Thomas H. Jones, MD
Neurosurgeon and
Medical Director,
Santa Barbara
Neuroscience Institute

 

 

Dear Colleagues,

 

All physicians know about "bloodletting." The practice of phlebotomy began well before Hippocrates, in the 5th century B.C. The practice flourished during the Middle Ages, lasted through the "age of enlightenment" and came to America on the Mayflower. George Washington died with a throat infection in 1799 after being drained of nine pints of blood over 24 hours. Only in the late 19th century was this practice labeled quackery.

 

Each subsequent generation of physicians, including our own, has been quick to condemn such examples of poorly scrutinized medical empiricism. Despite our self-assurance that we are practicing on a higher plane, we only to have to take a cursory look at the recent history of popular medical treatments to debunk this myth. Many mainstream treatments, including pericardial poudrage for angina, internal mammary artery ligation for angina, arthroscopic knee "washout" procedures for knee pain and gastric freezing for peptic ulcers, were all popular and accepted by the establishment until disproven by randomized, controlled trials. Intradiscal heating for low back pain was touted on our evening news, used to treat 400,000 patients and resulted in the physician owners of Oratec selling their company to Smith & Nephew for $310 million before three randomized controlled trials showed the treatment to be no better than no treatment.

 

 

 Fall 2012 issue:

•    Director's Letter
•   

Stroke Prevention

•   

Case Report

•   

Neuroscience Nursing

•    Frontotemporal Dementia

•   

Case Report

 

Chronic Low Back Pain

•   

Case Report

>> Download PDF

 

 

Nortin Hadler MD, an academic rheumatologist at UNC, has written two books that take on our medical establishment and criticize the way we are practicing medicine in this country: Worried Sick: A Prescription for Health in an Overtreated America and Stabbed in the Back: Confronting Back Pain in an Overtreated Society. He talks about "type II medical malpractice" as doing something very well that is not needed in the first place. Most worrisome are his examination and condemnation of standard therapies that we currently consider among the bedrock treatments for common diseases. He questions the standard use of statins, the definition of hypertension, the use of terms like the "metabolic syndrome." He examines the conflicting science behind prostate cancer screening and care, and breast cancer screening and treatment. He, I think correctly, states that the "theory that is supported by authority is likely to emerge as the truth of the moment. This has been called eminence-based medicine." I think he would describe himself as a "skeptic fomenting controversy," and would add that "controversy is the fuel for progress."

 

The delivery of health care in this country now costs more than $2.5 trillion a year, while annual insurance premiums average $8,500 for every man, woman and child. We are headed over a financial cliff unless we, the physicians, become better stewards of these resources. I am certain that Dr. Hadler would ask that we become skeptics and bring our medical training to bear on redesigning our treatments to better adhere to evidence-based medicine. In those all-too-common cases that lack good evidence to guide us we should usually choose the less expensive treatment option. Continuing to follow the herd will no longer adequately serve all of our patients.

 

   

Sincerely,

Tom Jones, MD

   

 010213