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We rely on our doctors to be skilled, ethical, and knowledgeable. What we often fail to realize is that these qualities don't always align. For instance, how can we be certain a new surgical method is truly effective, or if it simply appears to be? The only way to know is through a clinical trial, where some patients will unknowingly receive a placebo surgery. But is that morally justifiable?
This is only one example of the many heated discussions doctors are having behind closed doors, far from public scrutiny.
10. Doctors Are Not Immune to Errors or Deception
Medical journals are meant to keep doctors informed. Unfortunately, some of them feature articles written by ghostwriters working for pharmaceutical companies. Take for example a 2000 article in the New England Journal of Medicine, which touted Vioxx, a new painkiller. The authors—some of whom were later revealed to have ties to the company that produced Vioxx—downplayed the drug's cardiovascular risks. Sound familiar? Vioxx was pulled from shelves in 2004 for—you guessed it—causing heart problems.
Most medical treatments undergo clinical trials to verify their safety and effectiveness. However, recent reexaminations of some studies revealed that over a third of them had errors, ranging from minor issues to serious flaws, such as recommending treatments for the wrong patient population. Moreover, a second look at the studies behind the stockpiling of flu medications Tamiflu and Relenza showed that these drugs might not be as effective as previously thought. They may reduce the flu duration by half a day, but there’s no proof they prevent complications or hospitalizations.
9. Advance Directives Can Open the Door for Dementia Patients to Participate in Risky Research
Doctors can’t treat you without your informed consent. But what if you’re unconscious? Ideally, you’ll have an advance directive on file. You might even have a research advance directive, which would allow you to potentially participate in future studies and help others. It sounds simple enough—unless you develop dementia.
Alzheimer’s disease has been researched for over a century, yet our understanding remains limited. Research is essential, with some scientists relying on an advance directive to move forward. This consent must be given before a person develops dementia, but it's rarely obtained. Some argue that making this consent mandatory hampers valuable studies, while others are deeply uncomfortable with the idea. After all, there have been troubling outcomes in previous human trials.
The Alzheimer’s Association adopts a balanced approach. Their stance is to enroll participants in research when risks are minimal, obtain consent from a surrogate for higher-risk studies with potential benefits, and mandate consent for any risky research that offers no substantial benefit.
8. Unintended Discoveries Can Turn Your Life Upside Down
Modern medicine has access to some of the most advanced tools ever created, but sometimes, this can lead to discovering too much. Imagine visiting the ER for depression, only to learn from routine tests that you have a growth on your adrenal gland. This common finding is referred to as an 'incidentaloma.' While these tumors are typically harmless, doctors can't be certain it's not cancer without conducting further tests.
Cancer? Run every test possible!
So, they conduct all the tests, and the results come back benign, which is typical for incidentalomas. However, now you're faced with massive medical bills and an emotional toll, possibly even leading to feelings of despair. You could request the doctor not to mention incidental findings, but if it involves gene sequencing, the doctor may disregard your wishes. The American College of Medical Genetics and Genomics instructs its members to search for any unrelated risky genes during genetic testing and to inform the patient about whatever they discover. Medical advancements can lead to costly, heart-wrenching consequences, and there's no clear solution for handling the issue of incidental findings.
7. Unethical Co-Branding Practices
Co-branding can be incredibly effective. For example, some credit card companies promise to donate $100 to a medical center if new customers spend $500 within six months of approval. Companies, including hospitals, partner with others to enhance their visibility. This strategy typically benefits everyone involved. However, issues arise when hospitals fail to thoroughly vet their business partners before entering into these collaborations.
Certain genetic testing companies, for instance, circumvent regulations by labeling their tests as 'recreational.' Some direct-to-consumer companies offering cardiac screenings have come under fire from consumer groups, who argue that these tests may 'do more harm than good.'
It's a mixed situation. Even experts who oppose direct marketing to patients must acknowledge that, so far, there is 'no solid evidence' proving it's harmful as a tool for education. Beyond that, controversy abounds. So, don't simply assume that just because something carries the name of a respected medical institution, it’s automatically what the doctor would recommend—take time to think critically and read the fine print.
6. You Might Wake Up During Surgery
As grim as modern medicine can seem, at least we have anesthesia. In the past, undergoing surgery while fully awake was a horrific experience for both the patient and the surgeon. However, in today’s world, around 1 or 2 out of every 1,000 patients actually wake up 'during surgery.' Not surprisingly, up to 70% of these patients go on to develop PTSD.
This happens when the general anesthesia isn’t strong enough. The drugs used are so potent that it’s a delicate balance between no pain and no vital signs. Anesthesiologists aim to keep you both alive and comfortable, but sometimes they can’t quite determine how much is sufficient, especially toward the end of a procedure, when most of the anesthesia has been metabolized. Additionally, for certain high-risk surgeries, they have to 'go easy on the gas' because you’re already in a critical state.
There's no way to guarantee that you won’t wake up before the procedure is finished. The good news, though, is that if you do wake up, you’re more likely to feel pressure rather than pain. You’ll experience the sensation of instruments and unfamiliar hands moving inside you—no wonder the PTSD rates are so high.
5. Doctors May Face Conflicts Of Interest
Everyone enjoys free samples at the grocery store, so why shouldn’t doctors get some freebies too? Drug company representatives provide everything from notepads to free pizza. Naturally, physicians accept them. They then continue to practice medicine in their own way. In itself, this isn’t an issue—doctors need to eat and have something to write on like the rest of us. The problem arises when money and influence become involved, creating potential conflicts of interest.
It’s common for directors of drug companies to also hold leadership roles at major academic medical centers. Research shows that about 40 percent of them do. On average, these directors receive over $250,000 annually for their services, and then they return to the medical centers to run the health care, research, and educational sectors according to their own preferences. This is a frequent occurrence.
Your medical care could be more expensive and even vary based on whether your doctor owns labs, equipment, or has a stake in a specialty hospital. Despite self-referral laws, studies have shown that patients often undergo more tests and surgeries in regions where physicians own significant local medical infrastructure.
4. No One Truly Understands Your Health Care Costs
When faced with medical bills, most people instinctively grab their checkbook or call their insurance company (or even a bankruptcy lawyer). But did you know that hospitals might reduce the bill if you challenge it? Moreover, they often charge different amounts based on your insurance. Hospitals do this because there’s no clear way to determine the true cost of your visit. In 2004, the CFO of the UC Davis Health System remarked, 'There is no method to this madness. Over the years, we had these convoluted formulas, multiplying our costs to set our charges.'
Hospitals operate using a 'chargemaster,' which is essentially a comprehensive price list. With the exception of California, patients generally don't have the right to view it. Even if you manage to get access, it likely won't make much sense. There is no nationwide standard for these lists, and each hospital updates them independently. Your insurance might secure a discount of more than 50 percent on the chargemaster price. If you're uninsured, you will pay the full price. The rise of Obamacare has created a boom in the medical billing industry, but the system for coding medical bills remains unclear.
Unfair treatment of minority groups continues to be an issue in the United States.
Historically, Americans received different levels of medical care depending on their ethnicity. While we've made some progress, there's still much work to be done. In 2002, the Institute of Medicine revealed that minorities were consistently offered lower-quality healthcare and were often denied certain medications and procedures. Additionally, they were more likely to face amputations due to diabetes. The Institute called for systematic changes, as well as more minority healthcare providers and interpreters to address language barriers. Six years later, a different group confirmed these findings and published a book offering solutions to help communities address these issues.
In 2014, the situation for some communities had worsened. Medical professionals described the issue as complex, with factors such as inadequate insurance coverage and healthcare providers not serving low-income areas contributing to the problem. Cultural differences, communication challenges, and a lack of accessible information on how to navigate the healthcare system further exacerbate the issue.
2. Compromised Medical Devices
Medical equipment is supposed to have top-tier cybersecurity, right? Unfortunately, that's not the case. A health care chain in the Midwest recently instructed its IT department to attempt hacking its devices across 100 facilities. The results were alarming: medical records were exposed, medicine pumps were reset, defibrillators were reprogrammed, fridge temperature settings were altered, and emergency and lab equipment were disabled. And that's only the part the company was willing to acknowledge. Issues like weak passwords, infected devices, and inadequate firewalls were common. However, the system's most useful feature—directly embedding data into medical records—also made it a hacker's ideal target.
This is far from an isolated incident. In 2010, malware brought a New Jersey heart catheterization lab to a halt. The Conficker virus was found in 104 devices at a Tampa VA hospital. An antivirus program caused a third of hospitals in Rhode Island to delay all but emergency surgeries and treatments after mistakenly flagging a vital Windows DLL as harmful.
Thankfully, no patients have been harmed so far. The FDA has released new cybersecurity guidelines. Though not legally binding, it's clear that having a non-secure device could block its approval for use. These guidelines also serve as a warning to the healthcare sector: now is the time to secure all the vulnerable devices currently in operation.
1. Electronic Health Record Mistakes
Medical records were once kept on paper, but doctors and hospitals have saved time, space, and money by moving to electronic health records. These innovative software solutions save lives, but they're not without their flaws. Computer and human errors still happen. Even worse, contracts with software companies prevent doctors from publicly criticizing the systems.
Mistakes are all too common. Doctors may overlook critical lab results due to poorly designed screens. Medication dosages get mixed up. Notes are lost. And no one is monitoring these mistakes. It’s possible that this contributed to the US Ebola outbreak. Thomas Duncan contracted the virus in Liberia. After returning home, he visited a Dallas ER with symptoms resembling the flu. He did mention his travel history, and a nurse recorded that in his electronic file. What happened next is unclear, but it’s possible that the nurse’s note wasn’t readily accessible to the ER doctor and other medical staff due to a software design flaw. As a result, Mr. Duncan wasn't promptly treated for Ebola, and he later passed away from the disease.
+Simulated Surgery for Research
Sadly, the example of secret placebo surgeries is not purely hypothetical. While rare, it has indeed occurred. A report published in 2009 in the *New England Journal of Medicine* detailed a study in which 63 patients with osteoporosis-related compression fractures underwent a 'simulated procedure without cement.' This wasn’t limited to one hospital; several prominent medical centers participated. Though this may sound terrible, the study concluded that the real surgery likely wasn’t benefiting anyone. Was it justified? The debate over sham surgeries continues, with doctors still 'trying to make up their minds.'
