What'swrong with medicineUnlike Pilots,Doctors Don't Go Down with their planes

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[sSRI-Research] What's wrong with American medicine? " Unlike

Pilots, Doctors Don't Go Down with their planes "

 

 

 

ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)

Promoting Openness, Full Disclosure, and Accountability

http://www.ahrp.org/cms/

 

FYI

 

What's wrong with American medicine?

 

The answer given by Dr. Joseph Britto, a pediatric intensive care

physician, hits the nail on the head: " Unlike pilots, doctors don't go down with

their planes. "

 

A provocative article in The New York Times (below) refers to a report in the

Journal of the American Medical Association revealing that despite sophisticated

diagnostic tools in modern medicine, the rate of

misdiagnosis is about the same as it was in the 1930s! Autopsy studies have

shown that doctors seriously misdiagnose fatal illnesses about 20% of the time.

This means that millions of patients are being treated for the wrong disease.

In part, this is because " there is no bonus for curing someone and no

penalty for failing, except when the mistakes rise to the level of

malpractice

 

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics

 

/malpractice/index.html?inline=nyt-classifier> . So even though

doctors can have the best intentions, they have little economic incentive to

spend time double-checking their instincts, and hospitals have little incentive

to give them the tools to do so. "

 

Indeed, if truth be told, the culture in contemporary medicine is

self-serving:

 

" Under the current medical system, doctors, nurses, lab technicians and hospital

executives are not actually paid to come up with the right diagnosis. They are

paid to perform tests and to do surgery and to dispense drugs. "

 

" We just are not using the power of incentives to save lives. " Medicaid /

Medicare czar, Dr. Mark McClellan acknowledged.

 

A diagnostic software program has been developed: Isabel allows doctors to type

in a patient's symptoms and, in response, spits out a list of possible causes,

including rare conditions that most physicians would overlook. It is accessible

via the internet; access costs a hospital $80,000, or individual rs can

access it for $700.

 

In psychiatry the problem of diagnosis is far worse because psychiatry

lacks any objective, verifiable diagnostic measure.

 

Psychiatry's diagnostic " mood swings " are given to fashion:

 

Fads in psychiatry are a consequence of subjective methods of

" diagnosing, " accomplished by use of suggestive catch-all questionnaires. The

responses are interpreted by psychiatrists who have a vested interest in

increasing the number of people who will qualify for insurance reimbursement.

 

Indeed, psychiatry's ever inflated diagnostic manual, DSM-IV published by the

American Psychiatric Association, has recently been shown to be

fashioned by psychiatrists with financial conflicts of interest. The

DSM-IV is tailored to provide psychiatrists diagnoses justifying their

prescribing of the latest psychotropic drugs.

 

The latest diagnostic aberration in U.S. psychiatry is diagnosing young children

manic-depression (bipolar disorder). Even as leading child psychiatrists admit,

it is difficult to differentiate bipolar from ADHD, the gateway to pathologizing

children as mentally diseased.

 

The Australian Broadcasting Corporation reports (below) about concerns

raised by Dr. David Healy at an international conference earlier this

month focusing on disease mongering. Dr. Healy talked about the medically

unsupportable American trend of diagnosing young children with bipolar disorder.

 

Dr. Healy noted that the DSM-IV diagnostic guidelines specify that periods of

highs and lows should last for weeks at a time at least. But children's moods

normally fluctuate during the course of a day: " Every kid's mood goes up and

down during the course of the day. "

 

Dr. Healy is concerned that those who advocate " diagnosing " children with

bipolar, are lobbying to change the APA diagnostic guidelines: " The response

from most of the rest of the world is that the Americans have gone hysterical. "

 

Dr. Healy's concern is echoed in Australia by Dr Phill Brock,

Chairperson of the Royal Australian & New Zealand College of Psychiatrists

<http://www.ranzcp.org> ' Faculty of Child and Adolescent Psychiatry: " We do not

endorse that diagnosis in children. "

 

But in the U.S., Dr. Joan Luby, a leading academic child psychiatrist who

supports the bipolar diagnosis in young children, while acknowledging that

" Mania can be confused with ADHD. "

 

" During the manic phase of the illness children may experience exceedingly high

self-esteem, an inflated sense of power or ability...They may act extremely

happy, silly and giddy, but their moods can change rapidly. "

 

She cites the following as: " An extreme example that I've seen involved a manic

preschooler who believed that she made the sun rise and set. "

 

Dr. Joan Luby heads the University's TEAM (Treatment of Early Age Mania) whose

focus, she defined: " We hope that by comparing these drugs and drug

combinations, we might be able to find better ways to control this severe

illness in older, affected children, and as those results become available, we

can look at whether these treatments also might help younger children. "

 

See: Washington University Medical News Press Release, and graph, Dec.

2005 at: http://mednews.wustl.edu/tips/page/normal/6244.html or see:

slide 36 and 37 at: http://www.ahrp.org/ahrpspeaks/TeenScreen/index.php

 

An investigative reporter might learn a great deal by asking the

proponents of drugs for treating children's behavior how much they have received

from drug manufacturers within the last 10 years?

 

Contact: Vera Hassner Sharav

212-595-8974

veracare

 

 

~~~~~~~~~~~~~~~

http://www.nytimes.com/2006/02/22/business/22leonhardt.html?

 

THE NEW YORK TIMES

February 22, 2006

 

Why Doctors So Often Get It Wrong

 

By DAVID LEONHARDT

 

ATLANTA-- ON a weekend day a few years ago, the parents of a

4-year-old boy from rural Georgia brought him to a children's hospital here in

north Atlanta. The family had already been through a lot. Their son had been

sick for months, with fevers

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics

/fever/index.html?inline=nyt-classifier> that just would not go away.

 

The doctors on weekend duty ordered blood tests, which showed that the boy had

leukemia

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics

/leukemia/index.html?inline=nyt-classifier> . There were a few things

about his condition that didn't add up, like the light brown spots on the skin,

but the doctors still scheduled a strong course of chemotherapy

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics

/chemotherapy/index.html?inline=nyt-classifier> to start on Monday

afternoon. Time, after all, was their enemy.

 

John Bergsagel, a soft-spoken senior oncologist, remembers arriving at the

hospital on Monday morning and having a pile of other cases to get

through.

 

He was also bothered by the skin spots, but he agreed that the blood test was

clear enough. The boy had leukemia. " Once you start down one of these clinical

pathways, " Dr. Bergsagel said, " it's very hard to step off. "

What the doctors didn't know was that the boy had a rare form of the

disease that chemotherapy does not cure. It makes the symptoms go away for a

month or so, but then they return. Worst of all, each round of chemotherapy

would bring a serious risk of death, since he was already so weak.

 

With all the tools available to modern medicine - the blood tests and

M.R.I.'s and endoscopes - you might think that misdiagnosis has become a rare

thing. But you would be wrong. Studies of autopsies have shown that doctors

seriously misdiagnose fatal illnesses about 20 percent of the time.

 

So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not

really changed since the 1930's. " No improvement! " was how an

article in the normally exclamation-free Journal of the American Medical

Association summarized the situation.

 

This is the richest country in the world - one where one-seventh of the economy

is devoted to health care - and yet misdiagnosis is killing thousands of

Americans every year. How can this be happening? And how is it not a source of

national outrage?

 

A BIG part of the answer is that all of the other medical progress we have made

has distracted us from the misdiagnosis crisis. Any number of diseases that were

death sentences just 50 years ago - like childhood leukemia - are often

manageable today, thanks to good work done by people like Dr. Bergsagel. The

brightly painted pediatric clinic where he practices is a pretty inspiring place

on most days, because it's just a detour on the way toward a long, healthy life

for four out of five leukemia patients who come

here.

 

But we still could be doing a lot better. Under the current medical

system,

doctors, nurses, lab technicians and hospital executives are not actually

paid to come up with the right diagnosis. They are paid to perform

tests and

to do surgery and to dispense drugs.

 

There is no bonus for curing someone and no penalty for failing,

except when

the mistakes rise to the level of malpractice

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics

/malpractice/index.html?inline=nyt-classifier> . So even though

doctors can

have the best intentions, they have little economic incentive to spend

time

double-checking their instincts, and hospitals have little incentive

to give

them the tools to do so.

 

" You get what you pay for, " Mark B. McClellan, who runs Medicare and

Medicaid, told me. " And we ought to be paying for better quality. " There

are some bits of good news here. Dr. McClellan has set up small

pay-for-performance programs in Medicare, and a few insurers are also

experimenting. But it isn't nearly a big enough push. We just are not

using

the power of incentives to save lives. For a politician looking to

make the

often-bloodless debate over health care come alive, this is a huge

opportunity.

 

Joseph Britto, a former intensive-care doctor, likes to compare medicine's

attitude toward mistakes with the airline industry's. At the insistence of

pilots, who have the ultimate incentive not to mess up, airlines have

studied their errors and nearly eliminated crashes.

 

" Unlike pilots, " Dr. Britto said, " doctors don't go down with their

planes. " Dr. Britto was working at a London hospital in 1999 when doctors

diagnosed chicken pox in a little girl named Isabel Maude. Only when her organs

began shutting down did her doctors realize that she had a potentially fatal

flesh-eating virus

<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics

/viruses/index.html?inline=nyt-classifier> . Isabel's father, Jason,

was so shaken by the experience that he quit his finance job and founded a

company - named after his daughter, who is a healthy 10-year-old today - to

fight misdiagnosis.

 

The company sells software that allows doctors to type in a patient's

symptoms and, in response, spits out a list of possible causes. It

does not replace doctors, but makes sure they can consider some unobvious

possibilities that they may not have seen since medical school. Dr. Britto is a

top executive.

 

Not long after the founding of Isabel Healthcare, Dr. Bergsagel in Atlanta

stumbled across an article about it and asked to be one of the beta testers.

So on that Monday morning, when he couldn't get the inconsistencies in the boy's

case out of his mind, he sat down at a computer in a little white room, behind a

nurse's station, and entered the symptoms. Near the top of Isabel's list was a

rare form of leukemia that Dr. Bergsagel had never seen before - and that often

causes brown skin spots. " It was very much a Eureka moment, " he said.

 

There is no happy ending to the story, because this leukemia has much

longer odds than more common kinds. But the boy was spared the misery of

pointless chemotherapy and was instead given the only chance he had, a bone

marrow transplant. He lived another year and a half.

 

Today, Dr. Bergsagel uses Isabel a few times a month. The company

continues to give him free access. But his colleagues at Children's Healthcare

of Atlanta can't use it. The hospital has not bought the service, which costs

$80,000 a year for a typical hospital (and $750 for an individual doctor).

 

Clearly, misdiagnosis costs far more than that. But in the current health care

system, hospitals have no way to recoup money they spend on programs like

Isabel. We patients, on the other hand, foot the bill for all those wasted

procedures and pointless drugs. So we keep getting them. Does that make any

sense?

E-mail: leonhardt

Copyright 2006

<http://www.nytimes.com/ref/membercenter/help/copyright.html>

The New York Times Company <http://www.nytco.com/>

~~~~~~~~~

 

 

 

 

 

 

 

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