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Saturday, September 26, 2015

The eight stages of medical scams

Today's version is Ventolin
Taking note of the fact that the long-held conventional wisdom that aerosols like albuterol help with secretion clearance and mobilization have been overturned, we can now offer up the eight stages of how a medical hoax, faux theory, or scam is overturned and proven false.

1.  The theory is proposed by scientists on a nonscientific mission. (Example: the study of 4 COPD patients to which the hypoxic drive theory was devised.)

2.  It is believed because it plausibly explains an observation.  It taps into large anxieties about not being able to help those with chronic diseases we actually don't know much about, and make us feel like we are actually doing something good.

For example, albuterol mobilizes secretions and enhances clearance, or under oxygenating COPD patients will prevent their hypoxic drive from being blunted.  The solution taps into the hearts of physicians and nurses: it sounds like a good idea; it makes them feel like they are helping or doing something good.

They start ordering it, nobody complains, the patients eventually get better, and so the theory starts to become treated as a fact  -- even though no science has ever proven that it's true or that it does any good.

3. The causal relationship is worse than first supposed.  The research is found to be sloppy, the facts to be fudged or not even existent.  Subsequent studies do not support the original claims, or in the case of the hypoxic drive hoax, all subsequent studies completely disprove the initial claim. Nevertheless, the theory by now is beloved by the medical community and taught at both teaching hospitals and nursing schools.  The orthodoxy is promulgated all the more harshly for being doubted.  Those who doubt are ridiculed and made fun of and told that they are lazy and trying to get out of work.

4.  By now pride has taken hold of too many physicians and nurses who simply will not believe that what they learned in school in the 1980s could possibly be false.  Ideological interests have also taken hold. Professors consider for a moment the arguments against what they teach and then say things like, "There's no way IPPB only works to over distend good alveoli. It's just not possible something we learned in medical school could be proved untrue.  There's no way a silly respiratory therapist with only an associate's degree could be right."  They supply an ongoing supply of opinions to ensure the perpetuation of the alarm; in the case of the hypoxic drive hoax, that a patient's drive will be obliterated if we adequately oxygenate. We must not give COPD patient's more than 1-2lpm. By God, if you give more than 2lpm you will kill that patient." The irony that it never happens eludes them.

5.  Skeptics who have patiently argued on the basis of facts that the science of each phenomenon was weak are ostracized by the opinion establishment of medicine. Cranks but the cranks are right and the orthodox priests and Levites are wrong.

6.  Eventually, after 50 or 60 years, the subject of discussion just changes.  In the case of albuterol helping to mobilize and clear secretions, the evidence gets weaker and weaker.  The clinical evidence reported by millions of respiratory therapists that albuterol does not produce, thin, enhance, or mobilize secretions becomes overwhelming, and reaches a stage where it can no longer be ignored.

7.  The retreat of the orthodoxy is coveted by a smokescreen of fresh concerns for some other catastrophe.  No admission of errors is ever issued.  No apologies for therapist burnout, wrecked careers, or wasted money is ever issued. No apologies for following bad science is ever issued.  Time flows on, bringing neither knowledge nor greater understanding of the role of folly in human affairs and medical wisdom.

8.  Stages 6 and 7 have been reached in the medical reform cycle; they are beginning in the anthropogenic hypoxic drive hoax, or IPPB and aerosol scam.  Fifty years from now, there will still be clanking windmills in the minds of some old physicians who were educated back in the 1980s, or in the year 1915 by old dogmatic medical professors. Whether anyone will pay attention to them is doubtful. Yet the lobbies that like to cause alarm where no alarm ought to be ringing in order to come up with solutions that become the next hoaxes and scams, will still exist.

Name a hoax and all these steps play out.  How about the scam that carbohydrates are bad for you, or the scam that albuterol benefits all pulmonary disorders.  Consider that back in the 1950s IPPB was thought to enhance distribution of aerosols, and it took about 50 years for that scam to become completely extinct, only to be replaced with some other scam that encapsulates the medical profession.

This post is a facetious respiratory therapy perspective on "The Eight Stages of Scam."

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