• Richard Smith: The case for slow medicine

    17 Dec, 12 | By BMJ Group

    The characteristics of health systems are complexity, uncertainty, opacity, poor measurement, variability in decision making, asymmetry of information, conflict of interest, and corruption. They are thus largely a black box and uncontrollable, said Gianfranco Domenighetti of the Università della Svizzera Italiana at a meeting in Bologna on La Sanità tra Ragione e passione (Health through reason and passion). The meeting was held to celebrate the life and work of Alessandro Liberati, the founder of the Italian Cochrane Centre, who died last year.

    Only 11% of 3000 health interventions have good evidence to support them, said Domenighetti. A third of the activity in the US health system produces no benefit, said a recent study in the New England Journal of Medicine. Half of all angioplasties are unnecessary. Some €153m a day is lost through corruption in health systems in the European Union. Four fifths of new drugs are copies of old drugs. Screening is creating diseases like ductal carcinoma in situ. Most doctors (80-90%) have taken “bribes” from pharmaceutical companies, although many may not see their free pens and lunches and subsidised travel as bribes (but if they are not bribes what are they?). Between 15% and 40% of articles in medical journals are ghostwritten. Half of clinical trials are not published, and there is systematic bias towards positive results, hence suggesting that treatments, usually drugs, are more effective and safer than they actually are.

    Yet against this backcloth more than four fifths of people in most countries think medicine is an “exact or almost exact science.” In a study published in the Annals of Internal Medicine nearly 90% of patients undergoing percutaneous coronary intervention (PCI) thought that it would reduce their chances of having a heart attack, when it doesn’t. Asked about various scenarios almost half of cardiologists questioned would go ahead with a PCI even when they believed there was no benefit to the patient.

    It is time, said Domenighetti, to open up the black box of healthcare. Encouraging “health literacy” seems to be a way to do this, but Domenighetti thought that this was “old wine in new bottles.” We need, he said, to encourage a healthy skepticism about the medical market and to help people understand that medicine is far from being an exact science. Data should be published exposing variations in practice, corruption, and conflicts of interest. We should explain that health depends mostly on exogenous factors not the healthcare system. And people should be given practical tools to promote their autonomy—tools like access to evidence based information.

    Domenghetti ended his talk by pointing people towards the Choosing Wisely campaign in the US where professional organisations are identifying interventions that offer little or no value. A similar but broader campaign of Slow Medicine is underway in Italy, and I have little doubt that slow medicine—like slow food and slow lovemaking—is the best kind of medicine for the 21st century.

    We need to pull back from what Ivan Illich called the hubris of medicine.

    Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

    Competing interest: RS spoke at the meeting and had his expenses paid by the health department of Emilia-Romagna.

  • Topol: Runaway Use of Radiation Harming Patients

    From: Medscape
    Eric J. Topol, MD
    Dec 17, 2012
    Link to Article and Video

    Hello. I’m Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and theheart.org. In this series, The Creative Destruction of Medicine, named for the book I wrote, I’m trying to zoom in on critical aspects of how the digital world can create better healthcare.

    The topic here is radiation and how we’re not doing the right things for patients. We have a serious problem with overcooking radiation in the United States. It’s by far worse here than anywhere else in the world. We have runaway uses of nuclear scans, CT scans, and PET scanning, and we don’t even warn our patients; we don’t give patients any data on the dangers. In my book, imaging is a really important topic because there’s so much progress in imaging and use of nonionizing radiation like ultrasound or MRI, but we continue to rely heavily on scans. In cardiology, for example, there are more than 10 million nuclear scans being performed each year, mostly CT scans. We know from all the data we have today that 2%-3% of cancers in this country are related to use of medical imaging and ionized radiation.

    So, why don’t we tell patients when they have a particular imaging scan exactly how many millisievert (mSv) they’re getting exposed to? A CT angiogram of the heart is 16 mSv; a lot is being done to try to reduce that, but that is equivalent to 800 chest x-rays. How about a typical nuclear scan? A lot of patients who are treated in cardiology get this done every year. At 41 mSv, it’s equivalent to 2000 chest x-rays. But patients aren’t told any of this. And not only that, but we could actually measure exactly how many mSv they got by using the same type of radiation badges that the medical professionals use when they work in a cardiac cath lab or in an x-ray suite. But we don’t do that. This is a serious breach of our responsibility to patients.

    We have a very important problem here with this runaway use of radiation procedures but no accountability with respect to patients’ exposure. This has come to a crisis point in children. Children who have a diagnosis of a pediatric malignancy, for example, go through all sorts of radiation imaging, and there have been clear-cut trends that this is increasing. It’s worrisome and, in fact, it could even engender additional problems in children burdened with cancer. We really need to change this.

    In a digital world, this information could be collected from birth. Every individual should have their mSv exposure through medical imaging recorded cumulatively throughout their life and added to their electronic health record. Hopefully we’ll see that change come about in the future. This is something that’s a big hole in the current way that we work in medicine.

    Thanks so much for joining us for this segment, and stay tuned for more from Topol on The Creative Destruction of Medicine series.

  • Manufacturing controversy: CBC’s thermography story – who’s deceiving who?

    By Darcy Fitzpatrick
    Post at: SignalBlog.ca
    Posted on: Tuesday, December 18th, 2012

    A few weeks ago in late November, CBC’s Here and Now presented an investigative report on thermography.

    Sort of.

    It wasn’t really about thermography. I mean, they didn’t look into thermography in any great detail. What they did instead was focus in on the only clinic in the province that offers thermographic breast cancer screening services, and did their level best to rake them over the coals for it.

    I’m not going to spend any real time debating the potential merits of thermography here. But I will say, while the jury is still out on its usefulness here in Canada as a breast health screening tool, it has already been approved for such use and is regulated in several other developed nations, including the United States. The key thing about that is, thermography in the US can’t be used or advertised as the sole method for screening for breast cancer. It’s what is known as an adjunct service. In countries such as the US, thermography does not replace mammography, but it can be used to seek additional information about the health of a woman’s breasts.

    You wouldn’t know that from watching CBC’s investigation, though. While they did feature two Canadian breast cancer experts who testified against thermography’s effectiveness, never was it mentioned that thermography has been approved for use in other parts of the world, including our neighbour to the south. If there’s one idea this investigative report really wanted to prime the viewer with, it’s that thermography doesn’t work. A bit selective with their facts, maybe, but this for me was not the most concerning aspect of this investigative report.

    The report spends most of its time building a house of cards wherein they want you to believe that Avalon Laser Health Clinic is misleading patients about the intended use of thermography as a tool for breast cancer screening. The only problem is, they have no proof that this is actually taking place – because it isn’t. So instead, they go to great lengths assembling all the usual sites and sounds of a hard-hitting investigative report. There’s the ominous sounding score, the darkened lighting, the tinted camera effects, and the clincher: an undercover patient who goes into the clinic for a thermographic exam.

    And uncovers nothing. But you wouldn’t think that prior to seeing the footage, when reporter Amy Stoodley tells the viewer, “They say it’s only additional information, but we wanted to be sure. So we sent our undercover agent to Avalon Laser Health to find out what actually happens.”

    Several prolonged minutes and one entire commercial break later (the report is conveniently split into two segments), nothing happens.

    The sting turns out to be a bust. Everything the patient was told is everything the clinic has always said in public, that they offer the service as additional information and that it is not a replacement for other breast exams – indeed, the undercover patient even signed a standard consent form stating as much. But the viewers at home never get to hear or see any of this – if it was caught on tape, they never bothered to include it in the report. Instead, we get a shaky camera with a tinted lens walking down a corridor and muffled voices going over mundane test results. It’s all sizzle and no substance. But we still walk away with the sense of something covert taking place. The undercover footage has served its purpose, at least from an editorial perspective – it leaves the viewer with the impression that something worth going undercover for is taking place here. When it isn’t.

    Then there’s the video on the clinic’s website that the report compares to an online video in the US that was taken down by the FDA. The report refers to the FDA-offending video as a “similar video” that made “the same claims” as the clinic’s video. Only that isn’t entirely true. The video in the US taken down by the FDA was done so specifically because it made the claim that thermography could be used in place of mammography for a breast exam – which, as I explained earlier, is not allowed. The clinic’s video, on the other hand, actually states clearly in a slide that lasts for 35 seconds that a thermogram is not a replacement for a mammogram. Again, the CBC report doesn’t tell you this, and instead cherry picks images and text from the video out of context for maximum shock value.

    They even went so far as to try and make the clinic’s owner, Clare Barry, appear to be lying about a statement she makes in the report that frequent mammograms can increase a woman’s risk of getting breast cancer. Her claim is indeed a well documented fact. However, when Miss Barry says this, the footage is digitally zoomed in again and again and again on her lips as she speaks the words. Then breast cancer expert Dr. Nancy Wadden is shown saying that this is “incorrect advice” and “false advertising”. What exactly she’s referring to is unclear, but the connection the audience is being asked to make is that she’s responding to Miss Barry’s claim – a claim that is indeed factual and true.

    Dr. Wadden, who created our province’s breast screening program, claims at one point that thermography patients are “clogging up” her ultrasound and mammogram list. But what we aren’t told is that in the past two and a half years just seven thermography patients have been sent for further breast screening. Again, it’s all about what they’re not telling you.

    What this investigative report really lacks is a smoking gun. There’s no sign of anyone from Avalon Laser Health Clinic telling a patient, undercover or otherwise, that thermography is a replacement for mammography – because they don’t do that, and are explicit in telling their patients about the limits of thermography. There’s no interview with any women who were told by the clinic that thermography is a replacement for mammography – because no such woman exists. There’s nothing to really pin on anyone here, aside from some claims made by a couple of Canadian cancer experts that thermography doesn’t work, which contradicts the established practices of other developed nations, including the United States.

    Without anything substantial to give this story any real purpose, what we instead get is a lot of smoke and mirrors, ample suggestion and even some clever misdirection. The report is so well put together that by the end it’s almost impossible to tell that nothing has come of it. Unless you count the damage it’s done.

    This report has seriously damaged the entire reputation of Avalon Laser Health Clinic, its staff and its services, where thermography makes up less than one half of a percent of their business. By offering thermography as a breast screening service, Avalon Laser Health Clinic was following in a long line of other clinics across Canada, and clinics around the world where thermography has already been approved and regulated for use. Unfortunately for women in Canada, this country has yet to catch up with the rest of the world. And CBC’s Here and Now report seized on that opportunity to attack Avalon Laser Health Clinic for essentially trying to give women more choice in their approach to monitoring the health of their breasts.

    Now Avalon Laser Health Clinic, its owner, Clare Barry, and its many staff are suffering for it, both financially and emotionally. As Miss Barry explained to me over e-mail, this experience has shattered her.

    I urge anyone who saw this report when it originally aired to watch it again online and decide for yourself who is really doing the deceiving here. The CBC would like you to believe it’s the subject in front of the lens, Avalon Laser Health Clinic, but it should be clear to anyone after a second viewing that the real deception is taking place behind the lens at the CBC.

    You can view the video online by clicking here.

    I hope you’ll agree that CBC’s Here and Now owe Avalon Laser Health Clinic a heartfelt apology and a highly visible, well advertised retraction for the false claims and suggestions they made against them in their report.

    One final note: Throughout the day yesterday I tried getting a response from the CBC about some of my concerns with their investigative report, but I got stonewalled. I contacted the investigation’s reporter, Amy Stoodley, with a list of questions I was hoping to have answered for inclusion in this piece, but was eventually told that she was not permitted to comment on the story – though she did say she was happy with the story’s outcome. After further inquiry she suggested I try Peter Gullage, Executive Director of CBC News, NL, whom I contacted with the same list of questions. I received a curt reply from Mr. Gullage, asking who I was and who I wrote for. I explained myself fully, and followed up with another inquiry before the end of the day, but I never heard back from him.

  • About Thermal Imaging (thermography) by Greenpoint Thermography

    Video by Greenpoint Thermography in St. Petersburg, Florida.
    Visit their website at: http://greenpointthermography.com/

    About Thermal Imaging from samir on Vimeo.

  • Health Canada protects mammogram racket by criminalizing thermography for breast cancer detection

    Tuesday, December 11, 2012 by: Ethan A. Huff, staff writer
    By Natural News

    (NaturalNews) The forces of evil are currently running wild in Canada, where the government-run healthcare machine and the mainstream media are currently engaged in a vicious assault on the safe and effective breast cancer screening tool known as thermography. A recent “investigative” report aired by CBC News that claimed to have uncovered the so-called “fraud” of thermography has prompted Health Canada to issue an arbitrary ban on the use of the procedure in several provinces throughout the country.

    Health Canada, which on its website claims to “respect individual choices and circumstances” as they pertain to healthcare, decided to play the hypocrite by issuing several cease and desist orders against clinics that offer thermography almost immediately after CBC News ran its hit-piece on the screening procedure on November 27. Quoting several Health Canada “experts” who arrogantly disregard thermography as “useless,” the biased CBC News report has generated considerable controversy among the health freedom community, as Canadians may no longer have access to the safe, painless, and radiation-free procedure.

    CBC News hatchet job on thermography serves interests of cancer industry

    It all started when CBC News, possibly with a little financial grease from both the radiology cartel and conventional cancer industry, suddenly decided to target the merits of thermography just weeks after news emerged about the dangers and ineffectiveness of mammograms. The news rag conducted an “undercover” investigation that did not actually reveal all that much, other than the fact that thermography is a viable and preferable alternative to mammograms for many women.

    But because the procedure is not officially approved by the Canadian version of “Obamacare,” CBC News saw an opportunity to grovel at the feet of their medical overlords by “exposing” the procedure publicly. Repeatedly insinuating that women are simply unable to make informed decisions for themselves without the government telling them what is safe and what works, the CBC News report suggests that thermography is some kind of deceptive marketing scam that tricks women into avoiding having their breasts crushed inside a mammogram machine and blasted with cancer-causing, ionizing radiation.

    CBC News report filled with complete lies about thermography

    Such claims are utterly insane and false, of course, as there have literally been hundreds of published studies conducted on thermography over the years showing that it is a highly effective way to detect breast cancer early without the need for radiation. Dr. Christiane Northrup, M.D., a board-certified ob/gyn and bestselling author, wrote a detailed piece for the Huffington Post back in 2010 that explains the science behind thermography, and why it works better than mammograms at safely detecting breast cancer. (http://www.huffingtonpost.com)

    But CBC News ignored all this, and blatantly lied to its viewers and readers about thermography, effectively tainting the validity of the procedure in the minds of potentially millions of people. And as a result, the tens of thousands of Canadian women who currently rely on thermography as a safe alternative to mammograms suddenly no longer have access to the procedure, thanks to the blatant pandering of CBC News to the multi-billion dollar cancer industry.

    Government, please save us!

    What is perhaps most sickening about the CBC News report; however, is the fact that it screams of a mindset that believes the government knows all, and is some kind of societal babysitter that people can use to tattle on those who do not agree with them, and who actually think for themselves. Like good little sheep, the CBC News reporters that conducted the piece, and apparently a sizable chunk of the station’s viewership, have been brainwashed into the idea that, if the government does not officially approve of a treatment, then it must be a fraud. Such thinking is dangerous and, as illustrated by the actions of CBC News, leads to the elimination of other people’s health freedom.

  • Mammograms have led to over one million women being unnecessarily treated for breast cancer according to a new study. Are yearly breast exams actually hazardous?

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