MEDICAL FOLLOW-UP ... by Nicolas Negush

Discussion in 'Health and medical' started by Ilena, Oct 3, 2003.

  1. Ilena

    Ilena Guest




    By RFD Editor, Nicholas REgush

    What is medical follow-up? Is it for real or rather a carefully hyped
    medical fantasy?

    I ask this question because we are all on the lookout for health tips,
    but often the tips we receive are from physicians or other health
    professionals — and it would be nice, of course, if we actually
    learned as we embraced this or that health tip whether these gems of
    imparted wisdom stood the test of time. Perhaps even more important,
    and along similar lines, it would be of great value to know if the
    medical advice or treatment that is offered to many people actually
    works (and not just for a week or two but over the longer term).

    Back in the late 1980s and early 90s, I spent a lot of my time
    investigating the safety issues surrounding breast implants. During
    that period I wrote many stories which raised important questions
    about breast implants and the possible harm that they were doing to
    some women. It was during these years that I often met up with plastic
    surgeons who would try to impress me with the notion that their breast
    implant patients were doing "wonderfully." It seemed, if it could be
    believed, that every plastic surgeon doing breast implants was having
    remarkable success and that all their patients were "very pleased with
    the results."

    What I pointed out rather sharply in some of my investigations was
    that there was little science to back up these anecdotal reports. I
    would often ask a plastic surgeon to provide me with some data showing
    that he/she had followed up on breast implant patients. I could not
    find anyone in this field who could provide me with a reasonable
    account of what happened after patients left the clinic or hospital
    with the new implants. Did the plastic surgeons have any idea how
    their patients were doing? Oh, they were doing "wonderfully."

    I raise this as an example because it is classic behavior in a field
    where "care" amounts to very little or no follow-up. Of course, as you
    know, breast implants were finally yanked from the market because
    there was no science — which also means there was no systematic
    follow-up by plastic surgeons.

    These days, life often goes on in medicine — in both conventional and
    alternative realms - much as it did in the late 80s and 90s with
    breast implants.

    What often is called "follow-up" is merely a cover-up for what amounts
    to hype, sloppy practice, and negligence.

    Mind you, there are many doctors, both conventional and alternative,
    that take a lot of time with patients, see them regularly to determine
    how they are doing, and keep excellent records.

    But there are also many doctors that run what I think of as "mills,"
    shuttling patients through their so-called "system," one after the
    other, without giving much thought to a systematic follow-up.

    There is also the issue of art versus science. Some doctors will
    announce to you that their patients are doing extremely well on a
    particular pill, potion or diet. Well, one health tip I can offer you
    right now is to suggest that you might immediately ask them for the
    carefully recorded data that supports such a declaration.

    Here's a typical example of how I have often handled such a situation
    (in interviews) during the process of reporting on health advances:

    Doctor: My patients do very well on this diet.

    Regush: Do you have any data to support this?

    Doctor: My experience shows me that it works.

    Regush: Really. And your "experience" is basically how you see it and
    remember it? Or do you keep detailed follow-up records? Or perhaps
    you've participated in a study.

    Doctor: My patients tell me that they have greatly benefited.

    Regush: How many patients? And did you determine whether their health
    really improved — and how did you determine that, and if you did, for
    how long did the patient's health improve? And if it improved, how do
    you know that your treatment was the main cause of the improvement?

    At this point, as I have discovered time and again, this type of
    doctor is lost is a sea of his/her own double-talk. Anyone hyping a
    treatment and is telling you that the supporting data for health
    claims are based on personal experience is selling you the Brooklyn
    Bridge. This is one of the worst answers any doctor can give you. At
    the very least, there should be well-recorded follow-up data and some
    visible effort made to make sense of the information.

    Some patients will immediately say that they don't care. They'll try
    whatever the doctor suggests, particularly if they trust the doctor.

    My retort is that trust should be based on more than a handshake and a
    hope and a prayer if your health is at issue.

    Of course, if you are keen on being a guinea pig with no carefully
    recorded follow-up, that's up to you.


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