[Medicine-for-people] Resist the Hype

Douwe Rienstra medical at olympus.net
Thu Aug 2 08:32:52 PDT 2007 

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Medicine for People!

August 2007
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Contents
  - Resist the Hype
  - Summertime, Scrapes, and Scratches

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Resist the Hype
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A patient comes to see me about a painful knee.  As I palpate it and 
test for restrictions in movement, he looks at me hopefully and asks, 
"Shouldn't I get an MRI?" or maybe he says "My wife says I should get 
an MRI."  I understand what this is about.  Like all of us Americans, 
my patient lives in a culture that reveres high-technology.  If he 
puts his knee in a big, powerful machine with screens and computer 
read-outs, he feels like he is getting the most advanced healthcare possible.

I sympathize with this feeling, but the truth is, the MRI does not 
have the power to heal.  With careful questioning and examination, a 
competent doctor can get a good idea of what is likely to be wrong 
with a painful knee. Most often, a therapeutic trial of 
anti-inflammatory drugs or herbs, with or without physical therapy, 
will return the knee to normal.  The one time out of ten that the 
knee does not get better, I refer my patient to an orthopedist.  If 
the specialist thinks an MRI will help, he can be sure your $1000 
goes towards buying the proper kind of MRI (Contrast or not?  The one 
millimeter resolution machine or one that provides even more accurate 
images?) The MRI itself will do nothing to heal the knee.   Bells, 
whistles, LCD displays and all, the only value of the test occurs 
when that skilled orthopedist looks at the test to help decide what 
treatment will help you most.

I believe the yearning for high-tech solutions both interferes with 
good medical care and contributes to the medical cost crisis.  We are 
a consumer culture, and we tend to think that healthcare - like 
computers or cell phones or beauty products or dish soap - is another 
commodity.  We're trained to look for the best product or the best 
deal available and we are attracted to what is new and technically 
advanced.  We see power and brilliance in the product and, 
unconsciously perhaps, we imagine that in buying the product we will 
absorb some of that power.  University of Washington professor 
Richard Deyo, MD, details this in "Hope or Hype: The Obsession with 
Medical Advances and the High Cost of False Promises".  He gives many 
examples of doctors and patients beseiged on all sides with 
commercial interests pushing the latest technological marvel.  We buy 
those marvels at our own risk, not just of our pocketbook, but of our health.

Good healthcare is not a commodity - it is a working 
relationship.  The process of medical care requires work by both 
physician and patient.  When you see that Olympic medal awarded, you 
know both the coach and the athlete have contributed their best 
effort.  They didn't look outside themselves to some shining product 
but focused on developing effective strategies and working together 
to carry them out.  Your medical relationship is like that.  The 
power lies not in a high-tech test, but in you to do the prescribed 
activity, to adhere to nutritional changes, to take medications or 
supplements.  The power lies in the doctor in arriving at the most 
accurate understanding. The power lies in your communicating and 
working together.  The power lies in using technology appropriately.

Don't let your doctor or other caregiver "hype" you either.  If you 
find yourself in a medical relationship where you cannot communicate 
and the doctor seems to keep all the power, then maybe you should 
consult another physician.

Recently I completed the book "Second Opinions" by Jerome Groopman 
MD.  Groopman tells about a severe backache he suffered as a young 
man and his hasty agreement to back surgery in hopes of a cure.  The 
cure never happened, and his back has hurt ever since.  With bitter 
experience, he's learned that he should have gotten a second opinion 
rather than jumping on the first measure offered.

Dr Groopman tells the stories of several people with perplexing or 
difficult medical problems, and how they obtained second (and third 
or fourth) opinions to help return to health.  In each case, the 
person did not take the white coat on the doctor as evidence of 
competence.  In each case, the person took power into their own hands 
to coordinate their own medical care.  In each case, the person benefited.

There are plenty of forces in our culture offering us mysterious 
power that comes from outside ourselves - the authority of the white 
coat, cure-all supplements, high-tech machines and tests.  Remember, 
the greatest power for health lies in your body's physiologic ability 
to heal both physically and emotionally. That power liesa in your own 
healthy choices and in a good working relationship with your health 
care provider.  Don't give up your power.   Resist the hype.

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Summertime, Scrapes, and Scratches
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Summertime is the time for scrapes and scratches.  When you are 
stocking that vacation medical kit, choose bacitracin as your topical 
antibiotic, not Neosporin.  Neosporin contains neomycin which can 
cause pain after application and, in some people, causes a 
rash.  Plain old bacitracin is much less likely to cause a rash and, 
being generic, is less costly.

Pfizer, the maker of Neosporin, has newer versions including 
Polysporin that do not contain neomycin.  See details at 
http://en.wikipedia.org/wiki/Neosporin .

In my view, a healthy child or adult with a minor skin infection 
obtains maximum benefit per buck with bacitracin alone, always 
remembering the good old hot soak 
(http://www.rienstraclinic.com/newsletter/2005/2005Aug.html#03 ).


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Medicine for People! is written by Douwe Rienstra MD, edited by 
Carolyn Latteier, and published at Port Townsend, Washington. 
Copyright August, 2007.

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