The masquerade

When I see billboards for medical centers and doctors as I drive on the highway, all claiming to be top and number 1, or letting us know that we NEED these centers, it makes me think that the opposite is true.  Did Mother Theresa need a billboard?  Are billboards usually required if something is in your best interest?  I guess usually not in my experience.  So, we have entered the era of “Billboard Medicine” – how should this knowledge guide us?

To me, it means that any patient interest is no longer the priority, but medical center business interests, usually price and volume are the key.  This means, the most profitable procedures and treatments are maximized, and designed to fit within patient “complaints”.  This then generates information being generated online or even in the “medical literature” that will drive utility of the best revenue generators, and patient researchers largely do not realize that the information is largely generated by the same people who profit from the procedures, thinking they have done independent research, which is largely becoming impossible unless you can find dated sources (scoffed at by the establishment).

What is an example of this?  Sinus surgery, turbinate surgery, adenoid surgery, etc.  Largely, these procedures do not address the root cause of any patient’s breathing problem, which are actually caused by environmental factors, but more so, undiagnosed sleep apnea and mouth-breathing.  These procedures simply remove the VISUAL MANIFESTATION, and sometimes mask the symptoms of these problems.  To use an analogy, this is like having a leaky pipe in the basement, and hiring a company to clean the wet floor, and remove the damaged carpet.  But, of course the company does not fix the pipe because that is a separate STRUCTURAL issue.  No matter how clean the floor looks the pipe will never fix itself.  Getting the tissue cleaned or removed in the above surgeries is about as useful, but is scientifically proven…by a field called “OUTCOMES RESEARCH”.  Outcomes research was a brilliant advance made by physicians in the late 90’s to use surveys to follow before and after surgery.  NO PHYSICS INVOLVED!  Just symptom improvement, which of course nearly EVERY study shows.  This is the equivalent of letting JETS fans in a stadium decide the outcome of penalties.  (I have been to a few games over the years – they always strongly think that penalties are in favor of the JETS and are outraged when told the opposite by Refs).  Patients chose their surgeon, sometimes after seeing a billboard, and largely when handed a postop survey at 3 months, they typically behave like JETS fans and rate the surgery favorably.

What is the solution?  Ignore billboards.  They should be outlawed, like the rest of the consumerization and politicization of medicine.  If you feel like a provider is building procedural VOLUME with your case, maybe reconsider!  Consider your structure, tone and overall health.  Is it logical that one little piece of mucous or tissue removal will help you?  Sometimes we need to consider the problem ourselves.  Find structural solutions! (None of this is medical advice – just a thought experiment).

-Howard

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