I recently wrote a Washington Post column about platelet-rich plasma, a treatment highly touted for sports injuries but without much clear evidence. As I later wrote at Last Word On Nothing, PRP provides a case study in why it’s so important to track outcomes in medicine. If you don’t measure your outcomes, you have no way to really know how you’re doing. Humans are notoriously bad at self-evaluating. A 2006 study published in JAMA found that, “physicians have a limited ability to accurately self-assess,” and a 2012 study found that doctors overestimate the value of the care they provide. And if you have an incentive (money?) to keep doing something, results be damned, then if you’re not careful, an ineffective practice can become fixed as the standard of care. Once that happens, it’s very, very difficult to walk it back.
Since the 1980s, “Early detection is your best protection” has been a mantra of the cancer-awareness community, spurring an insistence on frequent screenings to catch ever-smaller abnormalities. But this approach to cancer screening loses sight of the real goal — saving lives. And it turns out that finding more and more smaller and smaller abnormalities churns out more cancer patients, but this doesn’t necessarily translate into lives saved.
Read the rest of my opinion piece at Popular Science.
Athletes, Stop Taking Supplements
They’re expensive, they don’t improve performance, and they might make you test positive for dope.
Slate, July 26, 2012
Hardy is among a growing number of athletes who have traced a positive doping test back to a tainted supplement. Swimmer Kicker Vencill and cyclists Flavia Oliveira andScott Moninger (an acquaintance of mine), also tested positive after taking supplements, and 400-meter gold medalist LaShawn Merritt linked his positive dope test to a product called Extenz that he picked up at 7-Eleven. The problem is so prevalent that the U.S. Anti-Doping Agency (USADA) has developed an educational campaign for athletes, called Supplements 411.
Supplements are risky thanks in part to a piece of legislation passed in 1994 called the Dietary Supplements and Health Education Act. The DSHEA essentially deregulated dietary supplements, including vitamins, herbs, protein shake mixes, nutritional supplements, and other powders and pills that millions of people of all levels of athletic ability might take to improve their health. Most people assume that if a product is available on store shelves, it must be OK. But supplements are not required to be evaluated or proven safe or effective before they’re sold. New rules finalized in 2007 gave the FDA power to regulate the manufacturing and packaging of supplements, but the agency’s ability to police supplement companies remains limited by DSHEA. Its chief author and most powerful advocate is Sen. Orrin Hatch, whose home state of Utah is home to much of the U.S. supplement industry. Hatch, who attributes his good health to the supplements he takes each day, fought a recent amendment to increase the FDA’s ability to regulate the industry.
Read the rest at Slate: Athletes, Stop Taking Supplements