January 24, 2013

Iatrogenics: Medical Treatments vs. their Risks. LESS IS MORE!

Yesterday, I posted the first of a three-part report on healthcare "tensions" we're likely to see in 2013. Dr. David Shaywitz made the predictions on his popular The Healthcare Blog. The first tension vibrates between our expanding options for preventing / treating disease and the risks that often accompany these options.

I like Dr. Shaywitz's observations, because they accord with what I find in "aging and Parkinson's and me."  In his discussion of treatment options and their risks, Dr, Shaywitz sprang a new word on me, "iatrogenics," the inadvertent adverse effect or complication resulting from medical treatment or advice. 

I've given lots of thought to this subject in the past year and reported on it frequently here. In fact, my experience and research led me to a new mantra for 2013: "less is more."

Almost every time I researched a disease or ailment on reputable sites, I found cautions about the use of prescribed medications and over-the-counter dietary supplements. Invariably, the best recommendations called for:
  1. Exercise
  2. Diet
  3. Meditation
The trouble for most of us is that this triumvirate requires more effort than popping a pill or getting an injection. Yesterday, I was working with my physical therapist on core strengthening exercises designed to alleviate lower back pain, my #1 health concern for over a year now. I told her I was scheduled to go to Sibley Hospital's pain center on Thursday for a follow-up steroid shot, also designed to ease the back pain.

Since I've been getting good results from the core strengthening exercises, she asked if I thought I should put off the steroid shot. My immediate response was "No, I'll go ahead with the shot." Underlying that response no doubt was the hope that the steroid shot will take care of the problem so that I can slack off on the exercises. 

"Less is More" as Antidote to Iatrogenics
Many of my blog posts over the past year suggest we should consider "less" as we deal with this tension between treatments and their risks. That advice may be particularly true for seniors, especially those of us over 75. Here are a few of the posts:

Screening Exams
  • Do we need annual physicals? I reviewed the current debate. I decided to continue with mine because I've been seeing my internist for over 20 years. We spend at least a half hour talking before any examination starts. But I might well forgo the annual physical if I were treated like a cog in an assembly line. http://bit.ly/MlGN5k
  • I reviewed the debate over the need for other screening tests being questioned these days, a debate that's sure to get louder as we try to contain healthcare costs. http://bit.ly/v2EFCz
  • I did a two-part post on (1) whether we'd be better off opting for "watchful waiting" rather than "just do it" when deciding on tests http://bit.ly/v2EFCz; and (2) why patients, families, and even doctors -- with the best information and intentions -- still opt for useless and even potentially harmful tests  http://bit.ly/10JLMWk
Prescribed Medications
  • I did a several posts based on the new book (Are Your Prescriptions Killing You?) by Armon Neel, a leading geriatric pharmacologist. I looked at his recommendation to "stay away from statins at all costs" if you are over 60 http://bit.ly/Nm4j0t, and his contention that NSAIDs are "one of the most dangerous classes of drugs" for older people http://bit.ly/OaWFZt 
  • Over the course of 2013, I was able to cut way back on my own prescribed medications and both my body and my bank account are better for it. http://bit.ly/VPyCPB
Dietary Supplements
  • I've also cut way back on the over-the-counter supplements I take. I'm down to three: vitamin D (after blood work showed I was deficient), 5-HTP, and curcumin. http://bit.ly/VPyCPB
  • Dietary supplements were the topic of many posts last year. I'll mention just two. Coconut oil has been hyped as a treatment for reversing symptoms of Alzheimer's, mainly by Pat Robertson's Christian Broadcast Network and Dr. Mary Newport. No scientific evidence supports this conclusion, and the Alzheimer's Association has pooh-poohed it. Still, they persist. And why not? The topic generated 5 million hits on Robertson's site, more than any other topic last year. Dr. Newport has also written a book about it. I covered this issue several times, most recently here: http://bit.ly/UKKbsb
  • Curcumin was the subject of several posts, for just the opposite reason. It has been the focus of more scientific studies than any other supplement, and most of those studies suggest it has potential to treat a wide variety of major ailments. Nonetheless, it has received scant attention because it's a natural substance (derived from the Indian curry spice turmeric) that has little profit potential for Big Pharma. It isn't being touted by Pat Robertson, Dr. Mercola, Oprah, Dr. Oz, or anyone else with broad media reach. 

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