NetNews Usenet Archive 1992 #31/NN_1992_31.iso/spool/sci/med/22902

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Xref: sparky sci.med:22902 talk.politics.medicine:408
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From: [e-mail] (Herman Rubin)
Subject: Re: Bashing, truth, etc.
Message-ID: <[e-mail]>
Sender: [e-mail] (USENET News)
Organization: Purdue University Statistics Department
References: <[e-mail]>
Date: Mon, 21 Dec 1992 15:10:03 GMT
Lines: 121

In article <[e-mail]> [e-mail] (David Nye) writes:
>[reply to [e-mail]]

>>Much of present established medicine was at one time considered
>>quackery, or at least ridiculous.  The conspiracy as stated in the
>>first paragraph is not a deliberate conspiracy, but it is not that far
>>from what is happening.  The conspiracy is there to keep people from
>>deciding what is appropriate for them, and part of it is the acts of
>>moralists and bureaucrats to keep substances from us "because we cannot
>>act intelligently", those physicians who do not provide the patient
>>with information, but TELL the patient what to do, etc.  Few physicians
>>have the ability to put widely separated information together, and
>>unfortuantely this is almost gone from our sorry excuse for an
>>educational system.

>>But the problems we face are often far more complex than our physicians
>>have learned to handle, and a bureaucrat is usually even worse.  There
>>is, in effect, a massive conspiracy to keep those of us who must use
>>medical process from acquiring the information, and in many cases from
>>making intelligent choices.  If anything, the situation is getting much
>>worse, and if the regulation mania gets worse, we will only get such
>>medical care as the bureaucrats are willing to permit.

>You are confusing two issues here.  One is the difference between
>scientific medicine and folk or alternative medicine.  None of us doubt
>that the latter possesses some beneficial treatments.  Scientific
>medicine has adopted many of them.  We only require that they can be
>proven scientifically to work.  We discourage our patients from seeking
>treatments that are unproven.  To do otherwise would be hypocritical and
>a disservice to our patients.  You can call this a conspiracy if you
>like.  By the way, most of us see our roles as health consultants, not
>dictators.  We tell patients what we recommend, often providing several
>alternatives.  It is then their place to decide whether to follow our
>advice or not.

As to the first issue, I am afraid you misunderstand both what I said and
also what is involved in "scientific" medicine.  I am putting on my
professional hat here.  The problem in any form of inference is that
of decision making under uncertainty.  Now this problem, even simplified
to the standpoint of a self-consistent person with infinite computing power,
has only been reasonably treated in this century, and from the most general
statement of the problem, I am credited with the first general result (1948).
But even in the last century, the idea that a simplified model could be
CORRECT, as distinct for APPROPRIATE FOR USE, came to be recognized.  It
is never the case that the proposed action has NO effect, so that the usual
testing is just plain wrong.  And in the cases in the biological, social,
and psychological sciences, where the accuracy of the simplified theory is
much worse than that of the data, this problem gets very difficult, and
even relatively simple problems show unexpected complications.

For example, I do not need any data whatever to know that saccharin has
an effect on cancer rates, or that vitamin C has an effect on longevity,
or even that the most disreputable quack treatments have an effect.  The
problem is how much is the effect, is the effect different for different
individuals, how does it interact with other things, etc.  The problem is
not an easy one which can be handled with a simple statistical package.
In addition, in quite reasonable problems, such as can be encountered in
everyday medical practice, the resolution of the problems with the available
information may involve computations, the results of which can be very much
counterintuitive.

We must use methods appropriate to the information available, not just
those appropriate to the simpler problems of physics and chemistry.  And,
in addition, we must take into account that "one man's meat is another
man's poison", and that individual preferences, even for supposedly
identical individuals, differ enough to affect the appropriate action.

I agree fully with your last three sentences, but I have yet to encounter
a physician who does this.  I suspect that even those who try fail because
of their lack of familiarity with the range of possible actions, of which
much must be laid to the medical school training, and the training of
interns and residents.

>The second issue is the one of payment.  No one is forbidden to visit a
>chiropracter, reflexologist, faith healer, or any other kind of
>alternative practitioner.

No one is forbidden from visiting such, but there is much that they are
forbidden to do, including giving specific advice.  A professor of nutrition
may make materials available to me, but is not allowed to give advice by law.
There are many actions which are illegal, even if all the cards are laid on
the table.  Most of them should not be so.  In addition, there is effectively
a conspiracy by government regulators to make information not available.
I have no way of finding out the information about a drug which I would
consider appropriate for an intelligent decision, nor does a physician have
access to that information.

                The "bureaucrats" just won't pay the bill.
>They are responsible for keeping costs, and as a consequence, taxes and
>insurance premiums, down.  They want to be sure that the money is spent
>wisely, so they require that any treatment which they will cover be
>scientifically proven.  Seems sensible to me, in principle at least.  In
>the rush to tighten the lid on costs, however, Medicare and Medicaid are
>now refusing to cover some things (mainly diagnosic tests) that we in
>the medical profession believe are reasonable and necessary to diagnose
>and treat certain illnesses.

This is a consequence of the anti-insurance procedures.  I know of no other
area where anything called insurance covers normal costs, and almost ignores
extraordinary situations.  Prepaid medical care, whatever it is called, is
a socialist conspiracy.

                This is "rationing."  Since this is
>intensely unpopular, the government tries to call it something else.
>It seems inevitable that it will get worse.  You can be pretty certain
>that as the screws are tightened, alternative treatments are likely to
>be squeezed out first.

You have now explicitly stated the conspiracy again.  Together with laws
against "practicing medicine without a license" and laws restricting the
availability of chemicals (the FDA wants to ban substances solely because
their medical effectiveness has not been "proven"); I doubt that anyone
reading this group will live long enough to find out whether, for example,
the doses of vitamin E now recommended by many reputable physicians are
particularly effective, and unless we are going to do massive experiments
on slave populations, whether they have dangerous side effects.
--
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: [phone]
[e-mail] (Internet, bitnet)
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