The Risks of Excess Medical Treatment

Medical treatment by a doctor is not risk-free. In an ideal world, medical diagnosis would be perfect and treatment would be appropriate for the patient’s condition, and without adverse side effects. In the real world, the risks of excess medical treatment arise from the fallibility of the healthcare system both to properly diagnose illnesses and to provide appropriate care.

The Rosenhan experiment

In a recent article on the ineffectiveness and potential harms of health screening, we saw that imperfect diagnosis can lead to medical treatment that carries health risks. False negatives – a failure to find a real disease – and false positives – “detecting” a disease that isn’t really there – make the screening of healthy people much less safe and effective than most people realize. The diagnosis or even suspicion of a non-existent cancer, for example, can lead to further extensive testing including biopsies, chemotherapy, and surgery, all of which carry risks from anxiety to death.

Back in the early 1970s, a Stanford psychologist, David Rosenhan, sent 8 volunteers, one of whom was himself, to a number of different mental hospitals around the country. All of the volunteers were completely normal. They made appointments at these hospitals and claimed that they had been hearing voices which said “empty”, “hollow”, and “thud”. All were diagnosed as schizophrenic and admitted to hospital. This became well-known as the Rosenhan experiment.

After the “patients” were admitted, they ceased pretending to hear voices, acted normally, and told the staff that they were fine. In all cases, it took days to weeks to a couple of months before they were released, all with a diagnosis of schizophrenia in remission. Meanwhile, they were prescribed anti-psychotic drugs (which they didn’t take) and confined to the hospital.

The false positive rate was 100%.

After Rosenhan published a paper on this experiment, psychiatrists were outraged that they had been tricked, and the head of a mental hospital challenged Rosenhan to send his volunteers to his hospital, where he said he would readily detect them. Rosenhan agreed. Out of about 200 people over the subsequent several months, the hospital’s doctors decided that 41 of them were definite fakes and another 42 were suspected fakes. However, Rosenhan had sent no one.

False negative rate was maybe 20 to 40%, depending on how you measure it, that is, assuming the people were really mentally ill but deemed to be faking it.

Do you suppose psychiatric diagnosis has improved much since the early 1970s? I’ve no idea.

People diagnosed with a mental illness can get lots of mind-altering and toxic drugs, including antipsychotics, antidepressants, tranquilizers, etc, which kill people.

It may be thought that a group of people faking psychiatric symptoms may not be relevant to psychiatric treatment, but normal people often think something may be psychologically wrong with them and seek treatment for it. Psychiatrists and psychologists should be able to detect normality, to simply say “there’s nothing wrong with you”; many people are placed on SSRIs or other drugs, and it’s a good bet that some fraction of them have little wrong with them.

Doctors aren’t infallible

A recent economics paper was written by some economists who sent a patient with healthy teeth to 180 different dentists in Switzerland.

Of those dentists, 50 recommended that the patient get at least 1 cavity filled. The economists found that the patient was considerably more likely to get a recommendation for treatment when the dentist needed the money.

If you can’t trust a Swiss dentist, who can you trust?

Imagine what happens when you go to a doctor. You could end up with toxic medications, surgery, chemotherapy.

Most physicians, through no fault of their own, don’t know how much of what they practice is not based on high-quality evidence. John Ioannidis et al. write:

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision-making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders.

Medical treatment comes with risks.

Unnecessary surgery

A number of patients consulted a neurosurgeon for a second opinion on whether they should have spinal surgery.

The surgeon determined that 17.2% of them had been scheduled for unnecessary spinal surgery.

From the physician perspective, overtreatment is common. In a survey of physicians, they themselves thought that

20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). 

Polypharmacy

Polypharmacy occurs when people take too many prescription drugs, and when those drugs are inappropriately prescribed. Polypharmacy is a significant problem, especially among older people.

In one study at a Veterans Administration hospital, 65% of patients were taking at least one drug that was inappropriate.

Virtually all drugs have adverse side effects, some of them serious ones.

Conclusion

The practice of medicine is as much art as science.

Physicians are not infallible, and medical treatment, whether surgery or drugs, carries risk.

Solving this problem isn’t easy, but one of the main things patients can do is to educate themselves.

Fear of malpractice may drive many of a physician’s decisions, which means your best interests may not always be in mind.

PS: You can stay a lot healthier and avoid excess medical treatment if you train for strength, as I write in my book, Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.

PPPS: If you enjoyed this article, hit me with a donation at my PayPal.

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6 comments
Anonymous says October 15, 2017

Good article. In response to the question posed, I don’t think that psychiatric diagnosis has improved since the 1970’s. AIso, the numbers of unnecessary surgery and wrong treatment are much higher than the percentages given here. Medical malpractice has been stated as being the third lead cause of death in the United States but that recent study does not include death in ambulatory centers, covered up reasons for medically induced death, those who died after surgery due to bad surgery or other inappropriate medical treatment. The study also did not include bodily injury. Doctors do not study nutrition, exercise physiology, meditation, and holistic health, so how can they be the accurate advisors for overall health? The coverups regarding medical harm are staggering. Many people get diagnosed with psychiatric problems during a life crisis that will pass, and their reactions are normal to that stressor.

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Montgomery says October 16, 2017

>Do you suppose psychiatric diagnosis has improved much since the early 1970s? I’ve no idea.

Even if psychiatric diagnosis had a 100% reliability rate, the evidence of psychiatric and psychological treatment suggests a very bleak reality:

According Martin E. P. Seligman’s book “What You Can Change and What You Can’t” exactly zero curative drugs exist in psychotherapy – all are only “cosmetic”, palliative, symptom-suppressing as long as they are taken – and they are not really effective at what they are supposed to do.
According to his data about 65% of drugs and psychotherapies lead to improvements in symptoms;
but the placebo effect is in the range of 45-55%, so that the real net effect of treatment is only in the range of
10-20%.

He argues that because most personality traits are heritable, and most psychological symptoms stem from personality traits, usually not much really can be done by doctors to patients that results in a lasting improvement of their symptoms.

He then argues for an ancient approach to understanding and managing one’s problems: Developing the “courage” to function well in spite of them: Accepting the unpleasant emotions (for example anxiety, panic, tiredness, fatigue etc.) and trying to consciously function anyway. This can be very unpleasant, but he shows that this is often, after some time of serious struggle, leading to significant improvements in symptoms – due to willpower-facilitated self-training. Severe panic attacks, for example, that suddenly happen to some patients without apparent cause and are putting them in existential fear of dying, their hearts racing, limbs shaking and sweat pouring, can be suppressed by tranquilizer drugs (not perfectly though, something like a 80% reduction in frequency) – but at a cost of constant fatigue, tiredness and inability to concentrate; he found that counseling those patients to try to consciously live through and endure the attacks made them soon learn that there is actually no existential threat, that the attacks would go by all by themselves – and that contrary to their immediate feelings (which are powerful and are perceived as “true”) they are actually not in an existential crisis. After the patients experienced some panic attacks with that mindset they learned to remain functional during their panic attacks, stopped fearing them, and in many cases, after a few weeks to months, the panic attacks stopped occurring again at all.

He gave an example from the military: Sniper training.
Those guys need to be alert for ~24h to move to their position in stealth;
then another 36h or so they need to alertly lay in wait until they can deliver the shot.
They are very tired. What does the military do to keep them functioning well despite this? Are they given drugs, stimulants? No. They are training over and over to function well under extreme fatigue, and this, given some time, leads to them being able to function well under extreme fatigue. Compared to that learned ability, drugs have been found by the military to yield inferior results.

The author argues that doctors and pharmaceutic industry are too often trying to sell drugs that just make their patients feel better or good quickly, while paying for this improvement with severe side-effects of the medication, which often leads to entirely new kinds of problems of comparable magnitude of the symptoms they were prescribed for to suppress.

He argues that a great many (not all, of course) of contemporary mediation is given to save people the trouble to “tough out” their problems – the latter, he shows, often yields lasting, superior results over medication.
More examples are given, for example anxiety, depression, weight control, mood disorders and the like.

He is also an expert at “learned helplessness”, and it seems to me he is trying to hint at the fact that, in effect, deliberately or not, people are softened, or “weakened” by doctors and pharmaceutical industry to not attempt to solve their little or medium-sized issues themselves by applying willpower and self-discipline, but instead to opt for the quicker, easier and more pleasurable way of just quickly eating some pill to end their troubles.

Reply
    P. D. Mangan says October 16, 2017

    Great comment, Montgomery, and everything there makes complete sense. Some mental illnesses are caused or exacerbated by biology, and therefore can be cured, but not with drugs. For instance, omega-3 fatty acids have efficacy in bipolar and other conditions; exercise is effective against depression; manipulating circadian rhythms through temporary sleep deprivation and/or light therapy is also effective against depression. Most schizophrenics appear to have some degree of insulin resistance. Magnesium may be effective against depression. So, getting the right nutrition and exercise may be a big help in mental illnesses, and in some cases be curative. In most cases, as you write, drugs are merely palliative. Another aspect of treating mental illnesses is that many will go away on their own given enough time, and that seems particularly the case with depression.

    Reply
Mellie Walks says October 16, 2017

Wow!!! I knew this was happening, but I didn’t realize to what a high degree!

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Rob says October 30, 2017

You absolutely have to educate yourself, and not blindly follow a doctors advice. Traditional doctors (not functional medicine doctors, which are better but not at all easy to find) generally will try to prescribe drugs or treatments designed to alleviate symptoms……..but not really address the root cause of your problem. I just got from a doctors appointment, and was told that I needed Lipitor, because my cholesterol is above 200. There is no way in the world I am going to take Lipitor, especially when all of my other blood markers (including triglycerides, HDL, A1C, etc, etc, are just fine, and I have no history of heart disease. And even the cholesterol above 200 is probably a good thing, since moderately high cholesterol is associated with longer lifespan. I have quite a few friends that still believe in doing “whatever the doctor says”………..big mistake, in my opinion!

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