My own pointless doctor visits

The other day, I looked up my old my medical records using an online “patient portal.” I wanted to see how it worked. Because I normally resist seeking medical attention, I didn’t have many records. (I don’t do annual checkups, so that eliminates a lot.) But it got me to thinking about the value of those occasions that I did seek medical attention: vertigo; alarming heart palpitations; pain in groin and huge bump on elbow after falling onto pavement from chair I was standing on; infection in finger that kept getting larger and lasted a couple of months; knee and hip pain.

In all these cases, the problems either resolved on their own or because of my own ministrations. Nevertheless, I was glad I sought medical attention, mostly to find out what caused the problem: glad to learn that vertigo is caused by out-of-place crystals in the inner ear, which I now know how to fix; glad to know my heart is fine—some people just get palpitations (they stopped, by the way); glad to learn that my bones are strong (nothing broken); glad to know my immune system handled the finger infection; glad to find out what was causing my knee problems, allowing me to work on them in my own way.

My sister tells me that her doctor visits were rarely helpful: “Most of my medical visits—especially specialists—have not yielded anything real. I've had two kidney tests with radiation and injections; a lung biopsy; carotid artery ultrasound; three-day heart tests and some I've forgotten. None told me anything except that I had no problems.”

Try it yourself! Make a list of your doctor visits and see what you come up with!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

“The Best Care May Be No Care”

The above title is the headline of a recent op-ed piece in the New York Times by cardiologist Sandeep Juahar. It’s right up my philosophical alley. Juahar is referring to the fact that, as a result of the pandemic, people have been avoiding medical care. Nevertheless, “a vast majority of patients seem to have fared better than what most doctors expected.” In fact, he says, “perhaps Americans don’t require the volume of care that their doctors are used to providing.”

Juahar maintains that a substantial amount of health care in America is wasteful. He cites a number of reasons: doctors practicing “defensive” medicine to avoid lawsuits; a reluctance to accept diagnostic uncertainty, which leads to more tests; exorbitant prices; lack of consensus about which treatments are effective; and the pervasive belief that newer, more expensive technology is always better.

Doctors themselves admit that 15 to 30 percent of health care is probably unnecessary. And studies suggest that up to 20 percent of surgeries in some specialties are unnecessary. A long list of medical societies, such as the Society of General Internal Medicine and the American Academy of Neurology produce lists of procedures to avoid. You can see these lists at choosingwisely.org. The lists run to more than 65 pages!

As Juahar says, “If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. …More care doesn’t always result in better outcomes.”  You go, Dr. Juahar!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

How to make a vaccine

The goal of a vaccine is to prepare your immune system to fight a bad virus or bacterium. It does this by stimulating your body to make antibodies that can quickly recognize a foreign invader and trigger an effective immune response. In the case of the SARS-CoV-2 virus, teams of scientists are working on three types of vaccines, all of which stimulate the body to make antibodies:

• Whole inactivated virus: You grow the bad virus in the laboratory then inactivate it with chemicals or other methods, rendering it harmless. This was the method Salk used for the polio vaccine. At the moment, a Chinese company, Sinovac, is in clinical trials using this method.
• Recombinant nanoparticle: You synthesize pieces of the virus protein and grow them in insect cells along with a special compound. The government has paid Novavax $1.6 billion to develop this vaccine. 
• Gene-based vaccine: You take a bit of RNA or DNA from the virus then stitch it into the genes of a vector, such as the virus for the common cold. This method was used to make a vaccine for Ebola.
• Viral-gene snippet: You take a snippet of a viral gene (m/RNA) which can enter the human cell and induce it to make the virus’ spike protein. The resulting antibodies latch onto the spike proteins. A company called Moderna is using this approach and is in the first phase clinical trials.

In Russia, they're experimenting with giving people the Sabin Oral Polio Vaccine, which is a live, but weakened polio virus. It's safe, available, and inexpensive. While the polio vaccine doesn't promote antibodies specific to the Covid-19 disease virus, it is a powerful stimulant to the innate immune system, priming it to attack invaders. This would be a stop gap measure.

Of course, the laboratories making the other vaccines must conduct a series of clinical trials to determine dosages, side effects, safety, and efficacy. Sinovac’s trials are encouraging, as are Moderna’s, although a few test subjects in Moderna’s trials have gotten sick, probably because of dosage issues. After the trials are complete, companies must then manufacture and distribute the vaccine, a process that normally takes years. To speed up the process, some companies are already preparing for production. This will be interesting.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Forget that ice pack

In 1978 an influential doctor, Gabe Mirkin, published a bestselling book: The Sports Medicine Book. In addition to sports medicine, Mirkin was an expert in many other fields. He was also a competitive marathoner and a charismatic guy. In his book, he promoted a method on how to treat sprains which he called RICE: rest, ice, compression, elevation. RICE became the go-to treatment for decades to follow. It turns out that his RICE idea was based more on instinct than evidence.

Beginning in 1989 researchers began performing experiments to test the theory. The tests continued through 2013. Their conclusion: there is no evidence that ice helps with pain, swelling, or speed of recovery. Ditto for rest, compression, and elevation.

The studies showed that cold packs actually worsen outcomes. That’s because inflammation—which increases blood flow—is the key to healing: increased blood flow increases clotting factors, brings immune cells to the rescue, and helps to manufacture more collagen. Thus, anything that decreases blood flow only lengthens the time to healing. In fact, heat is better than ice.

In 2013, Dr. Mirkin recanted his earlier advice: “There are no data to show that ice does anything more than block pain. And there are data that show it delays healing. RICE is just something that stuck—and it’s wrong.” As to rest, Mirkin said, “Nobody believes in rest anymore. You can get a hip replacement and you’re on the bike 12 hours after surgery.”

Yet doctors still give us ice packs. It takes years for old ideas to die. But once the no-ice idea catches on, sales of frozen peas will probably drop.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.