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High risk for a heart attack? Might be better if your cardiologist is away at a conference

Researchers at Harvard wondered if high risk heart patients were more likely to die if they turned up at the hospital during national cardiology meetings when most of the experts are not around. Instead, it turns out that mortality rates during the conferences fell from 70% to 60%. Oops.

Who do you want to see if you’re sick? In this situation, possibly not your specialist.

High-risk patients with certain acute heart conditions are more likely to survive than other similar patients if they are admitted to the hospital during national cardiology meetings, when many cardiologists are away from their regular practices.

Sixty percent of patients with cardiac arrest who were admitted to a teaching hospital during the days when cardiologists were at scientific meetings died within 30 days, compared to 70 percent of patients who were admitted on non-meeting days.

“That’s a tremendous reduction in mortality, better than most of the medical interventions that exist to treat these conditions,” said study senior author Anupam Jena, assistant professor of health care policy at HMS, internist at Massachusetts General Hospital and faculty research fellow at the National Bureau of Economic Research. There is substantial ambiguity in how medical care is practiced, particularly for these complex patients, he said. “This study may help illuminate some of those gray areas and suggest ways we can provide better care for those high-risk patients.”

To be fair, this only applies to one very specific subgroup of patients, and hopefully this red flag will help us figure out what needs to change. Possibly expert cardiologists are doing a bit too much to try to help their patients. But don’t feed me that line that experts are always right:

The results of the study are published today in JAMA Internal Medicine.

Along with collaborators at the National Institutes of Health, the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Los Angeles, and the RAND Corporation, Jena compared similar populations of patients treated at teaching and nonteaching hospitals during American Heart Association and American College of Cardiology meetings and on matched dates immediately surrounding those meetings. They looked at survival rates of high-risk and low-risk patients with heart failure, heart attack and cardiac arrest.

While survival rates at teaching hospitals went up during meetings for high-risk heart failure and for cardiac arrest, there was no difference in mortality between meeting and non-meeting dates for patients with high-risk heart attack or for low-risk patients with any of the conditions studied. There was also no change in mortality rates for any patients for any of the conditions in nonteaching hospitals.

“We don’t have the full set of answers about what works best in these cases, but the evidence suggests that a less is more approach might be best for higher-risk patients with these conditions,” Jena said.

The researchers found that certain intensive procedures were performed less often on the high-risk patients in the study during meeting dates than outside meeting dates.

One explanation for these findings, the researchers said, is that physicians who don’t attend the conferences take a more conservative approach for high-risk patients; another is that the physicians who stayed behind were reluctant to perform intensive procedures on another physician’s patients while that doctor was out of town. Survival rates might be higher because, for high-risk patients with cardiovascular disease, the harms of intensive procedures may unexpectedly outweigh the benefits.

High-risk patients are typically older people with complicated medical histories and clinical profiles that make them especially vulnerable to the illnesses studied and, perhaps, to some of the more intensive methods used to treat these conditions.

Little is known scientifically about the benefit of many interventions for high-risk patients: A 50-year-old overweight smoker having a heart attack is a classic candidate for certain intensive interventions, such as coronary artery stenting, based on the effectiveness of those procedures in clinical trials conducted on other similar patients. More complex, higher risk cases might not benefit from or tolerate the same interventions in the same way.

Clinical trials teach us a great deal about how to treat a certain subset of patients, most often low- to moderate-risk patients, Jena said. Many trials do not enlist the highest risk patients, and it may be incorrect for physicians to assume that patients of all risk levels should be treated the same.

“Our study provides some evidence that treating high-risk patients the same as lower-risk patients may be bad medicine,” Jena said.

The researchers speculated that differences in survival rates were detected only among patients treated at teaching hospitals because of the higher concentration of physicians from a teaching hospital who would be likely to attend a scientific meeting. Detailed information about the demographics of attendees at the meetings was not available for the study.

The study was inspired by prior research showing that patients hospitalized on weekends and late at night have worse outcomes than those who become ill during regular office hours, due to lower overall staffing levels during off hours. What might happen, the researchers asked, when overall staffing levels remained the same but the number of physicians dropped?

Every year, thousands of physicians attend scientific meetings. The researchers chose to study cardiology because cardiac conditions are often acute, with sudden onset, and a patient’s treatment cannot be easily rescheduled to accommodate a physician’s travel schedule. The researchers said they expected to find that patient outcomes were worse when physicians were out of town and so were surprised by the results of the study.

Anupam B. Jena, Vinay Prasad, Dana P. Goldman, John Romley. Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings. JAMA Internal Medicine, 2014; DOI: 10.1001/jamainternmed.2014.6781

[Science Daily]

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102 comments to High risk for a heart attack? Might be better if your cardiologist is away at a conference

  • #

    Research clearly shows that there aren’t enough big conferences for the expert cardiologists to be attending.

    140

  • #
    John de Melle

    Here, in France, most GPs and many hospital doctors are on strike from 25 Dec until 2 Jan.

    It will be interesting to see if the death rate is higher, lower or the same as usual.

    The results may be somewhat slewed as we have had a very cold spell during that period.

    100

    • #
      Matty

      I remember in 1984 when it was a very cold early winter across Europe. We heard that in France they were opening the Metro in Paris at night to allow the homeless to shelter from the intense cold. In London they were talking about it. I particularly remember it because every day I was walking past that then icon of homelessness, under the arches at Charing Cross Station, on my way to work in the Underground.

      70

  • #
    Jaymez

    This may be because the specialists have told their patients they are going to be away. They have instructed patients to go to the nearest hospital if they have any problems rather than call them. But when patients know their cardiologist is available maybe the waste valuable time trying to get on to them?

    70

    • #
      diogenese2

      Jaymez, you may be onto something in respect that in these conditions TIME to treatment is the biggest single determinant of outcome. The paper is pay walled so that(crucially) sample size and choice are not available. Jo has covered all the core information in the article.
      It could be that in some critical cases, the interns prefer to delay while consulting the specialist whereas, in absentia, just get on with it. This happens on many levels.
      At a minimum of 60% 30 day mortality these are seriously sick people.

      70

      • #

        The paper suggests the opposite — that perhaps the “left behind” staff err on the side of doing nothing, rather than putting eg. a stent in. It could be that in a high risk patient the odds of a stent being useful are different to low risk patients.

        I’ve read the suggestion recently that stents may not help as much as thought because in long slow arterial narrowing, the body “grows” new blood vessels around the narrow part to feed that part of the heart. It is apparently just the sudden blockages from loose material that the heart can’t deal with. If that’s true, it would change the cost benefit of surgery that deals with long slow buildups significantly.

        52

        • #
          Mark D.

          Jo, the saying “if you have a hammer everything starts to look like nails or if you have a scalpel everything looks like it needs to be cut” starts to have wisdom here.

          I doubt high ranking cardiologists are doing stents. That is kids play compared to open heart, bypass and valve replacements. It is likely that the high ranking ones are the ones going to conferences.

          40

  • #
    Leonard Lane

    Interesting article. But I would take medical news from the US which might lead one to conclude that fewer procedures and fewer specialist visits are better for the patient. We have suffered a blizzard of media stories related to Obamacare with some results following:
    1) Women should have fewer mammograms (which was hotly disputed by the professional organizations such as American Cancer Society, etc.),
    2) Fewer prostate exams and fewer prostate cancer procedures (also disputed), and
    3) Much fewer other preventative medical steps.

    Obamacare is in trouble. The middle class was supposed to sign up by the tens of millions to cover those in the lower classes who would get free or highly subsidized care. Instead of 40 million sign ups across all income classes, the total is somewhere around 5-10 million or so in the predominately lower income levels. Taking $750 billion our of Medicare (old age medical care paid in part by employee deductions and monthly premiums) was not enough.
    Now with the 2016 election coming up, the Democrats do not want to drastically increase the already high Obamacare taxes. Now they are heavily advertising and 2015 starts the penalties for those who lack their own health insurance but do not sign up for Obamacare. Penalties will increase each year. In addition, the health care advisory panels (Death Panels?) are really pushing for fewer medical procedures and reduced preventative care to save additional money.
    Therefore the heart attack study may be valid or it may be propaganda much like the global warming propaganda. Until it is confirmed in other countries without health care systems in financial trouble, I would recommend caution in believing the results.

    114

    • #
      KinkyKeith

      Great analysis.

      Politicians love messing with other peoples hard won tax payments for all sorts of vote catching ideas thought up by the “Compassion Industry”, why should health care input be any different.

      On TV there has been a bombardment of advertising for compassion projects like giving poor African families clean water etc with full details of how YOU can help for just $33 per month.

      Where this money goes is anybody’s guess but you can be certain that 99% will NOT reach the advertised targets.

      The best intervention in many African countries would be to have the UN detain and incarcerate African Warlords , presidents and hangers on and get these countries back to a sensible path of gradual community development which proved so effective in the USA and Australia as examples.

      Handouts don’t work and things like the Obama Care just make decent citizens lose faith in their own democracy to the point that they ask, why bother, why work hard and save when politicians just keep on grabbing and grabbing.

      KK

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      • #
        Binny

        Very true what Africa needs more then anything is ‘boots on the ground, guns in hand’ to enforce the rule of law. Throwing money over the border just makes the bad guys more powerful.

        As far as this study goes – Focusing on just one variable is a dangerous game. The most likely scenario is ‘high risk’ procedures are not being done while the experts are away. No one is dying, but they’re not being cured either.

        40

    • #
      NielsZoo

      Nice take. The other “fun fact” about Obamacare’s miserable “healthy” enrollment figures is that something on the order 4 million folks didn’t renew their policies. Apparently there is no option to “quit” so people were just not renewing… but not so fast. HHS or the IRS decided to “automatically” re-enroll everybody so at least 2.6 million people (or more) that didn’t want to continue in the program are forced to anyway plus the 1.5 million who did.
      Just another day in the glorious Banana Republic that used to be the USA.

      20

  • #
    jorgekafkazar

    Sometimes an “expert” is the wrong person to call. That certainly applies in climatological circles. I’m not much of a believer in “alternative medicine,” but here are some stats re a cholera outbreak in London, 1854:

    “…Of the 61 cases of cholera treated [at London Homeopathic Hospital], 10 died, a percentage of 16.4; of the 331 cases of choleraic and simple diarrhœa trated, 1 died. The neighbouring Middlesex Hospital received 231 cases of cholera and 47 cases of choleraic diarrhœa. Of the cholera patients treated 123 died, a fatality rate of 53.2 per cent…”

    Despite the facts, orthodoxy prevailed in best English fashion:

    “…the report of the Board of Health was presented to Parliament without the slightest reference to the London Homœopathic Hospital…”

    A complaint was lodged and the inevitable disingenuous reply generated:

    “…by introducing the returns of homœopathic practitioners [the Treatment Committee] would not only compromise the value and utility of their averages of Cure, as deduced from the operation of known remedies, but they would give an unjustifiable sanction to an empirical practice, alike opposed to the maintenance of truth and to the progress of science.” –THE RIGHT HON. LORD ROBERT GROSVENOR

    Where do the English get these people??

    Source: Mr. Peter Morrell’s rather excellent site, http://homeoint.org/morrell/londonhh/outbreak.htm

    70

    • #
      KinkyKeith

      Hi Jorge,

      An interesting piece.

      Stats like the ones quoted are always a little dodgy and really not too useful but the reply as you pointed out, was full on “Trust Me” I am the appointed one.

      The different stats from the two sources could have resulted from many factors , not limited to the self selection that went on where some people may have had a very strong inclination towards homeopathy rather than standard treatment.

      KK

      30

      • #
        jorgekafkazar

        Yes, there very well could have been other influences that are not clear to us now.

        And yet if you read the source, the hospital was visited by a sceptical allopathic doctor who verified that the cases under treatment there were, indeed, cholera, which removes the most likely error in the comparison.

        I suspect the LHH cases were, in accordance with homeopathic principles, given more hands-on attention and less rigorous treatment with drugs and chemicals. To be clear, I think the unknown factor was that Middlesex Hospital was killing their patients by ignorance, just as The Gullibles are killing people now via food-for-fuel starvation, denial of clean water and power, banning of DDT, etc.

        But I find it very hard to wave away the disparate mortality figures of 16% vs 53%, a ratio of three to one in favor of homeopathy. Compare that to the study discussed here, where the survival ratio (presumably significant) is a mere 1.17 to one. I’d say, given the numbers, the LHH result was a lot more significant. Cholera is not a respecter of self-selection alone; there would have to be another mechanism at work to explain 3:1 where we should, in my opinion as a sceptic and the son of an MD, expect 1:3 or 1:4 in favor of allopathy.

        Thus I think this is another good metaphor for the current “Trust us; we’re scientists” disaster we’re facing on a much larger scale than 1854 London.

        30

        • #
          Graeme No.3

          One treatment for cholera is merely to keep the patient hydrated until the diarrhoea ends. This may have been the homeopathic approach, whereas the “official” regime was drugs of unknown toxicity and little effectiveness.

          60

          • #
            jorgekafkazar

            I think you’re right. It could be that simple.

            30

          • #
            Byron

            Back then , the big advantage that homeopathic medicine had over regular medicine was that it did absolutely nothing .

            Regular medicine on the other hand liked to dose people up on fun little things like calomel which was used for treating everything from teething pains through to gout and for things like cholera the treatment was to dose heavy and often . Calomel is now known as Mercurous Chloride……

            20

    • #
      ian hilliar

      The first question I would ask is “How sick were the cohort in the Naturopathic Hospital?” One would not have expected acutely ill people to be admitted there. Google “Homeopathic ED” on youtube!

      20

      • #
        KinkyKeith

        That’s the point Ian, the two groups of patients were never screened initially to assess.

        A more realistic assessment would have been to have all patients turn up at the Hospital and then every second one be sent to the Homeopathic clinic; or the other way around.

        This would have shown up differences in treatment as mentioned by Graeme.

        Stats are only as reliable as the rigour of the set up.

        KK

        30

      • #
        sophocles

        It’s quite possible the LHH was hydrating its patients with clean, uncontaminated (distilled) water.

        The physician John Snow was able to prove cholera was transmitted through contaminated water. At the time, this was not known so the survival rate may have been dependent on each organisation’s water source(s).

        This finding kick-started the investment in London sewers and clean water distribution.

        30

    • #
      janama

      I had an interesting experience a couple of years ago. A friend suggested I visit a local Health centre and get one of their readings. The gear consisted of a PC hooked up to external hardware. The unit had two cables, one was wire with a solid brass tube, the earth, the other was the probe. I held the earth in my left hand whilst the practitioner probed each acupressure point on my right hand and the machine took readings of each one. I then swapped hands and read the left hand. It was then repeated for my feet.
      The practitioner then printed out a chart showing the significance and status of each pressure point.
      She then placed a bottle of distilled water on the machine that then transferred the “vibe” (for want of a better term) to the homeopathic bottle. I then took 12 drops twice a day under my tongue for a couple of weeks.
      Whilst we were doing the tests the practitioner asked if I’d had any problems with my kidneys and I replied I hadn’t – she smiled and said well lets see what happens.
      Within 3 days of taking the drops I discovered I couldn’t pee! After a very stressful day I finally passed a kidney stone and for the rest of the week I kept passing stones so the base of my toilet looked like a sand pit.
      The friend that directed me to this treatment had gone there with extreme eczema and had spent 5 days in the hospital having tests with zero results and very confused and baffled doctors. Yet 2 months after taking the homeopathic treatment prescribed by the machine the eczema was fully cured.

      62

      • #
        Leo Morgan

        Empirical Science, correctly performed, is excellent at separating reality from coincidence, wishful thinking and self delusion. It’s occasionally even useful at detecting practitioner fraud.
        And never, ever, has homeopathy passed any test performed with attention to scientific methods.
        I do not believe they have a useful diagnostic tool with what sounds like the scientologist’s e-meter.
        “Are your kidneys alright? Well, we’ll see” sounds like Gypsy fortune telling. “Keep taking the pills until your eczema goes away” sounds like the African Witch Doctor “Keep praying until the drought goes away” – and the drought went away only two months later!
        This is a sceptical site. If things were exactly as you say, well I’m glad you came through your experience okay. But your anecdote is not compelling scientific data.

        30

        • #
          janama

          Fair enough – I just presented it as one man’s experience. Never intended it should be taken any other way.

          50

          • #
            Leo Morgan

            I love the civility of this site, even when we disagree. Or, as in this case, agree :)

            51

          • #
            C.J.Richards

            The Doctor may well have sensed something from their readings to suggest kidney stones. The rest may just have been theatre bit that may be presumptuous.

            10

          • #
            John Knowles

            Your description sounds rather like Computerised Electro-Dermal Screening which I’ve seen in operation under the brand-name “LISTEN.” I know an osteo doctor with one and a local orchardist with obvious liver cancer attended her clinic for an assessment. In two hours the Dr was able to provide the orchardist with an almost identical diagnosis to Windsor Hospital NSW except they took three days of tests to get there.
            The process sounds like mumbo-jumbo yet my wife has used the system on patients with some apparent success and that rather confounds my conventional chemical view of healthcare. Perhaps it was a placebo effect.
            In your case it would be difficult to medically justify how pure water could psychosomatically illicit a kidney stone expulsion and I am inclined to leave my mind open to the idea that water can somehow “carry” vibrational energy of another substance.
            Clearly one can dissolve most kidney stones with complex chemicals found in Hydrangea root, Gravel root, Marshmallow root, Goldenrod tincture(be careful it’s a bit toxic), ginger root, and Uva Ursi. You also have to drink water that has had Parsley boiled in it (diuretic). The witches brew tastes pretty much like soil so you need a strong flavoured cordial and chilling it numbs your taste-buds.

            How pure water could affect your kidneys really interests me.

            00

            • #
              KinkyKeith

              “I am inclined to leave my mind open to the idea that water can somehow “carry” vibrational energy of another substance.”

              ??????????

              A lot of pure water may dislodge stones, but drops ??????????????????????

              The well known placebo effect will not dissolve stones!!!!!

              KK

              10

              • #
                John Knowles

                I agree, this flies in the face of logic but I’ve seen a few similar cases.

                10

              • #
                KinkyKeith

                John I have no doubt that there are some methods of assessment and treatments in Homeopathy which are based on sound experience and past practice and actually work.

                The problem is that other very very marginal concepts like ” water carrying vibrational energy ” are a little off the planet and do not help the reputation of Homeopathy.

                I can see a possibility of some herbs altering the pH of the body and helping with gallstones but have no real knowledge of it one way or the other; just the possibility.

                Chiropractic is another similar treatment system.

                Have experienced the amazing and the downright frightening in that business.

                Caution to the user would be the watch word in all treatments.

                KK

                00

        • #
          jorgekafkazar

          All right, here’s another anecdotal case. I once went to the office of a Dr. Nabongalele, a native medical practitioner. Based on my symptoms, he said I might have a kidney stone. An xray taken at a clinic down the road showed a 9mm renal calculus. The doctor sent me to a local apothecary to get a bottle of clear liquid. I followed directions and, the next day, another xray showed no kidney stone. Would you go to Dr. Nabongalele if you thought you had a kidney stone?

          31

          • #
            KinkyKeith

            Obviously this stone was dissolved and not passed.

            KK

            00

            • #
              jorgekafkazar

              Obviously. The question really is, how did he know what to prescribe and why isn’t every doctor in town using it?

              00

              • #
                KinkyKeith

                Hi Jorge

                One line of thought might be to ask; was the X ray actually of you or someone else from earlier?

                I know. I’m a cynic.

                KK

                10

              • #
                John Knowles

                Many already are and once your kidneys are operating properly your whole body can begin to excrete toxins and heal. My guess is that there are many different type of stones and many different herbal solutes.
                On the Sunday before Christmas I had to run my neighbour 40mins to hospital before dawn as she had intense kidney pain (worse than childbirth she said). She regularly drinks very strong coffee and also takes Vit D pills upon advice of an alternative quack. She also gets more than enough UV to make her own Vit D. Unfortunately the oxalates in coffee combine with excesses from the Vit D pills and create kidney stones but she’s not interested in cutting out either coffee or Vit D pills.
                Her scans taken after injection of dye showed some calcification and my reading indicates that the Loops of Henly would be partially choked with sharp crystals of X-ray invisible material by this stage. Strangely, the hospital doctor gave little advice to the patient yet my wife who sometimes runs the Emergency Dept, says he is a very thorough doctor.
                I guess medical school does not do herbal medicine studies. Herbs are bad for the modus operandi of the big pharacuitical mobs who run medicine.

                10

        • #
          sophocles

          never underestimate the power of the Placebo Effect. It works best if the patient is able to convince themselves the treatment will work, consciously or unconsciously.

          20

          • #
            KinkyKeith

            Soph

            Not sure that placebo could help in getting rid of kidney stones.

            KK

            30

          • #

            sophocles, the amazing thing is that the placebo effect even works when people know it is a placebo. As long as people in white coats say that a sugar pill can treat real diseases through a scientific mechanism called the “placebo effect”, the sugar pill still works.

            10

            • #
              sophocles

              yes, I know. That’s part of what I meant about self conviction, and I didn’t want to stretch too many people’s credulity too far, so thanks for adding it.

              My doctor says he `swears by it, because it achieves many improvements and cures which would be otherwise inexplicable.’ Since then, I’ve been careful to question him as extensively and thoroughly as I can, when he’s prescribing for me. He knows why, too, because he tells me `no, it’s not a placebo this time.’ Next question is obvious.

              10

    • #
      Lewis P Buckingham

      Recently it was found that cordial was a good electrolyte replacer for diarrhoea.
      Perhaps the homeopaths gave their patients an infusion that contained salt and potassium as well as a sugar such as fructose from some fruit and so the patients were better hydrated.
      Modern rehydration has well and truly caught up.

      00

  • #
    handjive

    One thing is for certain.

    Don’t take cardiac/medical advice from 97% consensus climate scientists.

    In 2012, responding to an op-ed in the Wall Street Journal (WSJ), “No Need to Panic About Global Warming” (Jan. 27),

    38 Doomsday UN-IPCC climate scientists co-signed a ‘smear’ op-ed “Check With Climate Scientists for Views on Climate” that begins:

    “Do you consult your dentist about your heart condition?”

    Answer: Yes.

    July, 2014: Gum disease linked to chronic health problems
    Researchers have found that treating gum disease (periodontal disease) may reduce heart disease, diabetes and other conditions.
    https://theconversation.com/gum-disease-linked-to-chronic-health-problems-29768

    (From personal family experience, this information was known in at least 2007)
    . . .
    How many of those 38 climate scientists are on record denying the ‘pause, or ‘hiatus’ in global warming, only to have written peer-review papers attempting to explain the pause since?

    81

    • #
      Lord Jim

      “Do you consult your dentist about your heart condition?”

      Climate science is not settled, so the appeal to authority fails in any case.

      Arguments as to the validity of the science must be settled on the facts.

      52

    • #
      MacSual

      Years ago while working on our cattle a vet told my Dad to get that little sore on his face seen to…it was a cancer.

      50

    • #
      janama

      That was the basis of the Howard dental program where the unemployed and pensioners were granted $3,000 dental checks if prescribed by a doctor who had determined that they suffered from gum disease – so it was well known in the Howard era.

      50

  • #
    bemused

    Could it be that ‘experts’ fall into a habit of doing what they’ve always done and not really taking individual cases on their merit, but more or less assuming one hat fits all?

    40

    • #
      Matty

      Experts may know or have forgot, everything that’s been taught, but uncertainty should keep you careful.

      10

      • #
        jorgekafkazar

        They believe they are infallible. So you see they have a lot in common with the Pope.

        20

      • #
        Robert

        Ask anyone who has had to go through an electrical safety course which group has the most fatalities and incidents regarding electrical accidents. It is the experts who have been working with generators, fuse boxes, system wiring etc. and have grown complacent.

        “Trust me I know what I’m doing” is all well and good until a crucial step is skipped because “it’s always worked before” or something as simple as checking that the power is off isn’t done for whatever reason.

        The “experts” who changed the water pump on my old vehicle never changed the bypass hose since removing it involved more time and work than simply disconnecting it from the old pump and reconnecting it to the new one.

        Unfortunately that also means they couldn’t properly inspect a good portion of it and it began leaking from there. I had them do it so I wouldn’t have to deal with draining the radiator and either reusing or having to properly dispose of the old coolant myself, and generally not wanting to deal with the mess the job would be. In the end I had to do it anyway so I could replace the hose they never replaced to fix the leak that developed because a section you couldn’t see without removing it had rotted from age.

        I took it to “experts” not because I couldn’t do it myself, but because I didn’t want to do it myself. In the end it was apparent that my “work ethic” with regards to the job was stricter than theirs.

        30

        • #
          C.J.Richards

          Professionals eh ! Only in it for the money.
          Still, think what it would have cost were they to do the job properly ?

          10

  • #
    Matty

    While Climate Experts can’t have any such impact on the Climate, the Economy is another matter.

    41

  • #

    Reminds me of a JCUNQ systems engineering study of shipping in the GBR area, early 1990s I think.
    Ships were 35 times more likely to be involved in an incident if the pilot was on board.

    50

    • #
      Matty

      Surely you only have a pilot on board when in a tricky situation that would require one though ?

      40

      • #

        True. Other explanations: crew members may have their eyes open but don’t see anything because the pilot’s in charge, in the absence of a pilot and any official witnesses, minor incidents don’t get reported.

        30

        • #
          ROM

          Cock ups of great consequence occur in every profession.

          And as the last couple of posts above are on shipping, I wonder if any other posters have noticed the disappearance of the former seriously considered alternative design contender , the high technology Spanish submarine project as serious contender for  Australia’s Collins class submarine replacement project.

          Well it seems that somewhere in all the design calculations for the Spanish submarine project, some engineer somewhere in the design bureau put a decimal point in the wrong spot.
          So the Spanish Navy now has a very nice, high tech submarine near completed US$680 million prototype sitting around that is 70 to 100 tonnes overweight before it even puts to sea.
          Had it gone to sea and submerged it might never have come up again.

          Spain just spent $680 million on a submarine that can’t swim

          60

  • #
    TdeF

    This is the extreme emergency business, not cardiology. There are probably very limited options. So it is very different to the medium to long term treatment of stabilized patients. A large proportion of people with a first heart attack do not survive, so it is about rapid emergency treatment with no room for trial and error. A General Practitioner is not going to cope well in a trauma situation where the nursing staff and ambulance people are extremely experienced in moving quickly which is what is needed. Working from general principles is not good enough, you have to make instant decisions and have the resources at hand.

    Cardiology is more about long term health and quality of life and carefully weighted intervention for stabilized patients. Most doctors are not trained to deal with life and death emergencies as much as stabilized patients and subsequent treatment and surgery. What these numbers tell us may be that waiting for a specialist may cost time and lives and that action taken quickly is on average better than waiting for a senior second opinion.

    20

    • #
      TdeF

      If you survive that first often unexpected heart attack, your odds of survival thereafter are vastly improved in a modern hospital. Bypass surgery has gone from rare and risky to commonplace with high survival rates. A very large proportion of Australian adults are on statins to reduce risk and blood pressure reduction medication to prevent strokes. Heart valve replacements are becoming much more common and getting simpler and faster, more robust, less invasive and with a higher rate of success, far shorter recovery times and much improved quality of life and life expectancy. These are all the jobs of specialist cardiologist consultants and cardiac surgeons for whom conferences are critical with rapidly changing solutions.

      However that first heart attack or stroke where minutes and seconds cost lives still has a large element of luck and it is not the place for a consultant cardiologist, long term medication, maintenance or even surgery. It is down to the emergency staff in the place with the flashing lights and people running. Even then the options are very limited.

      Finally, the Cardiology conferences are real and absolutely necessary and nothing like the absurd luxury Global Warming conferences for public servants and climate opportunists in Lima who are dealing with an imaginary problem in a non existent emergency. The moral dilemma they face is that they know it.

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        janama

        That’s correct – I had a heart attack and the ambos were at my door within 5 mins (they were passing near my place at the time) and got the clot breaking pill under my tongue immediately. Followed up at the hospital with the proper procedure I survived. The cardiologist in Sydney who put in my stent said it was their fast work and correct procedure that saved me.

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        • #
          TdeF

          Stents have been amazing. So many people get them, even in outpatients. Quick and easy and so effective. Real lifesavers and people can return to their lives. Disseminating such information and especially techniques takes too long in journals and is much faster in conferences because it is a many to many experience. Why climate scientists needs conferences is beyond me. They have nothing to communicate, except how to work the political system.

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    Shane

    No one has yet mentioned the timeless 4 month israeli doctors strike with the coincident mortality rate drop.

    http://www.straightdope.com/columns/read/2741/when-doctors-go-on-strike-does-the-death-rate-go-down
    Etc
    Seeing that a lot of us here have deliberately eschewed the wearing of PC blinkers,surely it should start at least some to start thinking outside the box.

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      ian hilliar

      Good link , and an excellent summary. Happy New Year , Shane. And a Happy New Year to you , too, Jo!

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      Peter C

      it’s not really so surprising that mortality statistics sometimes show a drop during a doctors’ strike. What’s staggering is that a reasonable person could see such stats and for even an instant think: Holy crap, those doctors are killing us

      Really? Doctors strikes don’t happen very often. Doctors are too smart for that. But now we have a second paper and the results are two out of two!

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      • #
        KinkyKeith

        Hi Peter,

        Beware of the warmer influence.

        “But now we have a second paper and the results are two out of two!”

        Sounds a bit like ‘Meta-analysis” ?

        Not much use if the original papers were flawed, just compounds the error.

        KK

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      jorgekafkazar

      The apparent lack of increased fatalities in Israel may be similar to that in LA in 1976, where there were 11,000 fewer elective surgeries during the strike and thus fewer fatalities, typically between 50 and 150 for that many surgeries. In Israel, there may have been more fatalities for some conditions, offset by a drop in elective procedures.

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    A C of Adelaide

    Most amusing Jo,

    This is what I call real science Collect real data, propose hypotheses, then test them in real trials

    Not advance a hypothesis, torture the data until it “proves” the hypothesis, collect accolades.

    Here we have some data – now for the hypotheses to explain the data

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    MacSual

    I have chronic heart disease or in the proper vernacular – my jam tart is stuffed.
    last year I was hospitalised and a junior cardiac doctor took me off one of my meds,I improved overnight,so much so that i could walk up and down stairs,after three days the senior cardio doc decided that it wasn’t the meds that was the problem but me losing two kilos of fluid so he put me back on my old meds,whithin the hour my blood pressure fell my heart rate slowed(I normally have a low to good blood pressure 110/70) it promptly went to 95/60,but the specialist kept telling me it wasn’t the meds(one particular med).
    I have had very good treatment from the public hospital system but I have also received some pretty ordinary advice from doctors.
    Unfortunately medicine is suck it and see(pardon pun).
    The most important tool re-your health is the internet,the most dangerous tool is the internet,common sense in large doses is needed.

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    • #

      It’s also possible that concealed in these numbers are two conflicting sets of people. It could be that some of these patients lived because the docs didn’t do aggressive invasive and unnecessary treatment, and others died for the same reason.

      We don’t know if the absence made a life-saving difference to just 10%. It could be that it changed the outcome for a third.

      Unfortunately there is an element of art in treatment, and also luck. But a lot of people don’t want to know that, and may be better off in ignorance believing the “expert” is 100% right. The placebo effect is real. The calming effect of giving themselves over to a specialist may outweigh the advantage of being independent minded and taking responsibility. Though I can’t live that way myself…

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        Yonniestone

        Jo I don’t know if you’ve heard of or seen Derren Brown sometimes referred to as a psychological manipulator, he did a TV episode called ‘Fear and Faith’ where he conducted an experiment with people using different colored pills as placebos, the results were impressive.

        I quite like this guy he’s skeptical and likes to explain things in a scientific manner, also highly entertaining I recommend watching some of his shows and apologies if you already have.

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        • #
          KinkyKeith

          Jo and Yonnie,

          It has been a matter of fact,for a very long time now, that the placebo effect is real and substantial.

          There is one very heavily used medication which I understand from studies fifteen years ago, relied almost exclusively for it’s benefit on the placebo effect.

          The placebo in this case being the boost given the patient by interaction with the prescribing doctor and the act of taking a “beneficial” and “government approved” medicine.

          KK

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          • #
            sophocles

            Some drugs work on some people and not on others. This can make treatment of patients for some conditions somewhat difficult, and doesn’t help either the patient’s GP or the specialists! If you wonder why you’re being quizzed about ‘have you used …’ with some fishing for effects, then be prepared for less than spectacular results, and maybe a return visit.

            I found out the hard way that paracetamol as an analgesic does nothing for me, zero, whereas a low (100-130mg) aspirin is wonderful. (It’s low when compared with the 500mg tablets …) I’ve never had an upset stomach from using aspirin, probably because I don’t take large doses. One dose lasts me 6 – 8 hrs.

            I encountered a female locum with a sense of humour when I fronted at my regular doctor with a complaint which was also quite painful. She waved her magic wand (pen on prescription form) and told me to take some paracetamol for pain relief when needed. I told her it was a waste of paracetamol, could I use aspirin? She said aspirin was fine but might upset my stomach. I said it never had, and besides, paracetamol was developed to treat period pain (pointing at the label on a packet on her desk whereon it said in a bright read box FOR TREATMENT OF PERIOD PAIN). As I don’t have periods it doesn’t work for me.

            She reckoned that was the best laugh she had had that week.

            Apparently Paracetamol doesn’t work for about 33-35% of males.

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            • #
              TdeF

              The original analgesic, used by chewing the bark of the willow tree did upset the stomach. The invention was the conversion from a base to an acid. This was patented by Bayer in Germany and was a huge business around the world under the trademark Aspirin. During WWI Britain ignored the German patents and Aspirin manufacture was licenced, as in Australia to the Nicholas family chemists from St. Kilda. It made them very rich.

              In the battle for drug mass income, the story was spread that paracetemol did not upset the stomach and was better for children. However I found it useless for high fever, even dangerous. Children are admitted with paracetemol poisoning. This business of upset stomachs is used as an argument, but the list of benefits of aspirin are longer than those for garlic with its sulphur based antibiotic properties. People find for themselves as you did, how effective and fast acting it is. Personally until I see other evidence, aspirin remains the wonder drug, far better than paracetemol and exceeded in effectiveness only by modern antibiotics starting with Howard Florey’s penicillin.

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              • #
                KinkyKeith

                I have a recollection that aspirin was present in some sort of herb or grass gathered by people before farming became widespread.

                Apparently it was a natural component of diet and we may still have a need for the aspirin now missing from modern food intake.

                KK

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              • #
                sophocles

                KinkyKeith:

                Mints contain salicylates (spearmint and peppermint). I rather like teas made from these.
                Peanuts, too, which might account for some of the peanut allergies. Many plants and foods contain salicylates and an allergy to these is one heck of a problem to live with because they are present in so many of our foods. Even mushrooms (and I never say no to ‘shrooms!).

                Willow bark’s active ingredient is salicin. It also contains other compounds which are thought to supplement the salicin. See here for more info.

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              • #
                KinkyKeith

                Thanks Sophocles,

                Interesting rundown on old fashioned pain relief.

                So the basic ingredient, salicylates, is present in more than just “a herb or grass”.

                KK

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            • #
              Yonniestone

              No paracetamol doesn’t work for me either…period.

              I actually very rarely take any painkillers or medication mostly because I’ve never had a headache in my life, I mentioned this once before and I think people thought I was joking but it’s true!

              Anyway I hope everyone has a happy and safe new year’s so Merry new year Ha hahahahaha!

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            • #
              KinkyKeith

              Interesting.

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          • #
            jorgekafkazar

            And no side-effects!

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  • #
    ROM

    I regularly hear people complaining about the skills or claimed lack of skills of doctors and specialists.
    Even the larger urban centres with good medical facilities and a good pool of doctors and specialists to draw on are often criticized quite heavily by a large percentage of the population.
    It’s much, much worse medical skill wise in rural practices where there is no choice although the criticism is very muted as there are usually no other readily available medical options than the local overworked [ and now aging ] doctor doing his / her best for the local community .

    Being a now retired old grain farmer and having had to deal with biology and Nature [ of which humanity is just one part of ] in it’s raw forms all my working life and knowing just how perverse, unpredictable, non co-operative and unreliable anything to do with a biological life form can be when you get involved with Nature at it’s rawest, I have a very considerable regard for the medical profession and a good appreciation of the very real problems they have in not only trying to come to grips with the infinite in range problems of those biological entities, those patients they are trying to solve the health problems of but also, oft times, the frequent and somewhat in-coherency of those same patients when they are trying to explain their symptoms and problems.

    The medical practitioners of all stripes are after all humans with all the faults, foibles, strengths and etc of humanity just like the rest of us.

    So I often wonder about those who complain loudest and longest about doctors, hospitals and lack of skills and etc, just how successful and skillful they might be themselves in their own particular profession or craft and trade and if their customers are more than ready to complain about the service and skill set they have to put up with from those same complainers.
    Or perhaps their loss or gain of customers due to their own skills being good, bad or indifferent

    Of course like all professions there is a very wide range of practical skills in the medical profession which unfortunately we as patients have to sort through and hopefully find a doctor / surgeon / specialists that is skillful in the amelioration of our problem and are compatible in personalities and outlook on life.

    Compatibility in personality and patient confidence in their medical practitioner is an often overlooked aspect of medicine which can have a large effect on the recovery rates of patients who have or don’t have much confidence in their medical practitioner’s skills.

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    • #
      MacSual

      Country people know,an inexperienced doctor is better than no doctor.
      I have been hospitalised on numerous occasions and I have no complaints about the public health system(Victoria),some advice from some docs has been crook but overall they have done a good job,after all I’m still here when i should have kicked of my clogs years ago,I put it down to some good medicine and God,in the end if he says you’re stayin then you’re stayin but if He wants you,well make certain you have made a will.

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    Eric Worrall

    Back last November I almost died. I visited a doctor with what I thought was a nasty stomach upset, turns out I had a ruptured appendix, internal gangrene, and a 30% chance of dying.

    Thankfully they decided to keep me at the local hospital, rather than sending me away to the “specialists”.

    You see, the local hospital had someone very special – a Serbian surgeon, who had spent over a decade treating gunshot wounds in the Yugoslavian civil war. I had been incredibly, unbelievably lucky – I had been admitted to the one hospital in Australia where the lead surgeon had spent a good part of his career learning how to save people who had f*cked up gangrenous stomach infections.

    I lived, and now I’m really healthy – even the surgeon can’t believe how well I recovered, people who have this kind of problem are often disabled for life, or at least for many years. So I learned something else last November – the reason everyone on my dad’s side lives such a long time, is because of what I’ve inherited – a much better than average immune system, an immune system which fought gangrene to a standstill for almost a week, only started to lose the battle after at least 5 days, fought so well that I thought I had a mild stomach upset for most of that time, I didn’t even feel ill.

    So you can keep your university educated experts – I’ll take my surgeon, who learned his trade the hard way, any day.

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    Hasbeen

    When I had my first heart attack the Asian doctor at little Beaudesert hospital, treated me, dissolving the clot, & sorting me out. They could have sent me home then.

    Instead they then sent me to the cardiology ward of a major hospital, where I sat for 3 days, treated by nurses, with “stuff” stuck all over me, but never saw a doctor of any type. Perhaps they were at a conference.

    After 3 days I discharged my self, then was called in 2 months later for a stress test, another 2 months later for the dye test, & finally another 2 months later they stuck a stent in me.

    As I don’t have high cholesterol, my doctor kept taking me off the cholesterol medication, & I kept having heart attacks.

    It was only after the 3Rd that a cardiologist actually bothered to talk to me. We public are evidently too dumb for most of them to bother talking to us.

    She explained I was on cholesterol medication to consolidate the existing plaque in my arteries, to stop it flaking off, forming a clot, which blocked the 45% restricted arteries they did not think worth stenting.

    They must know something, since I’ve kept up the medication, I’ve not had another heart attack. Pity they don’t bloody well tell us, & particularly our doctors, what & why they prescribe stuff.

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    shortie of greenbank

    My father passed away earlier this year from cancer. Ultimately mistakes were made over the few years he had cancer, some were the seeking of natural remedies and non-professional advice early on. Another was the ignoring of a grumpy old doctor after early treatment success.

    There is one thing that did stick with me. Near the end of last year and beginning of this one shadows were seen on the bones from a scan, the treating specialist recommended a rather nasty concoction that is not often used due to the danger it possesses. Still with the situation it was determined by the specialist that this was most likely to save his life, he only had to talk it over with other specialists just to confirm and then they would go ahead. In the end they overruled him and my father was given a normal run of what was the same treatment he had already been given. The end of march he was believed to be in remission, he died in July.

    Group think prevails in specialist fields and may provide some benefits, but it may also lean far too much to the ‘softly, softly’ approach of minimal risk to the establishment rather than best patient outcome.

    Similar to Eric’s situation above my grandmother was taken to hospital for blood in stool. They were told it was because of her medicine without a proper check up and a few weeks later she was hospitalised while on holidays at tweed heads. They removed about 1m of twisted dead bowels.

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    • #
      Richo

      Hi Shortie

      Sorry to hear about your bad experiences with the medical system.

      I’ve currently survived 14 months with advances gall bladder cancer and have had some very mixed experiences with the system. The survival stats in my situation are not good reading.

      My advice is that if your gut feels something is not right get a second opinion. If your not happy with your doctor shop around if you can, however this may not be possible in regional areas. Look for a doctor who is busy and has a full patient list because it usually means that he is competent because his patients have survived. In my case I changed oncologists because my partner had lost confidence in the original doctor. I’ve found that cancer care nurses are very good advocates and don’t mind standing on a few toes in your cause.

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      • #
        shortie of greenbank

        Thanks for the response and good luck with the treatment Richo.

        I don’t overly have an issue with the medical system except we are at the point where too many just look at a chart or computer screen without physically looking at a patient (as in my grandmother’s case). I’ve had issues with GPs too ready to prescribe drugs for conditions that can be easily managed by referral to non-emergency type specialists.

        In my case gastritis from elevated stomach acid was too hard to treat for one doctor since I do not drink or smoke and eat reasonably well, refused giving any advice and demanded that I take nexium, a rather nasty antacid. Being a drug it naturally raises your acidity level in the body while also locking up b-group absorption i.e. damages the stomach and can lead to insanity etc. I researched information and settled on a strict diet for awhile that used alkaline foods (those that lower the acidity in the stomach) such as apples and apple cider vinegar with food. Dieticians and Nutritionists in this case could have also helped me instead just prescribing something to cover the symptoms.

        Some years later I visited a GP for extreme sinus headaches when I stand sending my eyesight green. The GP did a thorough examination, including eyesight, blood pressure(how many times these days do they even check that?) and asked many questions. He knew I wasn’t looking for a long-term drug, prescribed a short course (a few days) of very weak valium and then advised me to slightly change my sleeping habits to remove the chance of the problem coming back. Worked a treat.

        This may also happen in the cases of specialists where without looking at a patient properly, like in my first case, they already have a prescription done. Whereas a non-specialist has to build a case based on further information before they can act and prescribe a course of treatment. I prefer GPs who ask lots of questions and can explain why they think the course of action is needed.

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    Tim

    Maybe not so much medical procedures, but perhaps the over prescription of legal drugs is the reason they now kill nearly 38,000 Americans every year.

    http://www.naturalnews.com/033639_prescription_drugs_deaths.html#ixzz3NHpkNNaT

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    john karajas

    Somewhat apropos: Belgian politicians had trouble forming a new governing coalition after an election a few years ago. During this period of extended political instability the Belgian economy improved markedly because the politicians could not enact any new expenditure legislation.

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    • #
      Matty

      That’s the sort of thing you might expect to leave a country without any viable energy policy. The UK’s LibCon coalition of the last 4 years has managed that while in full control of the country.

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    C.J.Richards

    A Very Happy & Prosperous New Year to one and all at JoNova’s site.

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    Mal Rosher

    Just got out of hospital after minor eye surgery. Its a loooong time since I was last in hospital and times have changed. However hospitals are still full of sick people and to be avoided at all caosts

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    Roy Hogue

    Medicine is moving in a direction I don’t like. It used to be about treating your specific complaint, getting to the bottom of it and doing the job right. But now it’s moving toward making sure you eat, live and love in the politically correct manner — of course, you must do it all at the minimum cost to the system.

    As the VA (Veteran’s Administration) in America is today, so will be all of medicine tomorrow — if it isn’t there already.

    I was recently hospitalized for unexplained back pain and everyone who saw me brought along a small 4-wheeled cart with a computer on top. After a while I began to have visions of these things running up and down the halls at night when all is quiet, having a party, monitors flashing brightly as they tripped lightly through everyone’s medical records — wirelessly of course — looking for interesting tidbits about which to make jokes and small talk, while somehow getting their batteries refreshed by drinking some concoction of electrons from tall champagne flutes.

    They look exactly like the intelligent robots from several past sci-fi epics. Lord help us all. ;-)

    I was sent home with a full dozen prescriptions I could fill along with a packet of healthy living advice that I have yet to work up the nerve to tackle.

    10