DU Favorite Bill Maher just said that people undergo too many medical procedures

[Orrex]

And that doctors prescribe too many.

As evidence, he cited the relative profitability of The Insurance Industry versus the even more profitable Medical Facility Industry.


He also just crapped out another anti-vaccination screed.


AND he just went off on amalgam fillings, declaring that "you're not a nut for asking these things."

:eyes:

[salvorhardin]

1. Looks like he didn't take Michael Shermer's letter to heart

I have a lot of very serious problems with Shermer, but on these sorts of matters we think alike. Over at HuffPo he wrote an open letter to Maher:

Dear Bill,

Years ago you invited me to appear as a fellow skeptic several times on your ABC show Politically Incorrect, and I have ever since shared your skepticism on so many matters important to both of us: creationism and intelligent design, religious supernaturalism and New Age paranormal piffle, 9/11 "truthers", Obama "birthers", and all manner of conspiratorial codswallop. On these matters, and many others, you rightly deserved the Richard Dawkins Award from Richard's foundation, which promotes reason and science.

However, I believe that when it comes to alternative medicine in general and vaccinations in particular you have fallen prey to the same cognitive biases and conspiratorial thinking that you have so astutely identified in others. In fact, the very principle of how vaccinations work is additional proof (as if we needed more) against the creationists that evolution happened and that natural selection is real: vaccinations work by tricking the body's immune system into thinking that it has already had the disease for which the vaccination was given. Our immune system "adapts" to the invading pathogens and "evolves" to fight them, such that when it encounters a biologically similar pathogen (which itself may have evolved) it has in its armory the weapons needed to fight it. This is why many of us born in the 1950s and before may already have some immunity against the H1N1 flu because of its genetic similarity to earlier influenza viruses, and why many of those born after really should get vaccinated.

More: http://www.huffingtonpost.com/michael-shermer/an-open-letter-to-bill-ma_b_323834.html

[Orrex]

2. Great citation!

I tend to avoid HuffPo because I can't get past the entertainment news and articles by Deepak Chopra, but Shermer's letter is quite a zinger.

Too bad about his crazy Libertarianism, though...

[LeftishBrit]

6. Agreed...

but at the same time, I do feel uncomfortable about quoting Shermer as a main source of support. If he kept his scientific arguments and political views completely separate, then one wouldn't be relevant to the other; but he does seem to promote both in the same places. And one of the main ways in which the anti-vaccinators do harm outside their own circles (apart of course from the public-health risks of making some other people scared of vaccines) is by promoting right-libertarians who oppose *all* government provision of health care, so I think we have to be careful not to do the same.

That being said, his letter is certainly accurate here.

[realisticphish]

3. I've never really liked Bill Maher

He always seems to be more of a contrarian than someone who has real, considered opinions

[Orrex]

4. That's been my view for well over a decade

It annoys me when I see a dozen DU threads pop up each Friday night to disseminate his wisdom.

[realisticphish]

5. a big example for me

He is an anti-vaxxer, yet is ok with Gardasil. Why? Because it pisses off right wingers.

[Warpy]

9. He's like the little girl with the curl in the middle of her forehead

When he's good, he's very very good and when he's bad, he's horrid.

Most of his anti science, anti medical rants are coming straight from the fevered brain of that quack and darling of the cocktail set, Gary Null.

Maher is just too ignorant in that particular area to be able to discern between science and quackery.

[PVnRT]

7. If he did it while calling women bitches, that's a trifecta

[trotsky]

8. They really need to rescind his Dawkins award.

The man is a disgrace to reason.

[Heddi]

10. well, as a nurse (surprise!) I have two thoughts on this

1) sometimes we don't know a procedure or test is unnecessary until it's done
2) sometimes we do procedures or tests that we are pretty sure are unnecessary, but they are done because of the liability associated.


It is pretty much standard that everyone who comes into the ER and complains of pain in the chest (especially), back, or abdomen is going to get a blood test that can rule out or rule in a heart attack (CK-MB and troponin). It's liability. Many people don't present with a heart attack with the "elephant on the chest" pain. Many women have abdominal pain. Many people have back pain, or headache.

So we do these tests and repeat them 3 times, 6-8 hours apart, because the enzymes associated with these tests may not be at detectable levels until 6-8 hours after an "event" (ischemia or infarct of the heart).

Liability.

If someone comes in with abdominal pain and we DON'T do CK/Trop, and they have a heart attack and drop dead, the hospital is liable for their death. We COULD have detected it with a simple lab test...

Same with CT and MRI's.

Some teens came in the other night after a minor car accident. None of them lost consciousness. None of them even had head wounds, black eyes, headaches. But they all got CT and MRI. Again, liability. IF they went home and died a la Natasha Richardson, guess who's ass would have been held out to dry---Hospital.



There are so many cases of this---MD and RN's call them CYA admissions, or CYA labs, or CYA surgery. Cover Your Ass.

I honestly do not think or believe it's for profit. Hell, hospitals as it is have such low repay rates, even at the for-profit I work for now we have nearly a 50% unpaid rate on services. So we're not doing it for the money, I'm sure. The MD's don't get bonuses for every MRI performed. It costs the hospital $$ when you do these tests---need the phlebotomist to draw the lab, the lab tech to put it in the machine, and another lab tech to read the results.

MRI, CT, xray...you have the tech to put them in the machine then, after hours, we fax the images to a radiologist somewhere else in the country (one hospital used radiologists in Australia) who read the film and fax back a result. Even during the day when you have a radiologist on staff, that radiologist is an MD and costs alot of money--even more $$ after hours.

The $$ spent on the tests and getting the results is more than the cost of the test themselves in many cases.

Admitting someone to the hospital for a CYA costs more than we're repaid for

Then look at places like the Health Lounge and associated dumbfuckery like that---Oh, you've got a hangnail? Well go to your Dr and DEMAND a vit D test, and TSH and T3 and T4 and radioactive iodine uptake and blah blah blah...THAT is unncessary testing, and i bet that counts as "unncessary testing".

Once I went to my Dr about a rash I had, and I was asking for allergy test and this blood test and that blood test. Why, he asked? You have exzema, not a rash, not an allergy. It's excema. Those tests would have been "unncessary".

[Orrex]

12. Great minds!

1) sometimes we don't know a procedure or test is unnecessary until it's done
2) sometimes we do procedures or tests that we are pretty sure are unnecessary, but they are done because of the liability associated.

I made those exact same points in another thread on this topic (started by a charismatic and stunningly handsome DUer).

It was in response to the breathless question "why else would doctors prescribe unnecessary procedures?!?!?!?"

I pointed out that if you're lying on a slab, and your next-o-kin says "why didn't the doctor perform that blood test?" then the doc is going to be facing some hefty liability or at least a pain in the ass inquiry.

My answers were ignored. Actually, they were dismissed.


No matter what the reality might be, everyone's convinced that every test performed by a doctor is performed solely to pad the bottom line.

[Heddi]

15. Sometimes it's hard because

1) I know this person doesn't have insurance (they've told me) so this test will really add to the bottom line that honestly, they're probably not going to pay anyways (I'm okay with that, really)

2) I know, and my coworkers know, and the MD knows, that in reality this test isn't needed. Yes, they fell, but they didn't break open their skull, they don't have a head bleed, they don't have any kind of brain injury

HOWEVER...they may. And let me tell you a story:

A lady came in and had broken her leg b/c she fell off a ladder while painting.

She was alert, oriented, all of that. She said she clipped her head on the washing machine as she was hitting the floor. No headache. Neurologically intact.

She was admitted to my unit, she was going to get surgery on her leg the next morning.

A few hours after admit, she complained of a headache. Still neurolgoically intact. They didn't do a CT in the ER because she just nicked her head, nothing serious, we'll do one in the AM before surgery.

Well, as the night goes on she's getting worse and worse, just headache, worst headache of my life. I give her pain meds and she starts projectile vomiting---big deal, people vomit after dilaudid all the time.

SO the doctor is at her bedside, see's all this. I ask him if he wants us to do the CT tonight? no, we'll do it in the morning as planned, she just hit her head, no big deal.

Well, about 4 hours later she was unresponsive, pinpoint pupils. She finally got the CT and had a massive bleed in her head, was at that point basically brain dead and died.

---
Moral of the story---sometimes you don't know if it's useful or useless until you do the test. I agreed with the MD that she probably didn't need the scan until the next AM. The signs she was displaying: headache, vomiting, are a hallmark sign of brain injury, but I was too new an RN to know this. (now I know and will never forget!)

So now, because of this woman's case, any report of head injury, no matter how minor, gets a CT at that hospital.

Another story:

Patient is confused, falls out of bed, Found on side of bed. Pt denies hitting head. Is neurologically intact. NO bruises or bumps. Patient is put back to bed. Found dead the next morning because of massive head bleed that occured when he fell.

New policy: All hospital falls, unless they are WITNESSED BY STAFF, will get head CT's, even if pt denies hitting head.

90% of the time is unnecessary. 10% of the time is necessary. Don't know until you do it.

[Orrex]

16. I was really hoping that you'd work the phrase "doom poop" into your post

Another dream shattered, alas.

[Heddi]

17. Doom Poop, ah my favourite

alas, did not happen in this case. More like Doom Vomit.

[SemiCharmedQuark]

11. The most annoying thing is that I have heard him referred to as "the left wing's this" or "the left

wing's that"

And I think...please don't lump him in with me...

[Orrex]

13. You had some great posts in that other thread, by the way

Thanks for chiming in!

[dropkickpa]

14. Bill Maher is a liberaterian douche guzzlin misogynist

He annoys the everlivin' shit out of me. His guests are always more interesting and intelligent than him.

[Djinn]

18. libertarian isn't a catch all

people at DU use at as a term of abuse too much - there's left libertarianism, right libertarianism and then there's plain old contrarianism - which is what Maher is - he's not a political theorist he's a comedian, why people expect him to make much sense is beyond me.