Episode Nine: Which outcomes of medical interventions matter

Straight Talking Doc Unhinged

When we have a medical society hell-bent on measuring and fixing your numbers, you'll get a lot of tests, procedures, and drugs all designed to find abnormal numbers and fix them. But really, we need to base our tests and treatments on clinically meaningful outcomes: does the intervention actually help you. That help may be subjective and not subject to be measured ("I have less pain from that medicine," or "My depression is much better since I started therapy."), or it may be measurable such as having fewer fractures, fewer heart attacks, fewer strokes, less confusion, or less chance of dying. However, even there our doctors and their drug-company pimps have tossed a trick in . For instance, drugs for atrial fibrillation may reduce strokes by 5%, but since we don't notice the vast majority of strokes that hit us, we care about strokes we actually notice, and on that score these drugs only cut the risk by 0.6%, of clinically relevant strokes, something your cardiologist won't tell you and likely doesn't even understand. Similarly, certain drugs can reduce the chance of your getting a compression fracture of your back, and that's what the doctor will say. But fractures aren't clinically meaningful unless you notice them, unless they hurt, and on that score, very very few clinically relevant back fractures are prevented with these drugs, even if the doctor will tell you otherwise based on the fact that your x-ray looks better. When we start looking at tests and procedures and medicines--from opening blocked arteries to fixing your bone density to treating your dementia to lowering your sugar--the only outcomes we care about are clinically relevant outcomes, outcomes that improve your health or quality of life in some way, and this is something your doctor will almost never talk with you (or likely you won't buy their snake-oils), but something you need to know about before you dive into all these worthless tests and interventions deemed as "necessary and lifesaving" by your myth-peddling doctor.