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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsI find this mildly interesting:(Reflections in a pile of bullshit)
Herein, I am going to examine three so-called medical truths from 1980. Each of these were stipulated to be conclusively effective and absolutely required in executing certain forms of treatment of human beings. If you failed to do any of these things, you were considered to be Subpar, not worthy of your credentials, and in some cases legally liable
Although not necessarily when it came to Good Samaritan laws in certain states.
First, anyone who had heart valve damage or a replacement valve prior to any treatment which might cause bleeding due to invasive processes, required Penicillin, or amoxicillin pre-medication four times a day two days before, the day of, and two days after the treatment. We were told as practitioners that every dose was critically important and if the patient were to admit, missing a dose or two a priori, then we were not to perform the procedure. I cannot begin to tell you the number of hours I spent imploring patients to take the required doses, following the procedure and staying up nights, worried that something bad was going to happen to them, which would ultimately be my responsibility. I am not necessarily talking about legal responsibility, but the idea that I may have damaged someone exceedingly for a dental cleaning or an extraction. But now, we premedicate using antibiotics one hour prior to the procedure and no medication thereafter. Many criteria went into the metamorphosis of this regimen, but the question is why did someone not take this into account for decades? Or conversely, is this dose of medication sufficient statistically? The answer is: I have no frigging idea.
Second, in CPR resuscitation back in the old days, the technique of the pre-cordial thump was sanctioned if you witnessed the patient actually collapse. It consisted of striking the sternum toward the lower part in order to possibly reestablish ventricular rhythm. This was a very, very big deal and was on every single test that we ever took, and it got hammered into us via all kinds of trick scenarios when we were attempting to pass our CPR test so that we may be relicensed. Now it turns out that the pre-cordial thump is no longer recommended at all whatsoever for pre-admission resuscitation. No explanation, no data presented, no contrary opinion, no Nothing it was simply announcement. The assumption, of course, is that new pronouncements are more valid than old pronouncements. Yeah, sort of like when Republicans tell you that in fact, Ukraine invaded Russia and the latter is actually just defending herself. Of course, they will say that studies show whatever, but do recall that there were ostensibly studies in existence which showed that OxyContin was non-addictive, but in fact there were no such studies.
Third, in keeping with the CPR theme, all kinds of complex combinations of breaths and chest compressions were mandated involving one or two individuals rendering CPR and it was absolutely required that everyone know and understand every nuance of the resuscitation protocol because if you dare do it wrong, the patient who has little chance of recovery anyway we almost certainly die. And this major guilt trip was hanging over everybody, as to whether they would remember exactly what to do when the time came if there ever were such a time, and it was thrust upon you randomly and frighteningly. So now, nobody talks about ventilations almost at all whatsoever. Its all about chest compressions and rescue breaths are secondary - to be given if at all, after thirty chest compressions if able. OK
fair enough
but oh boy do I recall our groups being harangued in the early days by the EMS personnel who used to teach this. Gone are the staircase ventilations and all the other nuances of the procedures.
And heres a bonus for you: for well over a hundred years silver amalgam restorations were placed in back teeth. If well-placed they might last forty years or much more. If questionably placed they might only last twenty to thirty years. In the old days I used to see fillings of long standing with fingerprints in them because the dentist hadnt bothered to use a condenser to press the material into place and rather used his or her thumb. Really. Now, we place composites, tooth-colored fillings which, if well placed in most individuals may last 5-10 years before they wear and break and if questionably placed, are literally failing as the patient walks out the door. And as an aside, all the cavity preparation has to be is damp and the bond is failing immediately followed by recurrent decay, possibly root canal treatment or extraction.
Now there were some junk science papers that the mercury in the silver fillings was toxic to the patient. I am here to tell you that silver filling material mixed in pre measured capsules has virtually no free mercury and theres much more in a can of tuna. But in many jurisdictions amalgam use is either forbidden or the patient is required to sign a waiver, so therefore it is rarely used now.
The combination of composite resin use executed poorly and the removal of fluoride from drinking water is going to increase the risk of dental disease exponentially and the profession will be an ideal one to make a fortune during the next thirty years and beyond. Of course, the morbidity and mortality of significant dental disease is not trivial, and death rates definitely go up in areas of poor dental care.
Good frigging luck. The whole system has been dumbed down in many cases due to highly questionable if not fraudulent research performed by hacks and greedy corporations. The point of this post is to demonstrate by example that almost none of us know what the actual facts are surrounding anything in our lives anymore and one cannot rely upon official pronouncements then or now.

TnDem
(742 posts)This is true and goes directly at some of the things that have went on in the "official" medical community in the last few years....Remember, George Washington was intentionally bled to death by his well meaning doctors.
unblock
(55,035 posts)Former ent here. Not sure, but I rather suspect, the change was based not on any medical improvement, but rather, based on educational improvement.
The idea being that the previous (and likely, more medically beneficial) approach was too complicated, so that *in practice*, what rescuers did was a less-than-ideal mess.
The simpler teaching may have been a step down in theory, but an improvement in practice as they were easier for rescuers to remember and implement when the time came.
Again, this is semi-informed speculation based on vague recollections of conversations either former colleagues and an article or two I once read, all years ago. I'll readily admit my recollection could be faulty.
PCIntern
(27,293 posts)That recent advances are faulty What Im saying is that this was taught to us as irrevocable science and that we were obliged to follow this without fail or we were absolutely remiss in our responsibility to the patient. Later research may show that this is better outcome, but no mention is ever made of the fact that prior to the alteration in the protocol, The treatment modality was quite frankly problematic. When we were instructed in those days, nobody allowed as to how this could be the case. It was do this or the patient dies because you didnt do it right.
unblock
(55,035 posts)What was considered best 20 years ago may be second best or even downright harmful today. Maybe 300 years ago, doctors were considered negligent if they didn't apply leeches and drain blood in many cases where later we figured out that was not such a good idea.
Knowledge is one thing, training is another. Knowledge may allow for nuance. The second best approach may become in many cases, or even more appropriate in certain exceptional cases.
But when training, there's a tendency to teach "the" protocol and dismiss any deviation as simply wrong and substandard and likely negligent and damaging. It simplifies training at the expense of real learning.
Institutionally, they don't want a lot of "dr. House"-type people running around creatively ignoring protocol, with possibly better outcomes, though more likely, many more disasters.
PCIntern
(27,293 posts)that at no time does or did anyone use the phrase Current thinking says that . It was all permanent absolutes with no discussion of evolution of theory or possible deviations from the norm. The instructors were most denigrating to those who asked simple questions.
Hugin
(36,056 posts)Some years ago I bought a used quick reference guide to MIs. Which consists of a spiral bound 3x5 300 page book printed on glossy stain resistant paper. I have always assumed it was meant to be stored in a crash cart or first response vehicle.
Well meaning, but largely useless.
It reads like a stereo manual written in Latin.
I did flip through it once. All of the steps boiled down to three basic concepts. Four if you include the unspoken step of invoking higher powers and sheer determination.
Also, it convoluted fibrillation and blockages.
It ultimately turned out, the one time in my life where I was personally confronted with a situation where everyone present took it for a MI, it turned out to be something else even more serious that few had even been trained to look for. Even though it is almost as common as an MI.
CaliforniaPeggy
(153,599 posts)You've written a fascinating post with data and your eloquent viewpoint. For anyone who wants to get into the weeds on all these topics, your post is an excellent place to start.
Thank you!
PCIntern
(27,293 posts)As always, thank you for your feedback. Many issues are bothering me these days. I was mildly upset that my prologue on the interrelationships of certain issues was largely ignored last week, but Ill continue on without hesitation.
People are understandably acutely upset about the federal political situation to focus on what they consider hypothetical or improbable occurrences. I certainly get it.