Sam Bauman: More on outdated medical procedures



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I recently discussed the way many therapies and procedures are continued long after they are shown to be ineffective and possibly dangerous to patients’ health. Two such were stents for heart disease and arthroscopic knee surgery. From personal experience I know that major knee surgery works; my right knee was replaced and it has held up fine for eight years. Not the same for arthroscopic procedures’ less invasive work.

In a number of common situations, Consumer Reports on Health of June 2016 found that doctors continued treatments when new evidence suggests the treatments could be ineffective and even dangerous. Consumer Reports lists several treatments that doctors may be recommending despite evidence against them.

Here’s some more on the subject.

Back pain is common as we age. Bones thin, tendons stretch and muscles weaken. As we age the bone around he spinal cord can pinch nerves and cause a burning pain in the buttocks that travels down the leg. That’s called spinal stenosis and is more common in folks over 60. In the 1960s medics started giving patients steroid injections to reduce pain, thinking to combat the discomfort. In recent times spinal injections have increased by nearly 300 percent to 2.2 million injections annually.

The first major study was in 2014 where the New England Journal of Medicine found no relief from injections of steroid shots and the pain reliever lidocaine. Those who received just the lidocaine did just as well as those who received steroids with the lidocaine. But many doctors continued to use the steroids because they seemed to work easier and faster than physical therapy. Steroid injections are no more apt to help with pain than an injection without steroids. If symptoms don’t improve, you may need a kind of surgery, a laminectomy, or decompression to ease pressure on the spinal cord.

Spinal cement came in the 1990s to deal with osteoporosis, the weakening of bones. The vertebrae can fracture, compress or flatten, which can cause pain. In the 1990s a University of Virginia team injected in each compression with medical grade cement to support the patient’s spine during healing. It grew to a billion-dollar industry. But the Mayo Clinic compared patients who tried the vertebroplasty with those who had received only an injection of salt water and found no difference between the groups. Yet many doctors continue to use the system facing some risks, such as numbness, bleeding and infections. Now the thinking is that more conservative procedures such as over-the-counter drugs or bracing and physical therapy. If a patient remains in severe pain, vertebroplasty may be worth trying.

In the last 10 years doctors have accepted testosterone as countering aging, improving sexual function, upping bone density, increasing lean muscle mass as well as improving cholesterol and insulin levels. There is evidence that some older men improve sexuality, but most don’t. Testosterone doesn’t improve physical stamina or energy, says a NIH study. Yes, testosterone prescriptions went up five fold from 2000 to 2013, says a JAMA study. Direct to consumer ads tell viewers they have to take it. “That it will make a 60-year-old man feel better,” says Consumer Reports. But most older men will not experience gains but will face higher risk of dying from any disease as well as a heart attack or stroke, according to a JAMA study. A newer study found men over 65 had twice the risk of heart attack or stroke while on the therapy. Testosterone therapy is found warranted only for rare testicular or pituitary disorders.

Control of blood sugars type 2 diabetes — Patients have long been told that controlling blood sugar levels in their HbA1c under 6.5 often requires high levels of drugs or if style changes. A 2006 study found that those who lowered their HbA1c to under 6.5 had higher death risk than those whose levels were between 7 and 8. While some doctors still recommend the lower number to 6.5, some doctors receive financial benefits when patients stay at 6.5 from drug makers. Consumer Reports says blood sugar control is important, but a HbA1c level of 7 or 8 is best.

Skin cancer apps?

If you’re using moles apps with iPhones, be alert. The apps are supposed to tell you if your moles are heading for melanoma. But the FTC which controls the apps market found that claims were not met, citing a JAMA study that found three out of four responses claimed that no melanoma risk existed, while the reality was 30 to 93 percent.

If a mole is changing, a visit to the dermatologist is your best bet.

Sam Bauman writes about senior affairs, among other things, for the Nevada Appeal.


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