You Get What You Inspect, Not What You Expect – Part 2
You probably aren’t getting what you want. You’re getting what you measure.
What’s your objective? What do you want? What results are you seeking? These are the most important questions in the only conversation that is not happening in the great health care discussion.
What do you really want…a lower cholesterol number, or a healthy heart, fewer heart attacks and a longer life? Do you want a passing MCAT score or a well-educated, well-balanced and happy child who is excited about learning and is prepared for the future?
I am afraid that we’ve lost sight of the trees. We stand confused in the forest of testing and exams – attached to the numbers and scores that, for the most part, are surrogate metrics for what we are truly after. Do you want better scores or better outcomes?
John Abramson of Harvard Medical School, author of Overdosed America, reveals the unnerving truth regarding the high-jacking of our Health Care System by the pharmaceutical industry. He explains that doctors at all levels are bound to protocols that are based on biased research and twisted statistics that are generated by pharmaceutical industry-sponsored research, seminars and medical schools. Unfortunately, even the best journals are subject to this type of influence – and it is changing the face of healthcare dramatically.
Why is this important to you?
Because you are one of the millions that make decisions about your health based on the best information available, the advice of trusted experts, and good old common sense. So consider this example:
Regarding bone health, osteopenia and osteoporosis: Is your objective a better bone density exam score or stronger bones that would resist fractures? I’ve asked this question to hundreds of patients. The answer is obvious: they want fewer fractures. The truth about bone scans, osteopenia, osteoporosis and Fosamax (and related drugs) is alarming.
Osteopenia, a gradual loss of measureable bone density is a natural part of aging. As you age, you lose some muscle mass (you can mitigate this to a large extent through resistance/weight training – but that’s for another blog post). The pharmaceutical industry has turned the natural aging process into a “condition” so that they can diagnose and prescribe a drug or procedure for you. Brilliant business model – terrible health care model.
A bone density examination yields a “T-score.” Categorically, if you have a T-score of 1.0 – 2.5 you have osteopenia; 2.5 (+) and you are diagnosed with osteoporosis. You are told that this is a pre-cursor to osteoporosis and you are prescribed Fosamax. This happened to my mother.
I asked her if the doctor explained that bone loss is a natural part of aging. Or did she discuss the aggregate research that clearly states that diet and exercise is the first and preferred course of action? That diet and exercise are superior in safety and outcomes? That the only side effects of diet and exercise are greater health and vitality?
I told her to ask her doctor if getting off her butt was right for her.
I then explained that the research shows that Fosamax does increase T-scores in women who are diagnosed with osteopenia. Unfortunately, the research also shows that these women had increased hip fractures. How can that be?
Briefly, there are two layers of bone, the outside layer or cortical bone, and the inside layer or trabecular bone. Trabecular bone forms an inner matrix for strength and fracture resistance. This inner bone is lost first in osteopenia due to its larger surface area. This weakens bone. Fosamax increases cumulative bone density by increasing outer, cortical bone – not inner, trabecular bone. Translation: T-scores go up, but, unfortunately, so do hip and wrist fractures. In fact, one pharmaceutical industry-sponsored study showed hip fractures increased by 84% on Fosamax, while another showed wrist fractures increased by 50% on Fosamax.
What was our objective again?
Even worse, medical journals informed your MD that research shows that Fosamax decreased hip fractures in women with osteoporosis by 56%. That sounds good, right? Not if you look at the numbers.
The study shows that an osteoporitic woman has a 99.5% chance of making it through the year without a hip fracture; whereas an osteoporitic woman taking Fosamax has a 99.8% chance of making it through the year without a hip fracture. This is an improvement in odds of 0.3% or 56% less relative risk. Not so impressive.
Winston Churchill said there are lies, damn lies and statistics.
We get better outcomes when we ask better questions. Start with “What is the objective here?” Think about what you really want and examine your methods and choices. What do you want? Now, what do you measure? What do you expect? Now what do you inspect? What is your goal? Now what do you celebrate? Better scores or better health?
Remember, a dry diaper is a good thing as long as there’s no puddle in the middle of the bed.
In Health from Within,
Dr. Stephen Franson