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Nov 12 2012

It’s Not Harmless

We keep thinking that quackery and medicine can co-exist. Complementary medicine and alternative medicine is a big business, preying on the lack of understanding about medicine, the fears about medical science and the apparent validation of quackery as a legitimate business. We don’t treat “quacks” as quacks. We treat them as doctors. We call their field “alternative” medicine not “bullshit”. An anti-biologist is a creationist. An anti-NASA dude is a flat earther. Not an Alternative Biologist or an Alternative Rocket Scientist. We call them out for the bullshit they peddle. Yet we don’t apply the same attitude towards quacks.

Hippa (names changed for privacy) passed away today. A friend of a friend. She died from complications arising from Necrotising Fasciitis earlier on sunday.

What went wrong? After feeling a pain in her hip she went to a chiropractor. From the Email she sent…

“Chiropractor says its a S-O joint compressing the sciatic nerve. My condition is worsening, as I can’t get up and down by myself or hardly walk. The chiropractic adjustments & massage don’t seem to be helping. I’ve contacted my orthopedic who is working me in today and ordering a stat MRI.”

1. There is no such thing as an SO joint. To my knowledge. In Human anatomy. There is a sacro-iliac joint. There is a Ilio-femoral joint. There is no Sacro-O (Obturator?) joint. We can give the benefit of the doubt as the patient may have transferred the information incorrectly. Happens. Medical Lingo is for the Nerds.

2. The Sacro-iliac joint is fixed… It cannot really impinge on anything barring fractures and what have you. It cannot compress on the sciatic nerve since the sciatic nerve is formed by the sacral nerves.

3. Spinal Disc herniation cannot be fixed by a chiropracter (cause of sciatica)

4. Neither can spinal stenosis and priformis syndrome

5. A chiropractor without a single x-ray, CT scan or MRI made this diagnosis.

NF is a disorder that can be treated. Broad Spectrum antibiotics and rapid surgical debridement can save lives if treated early enough. NF is easily seen (or not seen as I will explain) on X-Rays, CT and MRI scans. It can even be detected courtesy of basic physical examination. It’s a rare disease BUT one you have to keep in mind. Every doctor gets one…

To point out how badly the Chiro failed at basic medicine? During systemic exam the area over the skin would have some decolourisation. In addition to appearing like cellulitis which doesn’t respond to antibiotics there would be crepitations, severe constant pain that isn’t ameliorated by positional changes but is out of proportion to physical signs of damage, systemic illness, skin necrosis and bullae. He didn’t even do any of the things needed to diagnose his ORIGINAL diagnosis.

Two signs that are important to keep in mind is that with ANY joint pain or long bone pain an x-ray, CT or MRI is necessary. Immediately. On visualisation you will see gas even on the x-ray. It’s a sign that something is afoot and that requires exploratory surgery immediately. If you show up to a hospital going “my arm aches” even if it is tennis elbow (or wanker’s cramp) you will still get an X-ray or CT. The second sign is dishwater pus.

Now NF is hard to diagnose. The issue being that it looks like other conditions. But here is the thing. The other conditions are all pretty serious stuff too. Deep Vein Thrombosis, Limb Ischaemia, Gas gangrene or at best erysiplilas and cellulitis. But that’s why we have exploratory surgery and Emergency Debridement. We can save limbs, we can sometimes lose the limb but save a life. The disease still has a monsterous mortality rate (25%) but but 75% is better than 0%.

Like Steve Jobs, we cannot solely place the blame on the Chiro. She may have had medical care and may have still passed away. But the Chiro plays a big big part in why she died. Hindsight may be 20/20 but if she had seen a doctor initally it may have been caught prior to the stage of sepsis and shock and the ground work would have been laid out for a proper treatment. The Chiro’s lack of any professional skill, knowledge as well as the perception that he is a real doctor delayed her treatment.She believed that he had the knowledge to make this call.

And it cost her. It cost her everything. Jokes about medicine and chiropractic aside…

The validation of quacks as real doctors kills. It’s not complimentary. Bullshit isn’t complimentary to science. It’s not harmless.

37 comments

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  1. 1
    Parsley Victorious

    People ask me why I have to go around being a skeptic all the time, trying to change minds, trying to ‘force my beliefs’ on others. Stories like this are why. People believe in nonsense – and people die from it. That’s important enough to be talked about, in my opinion.

  2. 2
    Dalillama, Schmott Guy

    If you show up to a hospital going “my arm aches” even if it is tennis elbow (or wanker’s cramp) you will still get an X-ray or CT.

    HAHAHAHAHAHAHAHAHA…Not around here you bloody don’t. At least not without a damn sight better insurance than anyone I’ve known recently.

  3. 3
    opposablethumbs

    If you show up to a hospital going “my arm aches” even if it is tennis elbow (or wanker’s cramp) you will still get an X-ray or CT.

    This probably wasn’t what you meant, but I’m dumb enough to read this as confusing – how many people resort to going straight to hospital with an aching limb or joint? Wouldn’t most people go to their GP first, and how likely is a GP to refer you for xray or CT for something described like this?

    Though of course as long as you have a decent GP who doesn’t dismiss you out of hand as malingering, then at least there’s a good chance that they will actually know what they are looking at – having studied and qualified, unlike the self-proclaimed alternative practitioners.

    Anyway, the main point about the fact that “alternative” quacks rip you off and can kill you if going to them means not going to a real doctor – yes, sadly too bloody true.

  4. 4
    Avicenna

    Dalillama – Not everyone in the world lives in the USA. Some of us think socialised medicine is worth it even if we are forced to kill ourselves with death panels…

    One of the hallmarks of this disorder is severe pain. You would show up to a real doctor. If the pain is severe enough to go to a chiro then it’s severe enough for you to think something is wrong outside the norm.

  5. 5
    Argle Bargle

    We keep thinking that quackery and medicine can co-exist.

    What do you mean “we”, Kemo Sabe?

  6. 6
    Johnny

    This post started off well. Then it turned into an attack on a chiropractor. I could do the same. I´m a musculoskeletal physical therapist (I can refer patients for imaging as well as to specialist doctors). During the last three years I have seen three patients with lung cancer go unnoticed by their GPs for months (as well as a few patients walking around with fractures). One of the cancer patients I can see wasn’t well in hindsight. The two others (one Pancoast tumor) I suspected within 5 minutes and had confirmed on imaging. GPs had administered Ketobemidon for two months without suspecting, without taking the patients clothes off to examine them. I’d say if you’re in severe pain – get a second opinion and make sure whoever you visit do examine you properly. Hell I’ve even had GPs tell patients that I was wrong when I’ve told them they probably had a muscle tear when the GP had not examined the patients or taken their clothes off to inspect them. So I suspect a lot of GPs would miss NF. I hadn’t heard about it either so thanks for that – but I would have been ordering imaging when pain is out of proportion.

    BTW – The SI joint moves and although I agree it can’t impinge on anything it does get painful (sensitized – which is the doing of your nervous system) and pain can also be referred into your legs when you push on the joint.

  7. 7
    Corvus illustris

    From Wikipedia (this fact is well known in the US):

    “The American Medical Association called chiropractic an ‘unscientific cult’ and boycotted it until losing an antitrust case in 1987.”

    So here in the States we have venal legislatures that (in return for campaign contributions) pass laws making chiroquacktic into medicine, and then a “business model” of medicine (and probably venal judges, too; who knows) that lets the AMA be treated as if it were Ford trying to stop you from buying the wrong brand of tires. What’s the excuse–er, reason–for tolerating it in the UK (or Commonwealth), where it is not a native delusion? (In the land where Mormons run for president, we wonder at nothing.)

    BTW, the chiro who failed to refer Hippa to a real physician ought at the very least to be prosecuted for negligence

  8. 8
    Dalillama, Schmott Guy

    Dalillama – Not everyone in the world lives in the USA. Some of us think socialised medicine is worth it even if we are forced to kill ourselves with death panels…

    I know, I’m a huge advocate for it. That was more in the nature of a sarcastic commentary on the difference between what we’ve got in the States and a real healthcare system.

  9. 9
    bill rifkin

    I am a physician and I love your post. There are two types of treatments: proven and not proven. Not everything “mainstream” medicine does is proven, but that is quite different from saying something works that does not. “Alternative care” thrives because people like to be contrary, they like to think they ‘know their bodies’ (They wouldn’t go to an alternative auto mechanic), and alternative providers tend to do well what ‘mainstream’ does not: spend a lot of time with each patient, listen well and agree with patient preconceptions.

    Interestingly, once something is ‘proven’ if often falls out of alternative use. Example: it was found that St. John’s Wort has some antidepressant action. Similar to drugs in use. Once that came out, much less alternative use/belief in St. John’s Wort, it went mainstream.

    I feel very badly about your friend with NF. Not sure if this matters, but if you go to a chiro, you’ll get a chiro diagnosis. They cannot diagnosis what they don’t know. None of us can. Their training is short on microbiology and long on joint subluxations. I do agree the Chiro should have considered “bad things I don’t treat” as a possibility. Physicians should do that too.

    Also, tied into the alternative nonsense is conspiracy lunacy. You know, the “they can cure cancer, but they don’t want to” line of thought. Borders on insulting. Either I am out of the loop or part of an evil conspiracy.

  10. 10
    greengenius

    I keep wondering why kaiser permenente has chiroquacks on staff?

  11. 11
    bradleybetts

    When I first learned of Chiropractors and all the bone-crunching stuff, I was under the impression it was a relaxation thing akin to massage. It generally amazed me when I found out some people thought that cracking your joints could cure diseases. Seriously, wtf?

    These people are not doctors. If going to one regularly, much as some people go to a masseuse regularly, makes you feel more relaxed then great. But just because someone has a white coat on does not mean they are a doctor.

  12. 12
    irisvanderpluym

    I’m so sorry about your friend (of a friend). And you’re right: it isn’t harmless. But neither is science-based medicine in the U.S. of A., as bill rifkin hints at here:

    Not everything “mainstream” medicine does is proven, but that is quite different from saying something works that does not.

    In my experience with physicians in a profit-based system (and unfortunately I’ve had more than my share), I’ve found that there is a marked tendency to offer tests and treatments that are lucrative for the physician (or hospital), and eschew those that are less profitable, irrespective of their effectiveness. Also in play is the all-too-human bias that “when all you’ve got is a hammer, everything looks like a nail.” One can see specialist after specialist and get wildly differing opinions and treatment recommendations. In my case none of them worked and one turned out to be harmful and ineffective, according to the latest scientific literature (bonus: also excruciatingly painful).

    I’m in the U.S., and from what I understand single-payer systems have better internal mechanisms for dropping treatments that may have once looked promising but are eventually shown not to work.

    “Alternative care” thrives because people like to be contrary, they like to think they ‘know their bodies’

    That may be true; I have not seen studies. But alternative care also thrives because it is a last resort when one is desperate for relief and a year’s worth of attempts with multiple flavors of science-based medicine has utterly failed — as it did in my case. When you are in that situation you are willing to try pretty much anything, even if you are well aware (as I was) that alternative medicine is unproven and can be harmful.

    To finally get myself a correct diagnosis it took a doctor who is a hybrid: an M.D. associated with NYU who dabbles in chiroquacktice and other unevidenced stuff like prolotherapy. I did not take his recommended course of treatment; I chose to try a more conservative and conventional one first, and fortunately it was successful after a few months. But he was a better diagnostician than half the “head of the department” “chief of this” or “professor of that” at virtually every teaching hospital in New York City.

    Also, my “good” health insurance refused to pay for my successful treatment with physical therapy — but paid for everything else any other doctor wanted to try (including dangerous and painful treatments known not to work), and would have happily paid for piles of percoset for the rest of my life.

    I hope I was clear: this is not a defense of alternative medicine. It is an indictment of our for-profit system and the incentives that allow poor practices in science-based medicine to flourish, with very little accountability — much like alternative medicine.

  13. 13
    Avicenna

    I did mention that an X-Ray would have shown the gas associated with this condition. (If I can afford an X-Ray in India, americans can pay for one).

    Your system’s fault is simple.

    Socialism is such a dirty word in the USA that if Americans found out that weekends, compulsary education for children and anti-child labour laws are all considered planks of communism, they would send their children to work in a coal mine on saturdays.

    Iris, there is a massive amount of accountability in medicine. A diagnosis of this level getting botched would go to a Mortality and Morbidity meeting. Now malpractice suits occur. Errors occur. You are expected to make between two to three mistakes in your career and they are usually stuff that’s weird.

    Not “I didn’t take an X-Ray of joint pain but made a diagnosis”. EVEN in India, if your arm is clearly broken (AKA bent at an angle) you still need an X-Ray to declare it. If India has this legislation (And is frankly an Ayn Randian Paradise!) then the USA probably does too. The fact remains that chiropractic have no such body to control them. At best you have a civilian case and he can wrangle out of it because civilian cases aren’t decided like medico-legal ones. (In a medico-legal case you do not need any reason to bring forth a case and you are safe from counter suit. Basically? You can accuse me of ANYTHING. It isn’t decided by a jury, but by another doctor. The Judge calls up doctors and they each give testimony on the case. If it turns out that “my actions” were perfectly sensible in this case then I am exonnerated. I don’t even get to pay my lawyer’s fee for winning the case!)

    You can gish gallop in a civilian case. You cannot in a medical case. There is absolutely no oversight which is why the Chiro made such a moronic diagnosis.

    Any person who claims that he can make a outright diagnosis in an orthopaedic subject without any investigations is clearly a quack.

    And there are cheaper alternatives to the way americans work… The problem is people don’t realise there are more risks with the cheaper alternatives.

    For instance? X-Ray

    Again the second issue in the USA is “Your Countrymen Really Love Litigation”. Doctors do not. It’s better to do stupid tests then get sued by litigious patients.

  14. 14
    Lauren

    Obligatory nitpick – there are two ‘complimentary’s in the last paragraph, should be ‘complementary’. Great article though. The infrastructure of real medicine exists for a reason, and if you deliberately exclude yourself from it, then you’re going to miss things that a real medic would have spotted. Sometimes with awful consequences.

  15. 15
    irisvanderpluym

    Iris, there is a massive amount of accountability in medicine.

    Sure. In our for-profit system, medical practitioners are primarily accountable to insurance companies and their shareholders. Hospitals, group practices and individual doctors are in direct competition with each other for the best-insured patients. Which is why they spend so much money on TV advertisements instead of, you know, things like healthcare.

    EVEN in India, if your arm is clearly broken (AKA bent at an angle) you still need an X-Ray to declare it. If India has this legislation (And is frankly an Ayn Randian Paradise!) then the USA probably does too.

    Don’t count on it.

    But I fully agree with your diagnosis, Doctor:

    Socialism is such a dirty word in the USA that if Americans found out that weekends, compulsary education for children and anti-child labour laws are all considered planks of communism, they would send their children to work in a coal mine on saturdays.

    The patient is quite sick.

  16. 16
    Avicenna

    Iris

    There is an AMA, if you are drummed out of the AMA you cannot practice. As a doctor you are beholding to a public interest body.

    I know people like knocking the american medical system but the actual doctors within it are doing an extremely good job. It’s just that the system needs streamlining. You can have a public health system that functions perfectly fine and a private sector for those who want it too. It’s just that the USA doesn’t want it because it’s so easy to scare monger anything “socialist”.

  17. 17
    chrisj

    Just in case you’re not already familiar with the marvellous Dara O’Briain, a quick link.

  18. 18
    Avicenna

    I actually use “Morons of the Highest Order” and the “Science doesn’t know everything. If it did it would stop.” lines a lot.

  19. 19
    irisvanderpluym

    There is an AMA, if you are drummed out of the AMA you cannot practice. As a doctor you are beholding to a public interest body.

    Um, no. The AMA is a voluntary professional association. Membership total as of Dec 31, 2011 (including residents and students) was 217,490 of approximately 954,000 practicing physicians in the U.S.

    The AMA is actively opposed to single payer, I might add. I wonder why? (No, actually I do not wonder why.)

  20. 20
    redpanda

    Off topic, but I’m glad I found your blog. I’m also an atheist medical student surrounded almost exclusively by religious people, so I look forward to following what you have to say.

  21. 21
    Dalillama, Schmott Guy

    I did mention that an X-Ray would have shown the gas associated with this condition. (If I can afford an X-Ray in India, americans can pay for one).


    Clearly, you have very little idea of how the American healthcare system fails to work. If I had a broken bone tenting my flesh, I could go to the ER and put myself in debt for the next several years to get an x-ray (ERs are expensive. Anything short of that, I’d be looking at about $6-700 up front to get an x-ray, no billing later. For comparison, I make about $1200 a month, and pay $800 of that to keep a roof over my head. So, no as an American, there is no way that I could afford an x-ray, however advisable it might be.

  22. 22
    Alethea Kuiper-Belt

    I come from a more sane country than the US, but I still have a question. Do you think you might be over-using X-rays? It would not occur to me that *all* joint pain calls for an X-ray. I’m in the public health biz, where we consider X-rays just a little bit dangerous. To be used judiciously, not for funsies looking at how your feet fit in your shoes; nor mass x-raying everyone for TB when the population incidence is tiny.

    In my personal case, recently I went to my doc with intermittent knee pain. He checked for tendon damage by flexing it in various ways and prodding for the location of pain. Then he suggested I see a physiotherapist for exercises & taping. I have a diagnosis of patellofemoral maltracking, AKA runner’s knee. It never occurred to me to expect or request an Xray. Nor was an X-ray suggested years ago when I had tennis elbow. (I do not play tennis, nor do I run. Silly names.)

  23. 23
    Alethea Kuiper-Belt

    BTW, medical tourism from the US to India is a thing. Airfares and luxury hotels and Indian medical prices can often work out cheaper than US treatment.

  24. 24
    Avicenna

    Iris – The AMA doesn’t want a single payer system that would affect doctor’s earnings. The issue in the USA is that doctors can earn a lot of money through private practice. The FEAR is that the single payer system will force doctors to take in dud cases and cause all doctors to work like Public Healthcare doctors in the US. Relatively poorly paid and with no security that comes from private practice.

    Which is the problem you face when you have a single payer health system where the actual infrastructure is not government owned. What the AMA doesn’t like is that a single insurance payer that is the government can collectively bargain down prices and cut into the profits of the private industry who will take it out on their profits without any benefits. Doctors rarely get benefits from their hospitals and usually have to pay for things like their insurances which are monsterous considering the way (I explained earlier. Any of your patients can accuse you of being a terrible doctor and sue. The average doctor in Obs/Gynae may see 2 to 3 such suits in a lifetime. The average in A&E and Crit Care may see as many as 1 every few years.)

    These are massive costs. You are basically paying for a lawyer on call 24/7 and the necessary legal fees for things that are often not under your control that can affect your living. There are doctors who pay close to 200,000 dollars a year for malpractice insurance. You pay an average of 10% of your salary.

    Now imagine if you run a system which forces costs down but you still have to fork out that. What you need is a system that completely destroys the american medical system as it is. You need to do something radical. You need this…

    http://www.youtube.com/watch?v=-ywP8wjfOx4

    It costs a tonne of money to set up. No one wants to blow trillions on something that everyone thinks will kill you with a death panel. Doctors need to work for the system, but they won’t. Not if you have to cut their wages. No one takes a wage cut, especially not people who have massive debts and a skill set as valuable and hard to acquire as medicine.

  25. 25
    Avicenna

    Aletha

    That’s why the patient in this case got an MRI. I said it’s simple enough to diagnose on an x-ray which is a basic medical level.

    In the west you can afford MRIs. An MRI is out of the range of most hospitals and even if we had one many hospitals have power issues. They cannot fire them up as often as you see in the USA. So? X-Ray and CT and Ultrasound. You can make rough diagnosis through symptomology.

    Not for acute pain though. That’s indicative of serious shennanigans and an X-Ray is very quick and helpful. You can even diagnose things like DVT on an X-ray (Another potentially deadly condition that would have shown up). You could also look for things (in this case) like hip fractures and dysplasia).

    Or you could throw on an MRI if you have the resources. But this is how you would do it cheaply and effectively.

  26. 26
    Alethea Kuiper-Belt

    Well, I’ve certainly not had an X-ray or MRI or CT or anything for my runner’s knee or tennis elbow. Though being happily Australian, I can have a CT when I need one for not very much money – not entirely free, since I earn too much to get a concession rate healthcare card. I had a couple last year for other reasons; they cost me from $AU100-300.

    You didn’t really answer my question, but reading between the lines, I guess you’re probably talking about acute pain, not any old joint pain? Do they discourage X-rays at all in India?

  27. 27
    Avicenna

    It’s free if you need it in the UK.

    A CT is far far far more risky than an X-Ray. The dosage is astronomical comparatively. It’s why we prefer the MRI despite it’s price.

    They don’t discourage x-rays, they just use them for diagnosis. The cost benefit of knowing what’s wrong is more than not curing patients. Remember you are seeing sometimes upto 100 patients a day rather than 10 to 15. (the UK has 100 people per doctor. India has close to 100,000 in some parts.)

    The benefit isn’t just for your patient but other patients waiting in line for whom you cannot dither around with reductive logic because that takes time and a finite amount of resources that you don’t quite have. It’s simpler, cheaper and better for everyone to get the x-ray.

  28. 28
    Avicenna

    And yes it’s acute pain. However even for basic orthopaedic treatment of chronic joint pain, an x-ray or MRI is needed so as to determine what exactly is wrong.

  29. 29
    raymoscow

    Several years ago, my sister went to her chiro for treatment of a persistent headache and dizziness. The chiro did not even check her BP, which turned out to be extremely high (as she found much later).

    Two weeks later, when she wasn’t improving, she went to an actual doctor — and found that she had had a serious stroke. She spent two weeks in an ICU and is still working her way back to recover what she lost.

    IMO, her chiropractor came close to killing her through incompetence.

  30. 30
    smrnda

    I’ve been frustrated by doctors, but never enough that I would go to an ‘alternative practitioner.’ Part of this might be that, though I’m not trained in life sciences, I did teach statistics for medical students so I can at least distinguish evidence based medicine from woo.

    Because our medical system is for profit in the States, people tend to have very little confidence that they are viewed as anything but a way to make money – the doctor might just as well make you worse rather than better since it might make more money. This lack of trust is probably why people take ‘alternative medicine’ seriously. Not that it isn’t just as much a money-making venture, just that it seems to be less of one.

  31. 31
    Avicenna

    If that were the case there would be no vaccination in your country. Per 1000 cases of measles (A near universal disease) there would be 1 case of encephalitis which costs 10,000 dollars a day to treat. (Yeah, you could vaccinate more than that over the course of the entire disease)

    The sum total cost of measles and it’s sequelae would net the medical system an astounding amount of money. The problem in the west is that people have forgotten what disease is really like. There is no fear of disease so they think some really lethal diseases are harmless. Pertussis is just a “cough”, measles was something harmless (Not something that kills a million people a year and used to kill 8 million. That’s right. Measles used to be deadlier than AIDS.) There are some incredibly idiotic people out there telling people what they “think” medicine is about and it really really doesn’t help.

    Alternative medicine is an INCREDIBLE money making venture. For example? Vitamin Pills. The average american has access to the depths of gluttony the likes of which would make most people weep. The humble banana (A seasonal product in many parts of the world) is present in every store at the same price 24/7. If I so wish I can purchase sun ripened tomatoes in the depths of winter at midnight. If I was sufficiently busy (read: lazy) I could have it delivered to my doorstep.

    You don’t need supplementation unless you have some issue (AKA pregnancy, poor diet and old age). Most of us wouldn’t need vitamin C tablets or hell… Vitamin D tabs. We take vitamins like candy. Did you ever wonder how much they really cost? It costs me around Rs. 100 for 20 tablets of Multivitamins and Iron for supplementation purposes. These are a clinical dosage meant to correct malnourishment but can function as a normal tablet if you eat one every few days. These can cost upto £40 (around 60 dollars). I have seen some costing around 120 pounds. People buy them. People swear by them. You hear bizzarely moronic things such as how this vitamin D is superior to the vitamin D produced by your body. Or how the vitamin C cycle works in humans. They have markups of more than 100%. They are selling products that blatantly are harmless or useless at monsterous costs.

    Have you seen the price of some homeopathic meds? A bottle of evian probably does more good for you than homeopathic medication. A spoon of sugar and a pinch of salt in a glass of your water is better for treatment of disease than all the homeopathic medicine COMBINED (It’s ghetto ORS. It stops diarrhoeal deaths. The recipe can stop nearly 99% of diarrhoeal deaths. Go check out the homeopathic equivalent which doesn’t even do that.).

    Chiropractic is a money minting scheme. You have no oversight. You can make some frankly outrageous claims and you basically do little damage unless you cock it up and ruin someone’s back. Even then you aren’t subject to malpractice law so you can keep working even if you are a fantastic cock up.

    It is estimated that the value based on hits and purchases from Dr. Mercola’s “alternative medicine” site are in the multi million dollar category. Natural News too. There are monsterous profits to be made in Alternative medicine and all at the cost of it’s users health while piggybacking on real medicine.

    If I took my vitamins and iron supplements and rebranded them as the finest of indian medical products, hand wrought by virgins from pressed jasmines and flavoured with neem… Then I could probably charge a hundred to two hundred times more and make a killing of this. And many of them do. One of the biggest sources for alt med nonsense is Natural News. Check out their supplier.

    It’s a chinese drug company. Want to bet that their stuff isn’t dirt cheap IRL and just being flogged at ridiculous mark ups.

    Whenever I read alt. med, particularly eastern stuff…

  32. 32
    smrnda

    Totally agreed – I was pointing out what people *perceive* to be true rather than what is, and many Americans think that medicine is a conspiracy. It is true that our system is driven by profit, but so are lots of other industries and that doesn’t mean that they can’t deliver results. Architects don’t design buildings to fall apart so you can get billed for later repairs.

    I was aware that alternative med was a scam, but I had no idea how profitable of a scam it was.

  33. 33
    jb

    my boyfriend lives in florida and i believe he got either an mri or a ct scan for his kidney stones, and it cost 5 thousand dollars. he does not have insurance…

    also, the doctor charged him 1 thousand dollars for literally less than 5 minutes of work.

  34. 34
    Brian M

    That $1,000 was not a charge for just “5 minutes of work” but a charge for thousands of hours of (expensive) education and the time to acquire medical knowledge.

    Now…of course, in a rational system the MRIO could be quickly read and interpreteed by a nurse practiioner or a technician, and this is where the guild system builds in huge costs, but….

    As for the $5,000 MRI…that sucks. How much does your boyfriend spend on cable television per year? Just saying.

  35. 35
    jb

    He is unemployed at the moment

    he does not spend any money and is probably the most frugal person you will ever meet (job or not)

    he did not want to go to emergency at all, but his mom forced him to b/c he was in such agony, and she could not stand to see him suffer

  36. 36
    Avicenna

    MRI machines are expensive and eat power like crazy. They aren’t cheap to operate particularly in warm areas (they need airconditioned rooms or they generate too much heat).

    Medicine isn’t cheap. It’s the no. 1 cause of Bankruptcy in the USA. It’s why socialised medicine is so effective. No fear of bankruptcy mixed in with sensible usage of diagnostic tools. A lot of preventative medicine is cheap in the “long run” (It saves money by prevention) but stuff in medicine is incredibly costly because of R&D costs, electricity, infrastructure and staff costs. Doctors are pricey to train, pricey to maintain and with good reason.

    I know for a fact that I will probably die before my patients will. That I won’t have a family life that is considered normal. All my friends are married or are in long term relationships. Some of my friends are already buying houses and having kids. Some are enjoying a rather wild social life.

    I am stuck reading a book about retinal diseases in a place where many people don’t like me all that much.

    Ultrasound. Renal calculi are traditionally detected by ultrasound. Safer than an X-ray, cheaper than an MRI.

    However patients don’t like it. Seriously? There is a problem with richer patients. They don’t think cheap methodology is as good as expensive ones. This is a simple effective method. The usage of an MRI is like using a pneumatic hammer to crack a walnut.

    In a socialised medical system you would have government oversight so doctors would use the right tools. In addition they wouldn’t be urged to use stupid tools for the job. The MRI could have been replaced by a much cheaper ultrasonogram.

    You may want to blame the doctor but remember this. Doctors earn salaries. They aren’t salesmen. They get paid whether they see 300 MRIs or 30 Ultrasounds. There is hospital policy to worry about.

    Remember the Scrubs episode where hospital admin was pushing for whole body scans while the doctors thought it was money grubbing? That’s the issue in the USA. Doppler ultrasound is a marvelous thing.

  37. 37
    jb

    Avicenna, I am so slow

    I just realised that you are the blog owner haha

    you are great, love your posts!

    Anyways, its turns out that my bf got a Ct scan. And I do not think anyone here is blaming the doctors, more so the US medical system which expects people to go broke if they want to get treatment.

    My boyfriend doesn’t even own a tv, and his cellphone is an 8 year old hand me down. Like I said, frugal, and cannot afford insurance. He is the kind of person who would not be able to afford an x-ray every time he has a sore body part.

    His mom pays 1200 a month insurance for the rest of his family, and even *she* had to pay thousands in co-pays and so on after she had tests done for one her kidney stones and an operation for severe congestion. The US system screws patients, period.

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