If science advances one funeral at a time, what can be done about institutions that insist on bing wrong? The American Heart Association has a lot to answer for.
Sometimes doctors do good work, sometimes their training leaves much to be desired.
As someone who teaches pre-med students, I can attest to this! When I see their performance in my class and realise they are trying to become doctors and surgeons, I shudder to imagine being treated by them. I think easily 80% don't show enough competence at that point to have my trust in their abilities. I teach them a required experimental physics class and believe doctors should have a scientific mentality when it comes to treatment but very few come out appreciating the scientific method and how to approach empirical problems. I fear many will just end up treating patients with a cookie-cutter approach and cashing in.
Isn't it the case that every common diagnosis has an established "reasonable and prudent" treatment?
It seems to me that the main skill of a doctor is making the correct diagnosis. Once that's done, treatment (at least in the vast majority of cases) is going to be perfunctory.
And even the diagnosis itself is going to be, in most cases, the "most likely" condition that explains the patient's symptoms.
>As surgeon and health care researcher Atul Gawande observes, “Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.”
I am not trying to defend doctors but the article left out a little detail that messes up the entire system.
Malpractice Insurance
In the United States, if God forbid , they happen to not do a procedure or precautionary test, and the patient ends up affected or imparied in some way or form, R.I.P that doctor's insurance.
Only in America can you sue to get that witchcraft money( apparently copious amounts of money brings someone back to life) when someone dies after surgery complications in that life saving procedure.
Doctors/surgeons are not God, their is always a risk in surgery.
People should be able to sue. It's the only natural incentive for good practice. Otherwise there's no consequences for poor practice.
On the other hand, people should also be able to lose those lawsuits, and should also be able to sue for unnecessary preventative procedure, and the basis of winning or losing should be based on empirical evidence pertaining to risk.
Insurance isn't the problem, nor are malpractice lawsuits. It's the inherent risk in the field. Malpractice issues are greatly overstated in health care debates.
It's certainly not the only incentive for good behavior, and I don't think adding more lawsuits to the mix is the solution. The proper incentive is having a medical board which has the power to discipline, and can do so without acting on emotion or greed, which presumably is the source of many lawsuits.
>"Our current malpractice system doesn’t work. Why? Because 90 percent or more of malpractice cases don’t even go to court. And the amount of money – and it is vast – that is attached to this “medical malpractice settlement industry,” if you will, is divvied up in such a way that much of it doesn’t reach the patient. It goes to lawyers, it goes to the courts, and it goes to so-called experts who testify on behalf of the defendant or the plaintiff."
Well, from what I see in the US, the risk to be sued actually encourages a lot more damaging procedures than it makes people rigorous. That's not to say people shouldn't be allowed to sue. Actually, there is really no good solution to this problem.
The best situation I have seen is where people do sue, but hospitals provide legal protection for their employees (public sector in western Europe). Employees there still fear for their jobs, but not enough to put patients through nearly as much useless and risky crap as in the US. Patients there are also far less prone to sue, since the success rate of legal action is low. All in all, everyone seems to benefit from a little less tension in the system.
Of course, you will always find people who feel (perhaps rightly so) that they were wronged, and that we should cut the hands of the bad docs. Finding balance in those matters is a difficult social exercise.
And from my perspective, regarding "tort reform" with respect to medical malpractice, I'm against the caps.
Because the doctor/hospital side -- further backed by insurance -- typically has much more power and inertia than the patient. And these reforms add often quite severe limits that don't actually cover some or many patients' actual damages (cost of continuing care alone, not to mention quality of life).
Absent meaningful penalties, mistakes become just "a cost of doing business" and there may be little incentive to actually fix them. Or to punish the chronic bumbler -- where bumbler can actually mean de facto criminal negligence (in the eyes of reasonable people, regardless of legal outcome).
AND, that's what an awful lot of what intersects "white collar" and "business" comes down to, in the U.S. Money. It's our often poor substitute for real justice -- and for being more proactive to prevent problems before they happen (e.g. by spending smaller sums, up front, to better the process)
I'd be more supportive of a... "more rational" system of compensation, if ongoing care were guaranteed. The medical accident doesn't mean you will end up un-insurable. Or even on the street or in a family members bedroom or on a friend's couch, because you can no longer work in your career.
If it were a real medical system that pro-actively worked to improve itself, minimize mistakes and bad behavior, take responsibility for its outcomes, and provide ongoing care. Instead of limited fee for service transactions, regardless of the quality of said service.
All the more so as medical networks grow into behemoths (even if that was promoted to some degree by the insurance and legal systems), they employ tremendous legal resources on behalf of their own interests. Legislatively limiting the other side's leverage in dealing with them? No, thanks.
P.S. I may be mistaken, but I have a recollection of reporting on this... maybe 5-ish years ago, or a bit more. Study of malpractice settlements and judgments found that most were not outrageous and sought to meet the real resultant needs and injuries of the plaintiffs.
The "big payout", "ballooning expenses" story was/is to some significant degree manufactured. Citing extreme, outlying cases that are a small minority of what's really going on.
That is, the story has a political basis. The agenda of certain self-serving interests.
Whichever side you're on, with regard to "tort reform" with respect to medical malpractice, I think we all need to see the complete and unvarnished numbers. Settlements as well as judgments.
Again, the secrecy surrounding this is not doing us, the public, any good. With actually, comprehensive data, perhaps we could come closer to an agreement on policy, regulation, and legislation, in this area.
The malpractice insurance issue would be much reduced if doctors, hospitals and medical organizations wouldn't stonewall legitimate claims. I know someone whose surgeon messed up a surgery. First they denied everything, then they refused compensation, then they hired private investigators to look for evidence that would discredit her. She had several other surgeons tell her verbally that the surgery was incredibly botched but no one would testify in court because they seem to have a code of silence if one doctor snitches on another he will get ostracized.
When you look at airplane crashes the investigation gets done in public and the focus is on improving procedures and not assigning individual blame. This is a much better way to handle problems.
I think the issue is that we look at air travel as inherently risky and as such want to do everything to reduce risk. Over the past 100 years we've come to deeply understand risk management in the space and as such are careful to only assign blame in cases of blatant negligence (he wasn't IFR rated but flew into the side of a mountain while in a cloud) while treating other accidents as learning opportunities (Ok, the pilot fucked up but the MU-2 handles differently than most planes, we should require more training in type...).
The industry also had it's fair share of litigious behavior but it was generally recognized that it wasn't productive and legislation has since attempted to keep it at bay with varying degrees of effectiveness
It makes me wonder why similar practices aren't followed in the medical field...
In my view the medical boards should have a nationwide malpractice insurance that investigates, pays out quickly to the patient and then decides if procedures need to be improved or the doctor needs to be reprimanded. But as with everything else in the US medical system there is a lot of money to be made with the current status quo so nothing will change.
Couldn't agree more. The FAA-NTSB-NASA relationship doing the same thing works extremely well in the aerospace sector. The FAA creates the rules, NTSB investigates accidents and NASA handles "near miss" reporting, all working to eliminate conflict of interest. All of this creates a nice closed feedback loop.
It's not without it's flaws but the fact that you can hurl yourself through the stratosphere in an aluminum tube and essentially be statistically assured survival is nothing short of miraculous, especially when compared to the early days of aviation.
Note that accident investigators, including the FAA are NOT interested in blame. They are about preventing future harm which is different. As a result the accident report is specifically protected in law so that you can't use it as evidence for a lawsuit.
Medics have a mechanism for preventing future harm too, it's called a mortality & morbidity conference or M&M. Again it isn't interested in assigning blame and mustn't be used as evidence in a lawsuit.
Far too much of the medical "system" in the U.S. is adversarial.
All the harder to remain or get well, whilst in the middle of a fight.
Sometimes doctors. Insurance (and, any number of types of insurance, depending on what's happened). Institutions (hospitals et al.). Lawyers.
Then slap non-disclosure on top of it all, to make it all the more likely the next guy enters, unaware.
That's my "word for the day", with respect to health care in the U.S. "Adversarial".
I'm going to stop writing and just reflect on that, for a while.
(And even when it's not, it can/could be. Something that hangs over the head of every clue-ful patient, as they go through the system.
Maybe it's easier to be someone who doesn't follow the news and keep up on this, who goes through the system blissfully unaware and happens by chance or whatever to avoid the major pitfalls.
I feel a bit guilty, writing about this when a lot of the world struggles to achieve basic coverage. But, I've had the U.S. system screw me over, significantly, more than once. I used to be more trusting. Now, I delay and delay -- which creates its own problems.)
It does seem clear to me that if hospitals & medical practices were run with the same culture as the airlines (ie, a high-integrity approach to risk) the results would be measurably better.
However the political processes surrounding hospitals will block this. For example, there are lobby groups in the community that literally scream blue murder if decisions like "it isn't rational to live" are made in public. In Australia, we've been fighting the good fight to get euthanasia legalised for as long as I can remember. It is slow, hard going.
A system that can't let people go is simply never going to allow public investigations - it hasn't accepted that quality of life takes primacy or that death is sometimes inevitable. Medical care is very political and they cannot support the results-oriented culture of the airlines.
And there's a well-known surgeon in my hometown that slipped at the hospital, fell, and damaged his hands. He sued and won for 10's of millions. His kids are hardcore awful people and that lawsuit enabled them to be worse AND gave a very rich surgeon even more money from the seemingly unlimited pit of healthcare funding.
>> Before being randomized to receive the operation or the sham...
I know that people opt-in to such studies, but what exactly does a "sham" stenting procedure involve? I find it hard to believe that any hospital would insert something along a blood vessel and into a heart, or even just anesthetize a patient, for the purposes of staging a false surgery. These are commonplace but not risk-free procedures. What exactly does it take to convince someone that a piece of metal has been inserted into their heart? Are they presented with false x-rays and other records? Are they ever told the truth? How do they react when they learn that it has all been a sham?
>"In all patients, a research invasive physiological assessment
of fractional flow reserve (FFR) and instantaneous
wave-free ratio (iFR) was done. After the administration of
intracoronary nitrate, a pressure wire was placed in the
distal vessel at least three vessel diameters beyond the
most distal stentable stenosis.
[...]
In the placebo group, patients were kept sedated for at
least 15 min on the catheter laboratory table and the
coronary catheters were withdrawn with no intervention
having been done.
[...]
After the follow-up assessments, study participation
was complete, and patients and physicians were then
unblinded to the treatment group allocation. Patients
who had the placebo procedure had the opportunity to
choose to undergo PCI after consultation with their
physician."
Don't knock sham procedures; they're at least as effective as more than half of current medical procedures, and at lower risk. I'm thinking of getting one done.
After journal bias, conflicts of interests, and corruption, I now hold little remaining faith in the justice of “science”. It seems the “scientific method” I learned decades ago is inconvenient to publishers and consumers alike. (Also, I’ve had personal doctors push drugs on me when it was clear they were getting a kickback).
It’s frustrating when people read headlines and claim ”science” in a conversation, when the root of the research is fraudulent and the observer has never attempted to verify. When I challenge their assumptions, they are incredulous that I would question “science”.
Let's not throw the baby out with the bathwater. There's still plenty of excellent science being done every day; it's just not being written about in outlets like vox.com.
The solution to the problems you cite is more and better science.
Even more, it's only now that we're seeing some people apply a rigorous scientific and statical lens to medicine as a whole,
A good portion of that fifty or whatever percent of procedures that don't any backing evidence exist through being grandfathered-in from the medical tradition. Beyond the germ theory of disease, medicine circa 1900 was appalling in multiple ways.
Medicine continually advances, at least in parts. Hopefully that advance can continue against the grain of multitude of problems we see.
I was going to post a comment that may or may not be along the same lines as what you're getting at.
My impression, after working in the biomedical field, in clinical settings as well as in research settings, is that a lot of what happens is arrogant hubris, in part related to identification with the physical sciences in a biomedical context. I'm not saying those in the physical sciences are arrogant, what I mean is that there is a certain arrogance that people afforded to themselves by virtue of their privilege and monopoly, and it justifies itself along the lines of "I'm an expert in the physical sciences, which means that whatever reasoning I employ to justify something is sound, because it is based in what I perceive to be sound biological, chemical, physical theory."
I guess what I mean is that, although I agree with you that most of what is published is nonsense, to put it politely, the problems start much earlier, in conflating "science" with "physical objects of study." Often they don't even get to the stage of systematically collecting data, because they don't see reason to question the truth of their hypotheses. It sounds reasonable, because they are smart, therefore it must be correct.
When you get to the stage of shoddy data supporting these biases, it makes things even worse.
It's survivorship bias at its worst. People assume that because they get into medical school, or in some cases, grad school in the biomedical sciences, that they got there because they're geniuses (rather than because of who they know, luck, etc.), and that means they're somehow above the need to empirically verify their hypotheses.
People just don't understand that there are lots of good ideas that are just wrong.
After journal bias, conflicts of interests, and corruption, I now hold little remaining faith in the justice of “science”. It seems the “scientific method” I learned decades ago is inconvenient to publishers and consumers alike
Fully two-thirds of scientific claims cannot be reproduced.
Science at this point is just making stuff up, a scientist who published something fake should be struck off but it never happens. It’s just a racket to get more funding.
a joke either from Gray's Anatomy or something similar: The dean of med school at graduation ceremony - "Half of what we've taught you here will be proven wrong in 5 years. The problem is what we don't know which half. "
Ok, so how installing a shunt on a blocked artery can possibly not work? (Not alleviating chest pain is "understandable", not reducing the risk of heart attacks makes no sense to me)
Maybe they didn't need it in the first place, maybe the blockage is treated by the medication regemine and not surgery maybe it causes other complications so it's a wash, maybe just because it seems like the mechanism should 'just work' it doesn't.
Zillions of reasons. If you miss your meds, that stent can abruptly occlude and cause death. Maybe you open one large vessel but the downstream vessels are clogged—even microscopically. Place enough useless stents and you’ll hurt patients from dye, bleeding, infection, etc.
On the other hand, studies of procedures are done on very narrow patient populations. Our patients often don’t fit into those perfect boxes. What’s “needless” is difficult. As long as folks get paid per procedure, it adds bias that favors doing instead of not doing.
So ya that's what all cardiologists thought. Many still think this. They may even be right. But we don't have EVIDENCE that this does anything to prevent death, heart attacks or even reduce chest pain.
To be clear though, they aren't talking about ACUTELY closed arteries as in a heart attack or myocardial infarction, when there is a plaque rupture and a blood thrombus that develops to cut off blood supply suddenly. But rather, when blood flow, which has been slowly narrowing over years, starts causing chest pain on physical exertion, when the heart muscle distal to the narrowing is asking for more oxygen than the artery can supply.
We put stents in a lot of these people, because we like to try to help them, but there isn't much evidence that it helps. It may help, but we haven't been able to prove it yet. Or it may help select people, but we don't know which people to select. But many will still keep getting these stents. Medicine is tricky.
Except for the diet stuff, that is totally based on rock solid evidence, there's no possible way that they've been dead wrong for 50 years and are covering it up. Just because a high fat low carb diet improves every possible health marker doesn't mean it's healthy!
44 comments
[ 7.5 ms ] story [ 93.2 ms ] threadSometimes doctors do good work, sometimes their training leaves much to be desired.
As someone who teaches pre-med students, I can attest to this! When I see their performance in my class and realise they are trying to become doctors and surgeons, I shudder to imagine being treated by them. I think easily 80% don't show enough competence at that point to have my trust in their abilities. I teach them a required experimental physics class and believe doctors should have a scientific mentality when it comes to treatment but very few come out appreciating the scientific method and how to approach empirical problems. I fear many will just end up treating patients with a cookie-cutter approach and cashing in.
It seems to me that the main skill of a doctor is making the correct diagnosis. Once that's done, treatment (at least in the vast majority of cases) is going to be perfunctory.
And even the diagnosis itself is going to be, in most cases, the "most likely" condition that explains the patient's symptoms.
Specialists have a stranglehold on medicine: https://www.nytimes.com/2017/06/03/opinion/sunday/the-specia...
I am not trying to defend doctors but the article left out a little detail that messes up the entire system.
Malpractice Insurance
In the United States, if God forbid , they happen to not do a procedure or precautionary test, and the patient ends up affected or imparied in some way or form, R.I.P that doctor's insurance.
Only in America can you sue to get that witchcraft money( apparently copious amounts of money brings someone back to life) when someone dies after surgery complications in that life saving procedure.
Doctors/surgeons are not God, their is always a risk in surgery.
On the other hand, people should also be able to lose those lawsuits, and should also be able to sue for unnecessary preventative procedure, and the basis of winning or losing should be based on empirical evidence pertaining to risk.
Insurance isn't the problem, nor are malpractice lawsuits. It's the inherent risk in the field. Malpractice issues are greatly overstated in health care debates.
This is a good point, I concur.
I agree doctors should be held accountable, but it is not the case in the U.S.
This article does a great job explaining the issue about malpractice in the U.S.
I have no idea whether malpractice is overblown, but I do know that it doesn't prevent bad doctors from practicing.
(https://m.huffpost.com/us/entry/us_5a1f4595e4b0dff40be0362f)
>"Our current malpractice system doesn’t work. Why? Because 90 percent or more of malpractice cases don’t even go to court. And the amount of money – and it is vast – that is attached to this “medical malpractice settlement industry,” if you will, is divvied up in such a way that much of it doesn’t reach the patient. It goes to lawyers, it goes to the courts, and it goes to so-called experts who testify on behalf of the defendant or the plaintiff."
The best situation I have seen is where people do sue, but hospitals provide legal protection for their employees (public sector in western Europe). Employees there still fear for their jobs, but not enough to put patients through nearly as much useless and risky crap as in the US. Patients there are also far less prone to sue, since the success rate of legal action is low. All in all, everyone seems to benefit from a little less tension in the system.
Of course, you will always find people who feel (perhaps rightly so) that they were wronged, and that we should cut the hands of the bad docs. Finding balance in those matters is a difficult social exercise.
Because the doctor/hospital side -- further backed by insurance -- typically has much more power and inertia than the patient. And these reforms add often quite severe limits that don't actually cover some or many patients' actual damages (cost of continuing care alone, not to mention quality of life).
Absent meaningful penalties, mistakes become just "a cost of doing business" and there may be little incentive to actually fix them. Or to punish the chronic bumbler -- where bumbler can actually mean de facto criminal negligence (in the eyes of reasonable people, regardless of legal outcome).
AND, that's what an awful lot of what intersects "white collar" and "business" comes down to, in the U.S. Money. It's our often poor substitute for real justice -- and for being more proactive to prevent problems before they happen (e.g. by spending smaller sums, up front, to better the process)
I'd be more supportive of a... "more rational" system of compensation, if ongoing care were guaranteed. The medical accident doesn't mean you will end up un-insurable. Or even on the street or in a family members bedroom or on a friend's couch, because you can no longer work in your career.
If it were a real medical system that pro-actively worked to improve itself, minimize mistakes and bad behavior, take responsibility for its outcomes, and provide ongoing care. Instead of limited fee for service transactions, regardless of the quality of said service.
All the more so as medical networks grow into behemoths (even if that was promoted to some degree by the insurance and legal systems), they employ tremendous legal resources on behalf of their own interests. Legislatively limiting the other side's leverage in dealing with them? No, thanks.
P.S. I may be mistaken, but I have a recollection of reporting on this... maybe 5-ish years ago, or a bit more. Study of malpractice settlements and judgments found that most were not outrageous and sought to meet the real resultant needs and injuries of the plaintiffs.
The "big payout", "ballooning expenses" story was/is to some significant degree manufactured. Citing extreme, outlying cases that are a small minority of what's really going on.
That is, the story has a political basis. The agenda of certain self-serving interests.
Whichever side you're on, with regard to "tort reform" with respect to medical malpractice, I think we all need to see the complete and unvarnished numbers. Settlements as well as judgments.
Again, the secrecy surrounding this is not doing us, the public, any good. With actually, comprehensive data, perhaps we could come closer to an agreement on policy, regulation, and legislation, in this area.
What about the whole hypocratic oath thing? Or isn't that natural?
When you look at airplane crashes the investigation gets done in public and the focus is on improving procedures and not assigning individual blame. This is a much better way to handle problems.
I think the issue is that we look at air travel as inherently risky and as such want to do everything to reduce risk. Over the past 100 years we've come to deeply understand risk management in the space and as such are careful to only assign blame in cases of blatant negligence (he wasn't IFR rated but flew into the side of a mountain while in a cloud) while treating other accidents as learning opportunities (Ok, the pilot fucked up but the MU-2 handles differently than most planes, we should require more training in type...).
The industry also had it's fair share of litigious behavior but it was generally recognized that it wasn't productive and legislation has since attempted to keep it at bay with varying degrees of effectiveness
It makes me wonder why similar practices aren't followed in the medical field...
It's not without it's flaws but the fact that you can hurl yourself through the stratosphere in an aluminum tube and essentially be statistically assured survival is nothing short of miraculous, especially when compared to the early days of aviation.
Medics have a mechanism for preventing future harm too, it's called a mortality & morbidity conference or M&M. Again it isn't interested in assigning blame and mustn't be used as evidence in a lawsuit.
That's completely counterintuitive. You better have some sort of evidence to back that up.
All the harder to remain or get well, whilst in the middle of a fight.
Sometimes doctors. Insurance (and, any number of types of insurance, depending on what's happened). Institutions (hospitals et al.). Lawyers.
Then slap non-disclosure on top of it all, to make it all the more likely the next guy enters, unaware.
That's my "word for the day", with respect to health care in the U.S. "Adversarial".
I'm going to stop writing and just reflect on that, for a while.
(And even when it's not, it can/could be. Something that hangs over the head of every clue-ful patient, as they go through the system.
Maybe it's easier to be someone who doesn't follow the news and keep up on this, who goes through the system blissfully unaware and happens by chance or whatever to avoid the major pitfalls.
I feel a bit guilty, writing about this when a lot of the world struggles to achieve basic coverage. But, I've had the U.S. system screw me over, significantly, more than once. I used to be more trusting. Now, I delay and delay -- which creates its own problems.)
However the political processes surrounding hospitals will block this. For example, there are lobby groups in the community that literally scream blue murder if decisions like "it isn't rational to live" are made in public. In Australia, we've been fighting the good fight to get euthanasia legalised for as long as I can remember. It is slow, hard going.
A system that can't let people go is simply never going to allow public investigations - it hasn't accepted that quality of life takes primacy or that death is sometimes inevitable. Medical care is very political and they cannot support the results-oriented culture of the airlines.
Doctors are patients too.
I know that people opt-in to such studies, but what exactly does a "sham" stenting procedure involve? I find it hard to believe that any hospital would insert something along a blood vessel and into a heart, or even just anesthetize a patient, for the purposes of staging a false surgery. These are commonplace but not risk-free procedures. What exactly does it take to convince someone that a piece of metal has been inserted into their heart? Are they presented with false x-rays and other records? Are they ever told the truth? How do they react when they learn that it has all been a sham?
>"In all patients, a research invasive physiological assessment of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) was done. After the administration of intracoronary nitrate, a pressure wire was placed in the distal vessel at least three vessel diameters beyond the most distal stentable stenosis.
[...]
In the placebo group, patients were kept sedated for at least 15 min on the catheter laboratory table and the coronary catheters were withdrawn with no intervention having been done.
[...]
After the follow-up assessments, study participation was complete, and patients and physicians were then unblinded to the treatment group allocation. Patients who had the placebo procedure had the opportunity to choose to undergo PCI after consultation with their physician."
http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
So it looks like they did an exploratory surgery on the sham patients, then just left them laying sedated on the table.
It’s frustrating when people read headlines and claim ”science” in a conversation, when the root of the research is fraudulent and the observer has never attempted to verify. When I challenge their assumptions, they are incredulous that I would question “science”.
The solution to the problems you cite is more and better science.
A good portion of that fifty or whatever percent of procedures that don't any backing evidence exist through being grandfathered-in from the medical tradition. Beyond the germ theory of disease, medicine circa 1900 was appalling in multiple ways.
Medicine continually advances, at least in parts. Hopefully that advance can continue against the grain of multitude of problems we see.
My impression, after working in the biomedical field, in clinical settings as well as in research settings, is that a lot of what happens is arrogant hubris, in part related to identification with the physical sciences in a biomedical context. I'm not saying those in the physical sciences are arrogant, what I mean is that there is a certain arrogance that people afforded to themselves by virtue of their privilege and monopoly, and it justifies itself along the lines of "I'm an expert in the physical sciences, which means that whatever reasoning I employ to justify something is sound, because it is based in what I perceive to be sound biological, chemical, physical theory."
I guess what I mean is that, although I agree with you that most of what is published is nonsense, to put it politely, the problems start much earlier, in conflating "science" with "physical objects of study." Often they don't even get to the stage of systematically collecting data, because they don't see reason to question the truth of their hypotheses. It sounds reasonable, because they are smart, therefore it must be correct.
When you get to the stage of shoddy data supporting these biases, it makes things even worse.
It's survivorship bias at its worst. People assume that because they get into medical school, or in some cases, grad school in the biomedical sciences, that they got there because they're geniuses (rather than because of who they know, luck, etc.), and that means they're somehow above the need to empirically verify their hypotheses.
People just don't understand that there are lots of good ideas that are just wrong.
Fully two-thirds of scientific claims cannot be reproduced.
http://www.bbc.co.uk/news/science-environment-39054778
Science at this point is just making stuff up, a scientist who published something fake should be struck off but it never happens. It’s just a racket to get more funding.
This article makes some "hand waves" about how understanding of the disease was simplified https://www.vox.com/science-and-health/2017/11/3/16599072/st... but the fact is blocked arteries don't let blood flow.
On the other hand, studies of procedures are done on very narrow patient populations. Our patients often don’t fit into those perfect boxes. What’s “needless” is difficult. As long as folks get paid per procedure, it adds bias that favors doing instead of not doing.
To be clear though, they aren't talking about ACUTELY closed arteries as in a heart attack or myocardial infarction, when there is a plaque rupture and a blood thrombus that develops to cut off blood supply suddenly. But rather, when blood flow, which has been slowly narrowing over years, starts causing chest pain on physical exertion, when the heart muscle distal to the narrowing is asking for more oxygen than the artery can supply.
We put stents in a lot of these people, because we like to try to help them, but there isn't much evidence that it helps. It may help, but we haven't been able to prove it yet. Or it may help select people, but we don't know which people to select. But many will still keep getting these stents. Medicine is tricky.