within seconds, and your medical history of whatever is being looked at is available instantly, covering the last ten years or so. After examining your chart, which takes only seconds, the doctor then turns his or her attention to you. After your appointment is finished, the doctor turns back to the computer, types in his or her latest diagnosis, and with a few keystrokes, arranges for your medications to be either picked up by you at the pharmacy, or for them to be mailed to you.

All of the above almost always takes less than two hours. Then, you're on your way home. And, all of your medical records are available at every one of the 153 VA hospitals, in case you need to see a doctor while traveling.

Maybe the doctors that don't work at the 153 VA hospitals don't know how to type? Or they have a phobia about computer monitors or technology in general?

"Scribes, as they are called, now trail the doctor, room to room, entering data."

Never saw one, I really don't understand. None of the above is science fiction, it happens every day at every VA hospital.

Beator 4 years, 3 months ago

Since when are facts important? Heck, even the Constitution, the only plan on earth created by Scientists, that produced a productive society of equal opportunity for all, is cast aside as a "living breathing document".

Ron Holzwarth 4 years, 3 months ago

Facts are important because they reflect what we think reality is. But reality is no more than what our perception of it is, and we are often deluded.

Linda and Bill Houghton 4 years, 3 months ago

Comment about body temperature - How we got 98.6 as our body temperature: 98.6 is just 37 (Celsius or centigrade) converted to Fahrenheit. In other words the standard body temperature that most of the rest of the world uses is less precise, not expected to be an exact figure, not exactly 37.0.. A Celsius degree is also a wider span. When the Celsius temperature changes by 1 degree, the Fahrenheit temperature has changed by 1.8 degrees.

The normal temperature for a person varies slightly from person to person. For me it is in the 97 range. At 98.6 I am noticeably feverish. For a woman in childbearing years her normal temperature varies in a recognizable pattern throughout the month.

Ron Holzwarth 4 years, 3 months ago

If you're going to talk about body temperature in any depth, you need to reference it to the measurement of temperature itself. That's a pretty complex subject, with quite a bit of history behind it! The following is a very brief clip about the history of the measurement of temperature that only references the temperature of a normal human.

Clipped from:

'Temperature of a Healthy Human'

"When Fahrenheit began producing thermometers of his own, he graduatied [sic] them after what he believed were Roemer's methods. The upper fixed point (labeled 22-1/2 degrees) was determined by placing the bulb of the thermometer in the mouth or armpit of a healthy male. The lower point (labeled 7-1/2 degrees) was determined by an ice and weater [sic] mixture. In addition, Fahrenheit divided each degree into four parts, so that the upper point became 90 degrees and the lower one 30 degrees. Later (in 1717) he moved the upper point to 98 degrees and the lower one to 32 degrees in order to eliminate 'inconvenient and awkward fractions'. (ref- Middleton)"

Richard Heckler 4 years, 3 months ago

So Charles Krauthammer is saying I should quit eating Blueberries. What an idiot. Charles Krauthammer is like a spokesperson for Sam Brownback and ALEC which is to say that Charles Krauthammer has no credentials to be writing on antioxidants or Medicaid which Brownback and ALEC oppose.

Charles Krauthammer is an expert on vitamin supplements? Since when?

Charles Krauthammer advocates total global war with the USA military leading the way to support the right wing perspective known as the New World Order Global Economy. In fact Charles Krauthammer actually endorses this war mongering policy. http://www.sourcewatch.org/index.php?title=Project_for_the_New_American_Century

For the record I do believe in supplements and I ingest such daily. Herbs are from plant sources which is a plus. A lot of antibiotics are also derived from plant sources. Then again and unfortunately too many medicines are synthetic from who knows what sources. Again for the record I'll stick with whole food sources.

In general I do not trust Charles Krauthammer.

Ron Holzwarth 4 years, 3 months ago

Give the man a break. He's got to think of something to write about once a week.

Richard Heckler 4 years, 3 months ago

"After all, Americans so believe in their vitamins/supplements that they swallow $28 billion worth every year."

Lord have mercy how many trillions a year are consumers FORCED to pay for medical insurance whether they believe in or not,whether they use it or not or whether the insurance industry approves treatment or not. Compared to medical insurance good food and whole food supplements is a bargain and is left to the consumers to decide.

Paying More Getting Less - How Much is the Sick USA Health Care System Costing You? http://dollarsandsense.org/archives/2008/0508harrison.html

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