A really simple example of what industry doesn’t care about outcomes and pumps out product despite lack of evidence of effect and even potentially adds harm is the supplement industry. They dont care about brand reputation because they just change their name or bring another product to market eventually. If you take the FDA away you will have every major pharmaceutical just releasing garbage medications that barely improve life, yet increase cost and add side effects. They already try to do this with non-inferiority studies rather than coordinating studies that show improvement. Not to mention many currently available medications barely (and statistically suspect at times) show efficacy yet rake in serious money. This argument clearly is coming from someone outside of the medical industry with a limited understanding of mechanisms at work. It seems to be coming from someone on the early side of the Dunning-Kruger Curve.
Regarding surgery there are immediate outcomes and they are treating a specific problem so it is easy to measure. These are absent or limited with medications. If a surgeon is consistently not taking the gallbladder out from patients but telling them they did, this will be discovered quickly and typically the surgeons will either be sued into not practicing or be removed from the surgeon pool. The same goes for a surgeon who isnt safely putting an aortic valve in. First off, they typically dont get to the point of being able to operate on people if they are terrible. If they do, patients die. Then the surgeon is removed from pool of operating surgeons. Thats not the same for a medication that reduces the risk of heart attack by 50% from 1% to 0.5% over a 5 year period. Have you ever seen marketing from industry? Its terrible and not aligned with the truth. It is aligned with selling a product and if thats all they need to give to a doctor then you are going to get offered medications you dont want to take.
There are also methods of self-regulation by surgery departments, residency training programs, medical boards, state licensing agencies and professional associations. So, to say that surgery is not regulated is just misinformed at best. Your argument is just really empty. I understand what you wish to be the case, its just not realistic. Its the same argument that there is no need to regulate companies from dumping pollutants into the Hudson because they will avoid it due to reputation. Thats just not how real life works.
Not to mention the actual quackery that’s slipped through the cracks anyway, such as the homeopathic “treatments” that people are still somehow allowed to sell.
“Regarding surgery there are immediate outcomes and they are treating a specific problem so it is easy to measure”
There are longer term impacts of surgeries, though, that aren’t easily measured, and surgeries tend to score far more poorly on those fronts. Fixing a (sometimes minor) problem in ways that make people need more healthcare later is at best a mixed bag.
I had not heard of the Dunning-Kruger Curve, though had heard about human tendency to over estimate our own intelligence. It’s really good to have the wiki graph image in mind (being something of a jack of many trades but master of nothing—clearly something to take a personal interest in ;-)
At the same time, it’s not like the AMA or FDA or even the complex of industry controls are getting things right all the time, or even consistently weeding out the bad actors. Rather than a status quo is working or we need to change because something is not working, a better approach might be to frame the discussions in something of a Type I and Type II error context. Then we can focus on which error space represents the greatest costs/risk or greatest benefit for various settings. I’m not certain your were actually claiming the status quo is what we should want, I think more likely offering a balance to the OP’s claims.
If a surgeon is consistently not taking the gallbladder out from patients but telling them they did, this will be discovered quickly and typically the surgeons will either be sued into not practicing or be removed from the surgeon pool.
A surgeon saying they take out a gallbladder but don’t is more equivalent to some Indian generic company like Ranbaxy saying they produce a drug that has certain active bioavailable ingredients and then they don’t then it’s about a ingredient having different effects.
Taking out a gallbladder might be an intervention that’s positive for health or negative. Whether surgeries sold by surgeons are provide a net positive health effect is a distinct question from whether they do the surgery according to the book.
Everything you said about the myriad of ways the field of surgery regulates itself actually works to support the point you are trying to argue against.
A really simple example of what industry doesn’t care about outcomes and pumps out product despite lack of evidence of effect and even potentially adds harm is the supplement industry. They dont care about brand reputation because they just change their name or bring another product to market eventually. If you take the FDA away you will have every major pharmaceutical just releasing garbage medications that barely improve life, yet increase cost and add side effects. They already try to do this with non-inferiority studies rather than coordinating studies that show improvement. Not to mention many currently available medications barely (and statistically suspect at times) show efficacy yet rake in serious money. This argument clearly is coming from someone outside of the medical industry with a limited understanding of mechanisms at work. It seems to be coming from someone on the early side of the Dunning-Kruger Curve.
Regarding surgery there are immediate outcomes and they are treating a specific problem so it is easy to measure. These are absent or limited with medications. If a surgeon is consistently not taking the gallbladder out from patients but telling them they did, this will be discovered quickly and typically the surgeons will either be sued into not practicing or be removed from the surgeon pool. The same goes for a surgeon who isnt safely putting an aortic valve in. First off, they typically dont get to the point of being able to operate on people if they are terrible. If they do, patients die. Then the surgeon is removed from pool of operating surgeons. Thats not the same for a medication that reduces the risk of heart attack by 50% from 1% to 0.5% over a 5 year period. Have you ever seen marketing from industry? Its terrible and not aligned with the truth. It is aligned with selling a product and if thats all they need to give to a doctor then you are going to get offered medications you dont want to take.
There are also methods of self-regulation by surgery departments, residency training programs, medical boards, state licensing agencies and professional associations. So, to say that surgery is not regulated is just misinformed at best. Your argument is just really empty. I understand what you wish to be the case, its just not realistic. Its the same argument that there is no need to regulate companies from dumping pollutants into the Hudson because they will avoid it due to reputation. Thats just not how real life works.
Not to mention the actual quackery that’s slipped through the cracks anyway, such as the homeopathic “treatments” that people are still somehow allowed to sell.
“Regarding surgery there are immediate outcomes and they are treating a specific problem so it is easy to measure”
There are longer term impacts of surgeries, though, that aren’t easily measured, and surgeries tend to score far more poorly on those fronts. Fixing a (sometimes minor) problem in ways that make people need more healthcare later is at best a mixed bag.
I had not heard of the Dunning-Kruger Curve, though had heard about human tendency to over estimate our own intelligence. It’s really good to have the wiki graph image in mind (being something of a jack of many trades but master of nothing—clearly something to take a personal interest in ;-)
At the same time, it’s not like the AMA or FDA or even the complex of industry controls are getting things right all the time, or even consistently weeding out the bad actors. Rather than a status quo is working or we need to change because something is not working, a better approach might be to frame the discussions in something of a Type I and Type II error context. Then we can focus on which error space represents the greatest costs/risk or greatest benefit for various settings. I’m not certain your were actually claiming the status quo is what we should want, I think more likely offering a balance to the OP’s claims.
A surgeon saying they take out a gallbladder but don’t is more equivalent to some Indian generic company like Ranbaxy saying they produce a drug that has certain active bioavailable ingredients and then they don’t then it’s about a ingredient having different effects.
Taking out a gallbladder might be an intervention that’s positive for health or negative. Whether surgeries sold by surgeons are provide a net positive health effect is a distinct question from whether they do the surgery according to the book.
Everything you said about the myriad of ways the field of surgery regulates itself actually works to support the point you are trying to argue against.