A new study in JAMA surgery by Johns Hopkins surgeon Dr. Martin Makary has shown that arthroscopic surgery to trim the cartilaginous meniscus was no better than non-operative treatment for patients in their 60s.
There are a steadily increasing list of applications of the use of low level laser light in medicine. Now a group of researchers have devised a brilliant cancer fighting technique using nanoparticles and treatment with near infra-red laser light to provide a 5 day window during which cancer cells’ defense mechanism against chemotherapy is paralyzed.
A recent meta-analysis (an aggregation of many studies on the subject) showed about a 14% reduction in heart attack and 10% reduction in stroke risk... in people who ate roughly 40 grams (about 1.5 ounces) of cheese daily, compared to people who ate none or significantly more. 40 grams is about two slices of pre-cut cheese. The study, entitled Cheese consumption and risk of cardiovascular disease: a meta-analysis of prospective studies is one of many that have shown mild health benefits of cheese. This study shows how dangerous it is to condemn entire food groups, such as dairy products, based on limited evidence.
It is well known that Obamacare has resulted in accelerated increases in health costs. An interesting recent op-ed in the Wall Street Journal entitled “The Deception Behind Those In-Network Health ‘Discounts” explains how a little known provision of Obamacare incentivizes insurers to raise costs even more. The essential problem is easy to understand. It is simply that insurers make ever more money when health costs rise because they just pass the increased costs on to their enrolled insures, and keep a percentage of the premiums that these clients-patients pay. The higher the costs the more the insurance companies keep.
My mentor at Harvard/Mass General Hospital, Bert Zarins MD told me to always beware of “the triumph of technology over reason”. Skill and diligence on the part of health care providers is the most important element in quality care; and one of the problems with health care currently is money being spent on items that do not improve health. Now it appears that surgical robots may be part of that equation. A study from South Korea has shown that robotic surgery “was associated with prolonged operating time and higher hospital costs compared with laparoscopic surgery” for patients undergoing radical nephrectomy (kidney removal) for a renal mass with no benefit to the patient for that extra time spent in surgery. The adoption of new, and potentially unproven, technology is used as a marketing tool, because new technology, like new buildings, has commercial appeal to consumers. I am constantly approached by well meaning industry representatives appropriately doing their job to tell me about new technology from their company. However, it is important that I also do my job and not adopt them unless there is evidence that newer is really better. But, unfortunately, as more and more doctors are employed by hospitals, doctors have less and less say about what is offered to their patients, since hospitals often dictate how their employed doctors provide care. The physicians in South Korea are to be commended for providing important evidence that this costly technology is not better, at least in this instance.