nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Wednesday, June 9, 2010

Underwhelmed By Allegations Of Overtreatment

There's a big push to reduce "unneeded" treatments, which sounds good until YOUR treatment is determined to be unneeded.

Imagine these circumstances:
1.  You have a blockage in your heart.  We can put you on medicines--for now--to control, but not solve, the problem; a non-invasive treatment to open up the blocked vessel is "unneeded."
2.  Your kid has a head injury.  The clinical standards review agency says that in your kid's case, a brain scan to rule out intracranial injury is "unneeded."
3.  You've had daily back pain for years.  You've tried all kinds of treatment and nothing works.  Life is miserable.  The government says back pain is over treated; injections and surgery don't help the majority of patients, so in your case they are "unneeded."
4.  You have a severe sore throat, a fever and feel miserable.  The clinical guidelines say that strep is not likely, so an antibiotic is "unneeded."  You are told to go home, rest and drink fluids--come back if it lasts for more than a week.
5.  You have severe acid reflux.  The clinical standards say to start with the simplest measure first.  Try them for several weeks, and only use the more powerful "unneeded" drugs if after several weeks of suffering there is no improvement.

I'll admit that overtreatment occurs.  And some of these examples have some legitimate basis.  But isn't it interesting that when you talk in the abstract about thousands of people undergoing "unneeded" tests it sounds bad?  By contrast, when it comes down to your own personal needs, maybe sometimes these things aren't so bad.  I've chosen examples that highlight the phenomenon, so this skews things a bit in my favor.  But ALL of the situatons above have been touted as examples by advocates of reducing so-called "overtreatment." 

I really hate it when reformers talk about populations instead of persons.   Persons then become objects, pieces of data, and not sovereign over their own bodies and selves.  I'm a great believer in using science to make individual clinical decisions, but I'm suspicious of policy makers who want to use science to transform the unique needs of individuals into a formula for the masses.  There's an important place for looking at best policies, but the person should come first.

I'll take responsibility for deciding what I "need," thank you.

Doc D

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