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After century of removing appendixes, doctors find antibiotics can be enough

arstechnica.com

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Re: After century of removing appendixes, doctors find antibiotics can be enough

#151

Post by pervycreeper »

ransom1538 wrote: post #45

I found this conversation unnerving at 13 years old: Doctor: "Does all this make sense? We need to remove your appendix.. now." Me: "Doctor, ok, so you need to remove my appendix cause if you don't I could get really sick. " Doctor: "Yes." Me: "What does the appendix do?" Doctor: "We don't know."

Someone mentioned tonsils below, but in the past, we also had bloodletting, trepanation, and various other unnecessary excisions. Foreskin may one day join the list (who knows, though). This all raises the question of why medicine is practiced the way it is, with so much appeal to authority and memorization, rather than something more intrinsically scientific. Why do bad practices persist for so long?

Re: After century of removing appendixes, doctors find antibiotics can be enough

#152

Post by russdill »

colordrops wrote: post #125

I recall reading sometime in the past that appendectomies are the perfect cash crop at hospitals. Most are not needed but it's not worth the risk so everyone gets them, they are a low risk easy surgery, and they can charge a lot for them. I also recall that the cost for the surgery varies widely across hospitals.

What's interesting is that you'd think the switch over to a laparoscopic technique would save money, but it actually costs more.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653254/

Re: After century of removing appendixes, doctors find antibiotics can be enough

#153

Post by philsmith35 »

crazygringo wrote: post #80

I'm so confused. From Wikipedia: > Appendicitis is caused by a blockage of the hollow portion of the appendix. This is most commonly due to a calcified "stone" made of feces. Inflamed lymphoid tissue from a viral infection, parasites, gallstone, or tumors may also cause the blockage... The combination of inflammation, reduced blood flow to the appendix and distention of the appendix causes tissue injury and tissue de…

in general the presence a stone (appendicolith) would no longer qualify as uncomplicated acute appendicitis. I did not see if that was specifically mentioned in this trial, but I have seen similar trials enrolling in the US where this was the case

Re: After century of removing appendixes, doctors find antibiotics can be enough

#154

Post by carapace »

rscho wrote: post #50
arkades wrote: post #40

Earlier quoted context omitted.

I understand that, looking at individual scientific problems, it's easy to get cynical. It's even fashionable to be so. Deaths attributable to heart disease in 1970 were just shy of 800k per annum. As of 2010, it was about 600k. A 25% drop in the leading cause of death, in less than a generation. Life expectancy was 70.8 years in 1970, and 78.7 in 2010 - an increase of more than 10% in a single generation. Science is…

I have both feet in the game, being a clinical researcher. So, cynic but not casual.

"Politicized agenda-propelled random search" Lol!

I think you and arkades both have it right. It's a "politicized agenda-propelled random search" on a large enough scale and over a rich enough search space that it "has made impressive strides" despite its flaws and inefficiencies.

I have a friend who works as a Healer. People come to him and pay him good money and he gets results. He doesn't advertise, he gets referrals by word-of-mouth alone. My point is he gets results.[1] He can do things that are totally off the map of conventional medicine. However, he's uninterested in science and scientists (in general) are uninterested in him. "It's something that moves generationally" indeed, if paradigm shifts really require the dying out of the old guard.

If we think of inefficiencies in the search due to e.g. politics and superstition as a kind of malady, then it seems we are witnessing a phase of "Physician heal thyself", what with the advent of mass medical monitoring and big data correlation, eh?

[1] Have you heard the joke, "If alternative medicine works it's just called medicine."? Well, yes and no. Some things that work are too far outside the belief structures and will be ignored or ridiculed.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#155

Post by rscho »

arkades wrote: post #128
kevin_thibedeau wrote: post #127

Earlier quoted context omitted.

That's mostly because smoking has been stigmatized.

And nothing to do with the pile of research that’s been done in the past few decades identifying exactly which medications actually provide mortality benefit in cardiac disease and which don’t, of course.

Well, that's precisely my point. Yes, new drugs help, but often less so than the "dogma of the year" lets you hope at first. The point is that MDs are usually identified as scientists because many people think they actually had an important part to play in the development of new useful technology, and don't see that most of the time those new things come directly from the lab and clinicians just test drive them to find the optimal use case. It's true that test driving is essential, but I have a hard time calling it science when you see what people from hard science can do. Additionally, the proportion of MD researchers who understand nothing about what they do, or who even deliberately cook up results is absolutely alarming.

To follow up on your cardiology example, I'd say that pills certainly helped, but the game changers really are the new toys of the interventional cardiologist.

And I would also add one of my favourite pseudo quotes: "science advances one funeral at a time." -- Max Planck

Re: After century of removing appendixes, doctors find antibiotics can be enough

#156

Post by ryanmcbride »

da02 wrote: post #147
fredsanford wrote: post #140

Earlier quoted context omitted.

The doctor told me that there was no heartbeat and no breathing for approximately 3 minutes. Since I'm still here... :) I called it technically dead. As for afterlife... I don't remember anything from surgery until I woke up 9 days later in the ICU.

Any permanent damage? Or did you make a full recovery?

Not a doctor but supposedly a brain can be without oxygen for about 6 minutes without permanent damage.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#157

Post by philsmith35 »

JoeAltmaier wrote: post #91
gwbas1c wrote: post #87

Earlier quoted context omitted.

> Or are the antibiotics for dealing with an actual ruptured appendix If your appendix ruptures, it is life threatening and has to come out. Most appendix removals happen before the appendix ruptures. The conclusion of the study is that high doses of antibiotics is an effective way to prevent the appendix from rupturing without surgery.

I still have the question: what about the 'stone'? Do antibiotics cure that somehow? Or is that the reason that 30% of those treated with antibiotics ultimately have the surgery?

the actual study states that presence of a stone was an exclusion criteria

Re: After century of removing appendixes, doctors find antibiotics can be enough

#158

Post by cimmanom »

sandworm101 wrote: post #129
jawns wrote: post #98

Earlier quoted context omitted.

About 10 years ago, one study set forth an interesting hypothesis: The appendix is a place where "good" bacteria can safely hide during infection. I'm not sure if there's been any work since then to confirm the hypothesis, but it sure is an interesting idea. Source: https://www.nytimes.com/2008/06/17/health/research/17appe.ht...

Hands and feet are also very useful ... until they turn septic and need to be removed. Antibiotics can treat infections in the early stages if diagnosed well ahead of time. But once an organ is totally taken by infection it may be unrecoverable. Either you remove it or it becomes a lump of dead tissue spreading evil to the rest of the body. By the time someone is in the emergency room due to abdominal pain, by the ti…

Pretty sure the whole point of this article is that often enough patients arrive in the emergency room at a point where it's NOT too late to treat successfully with antibiotics.

Re: After century of removing appendixes, doctors find antibiotics can be enough

#159

Post by cimmanom »

fredsanford wrote: post #29
algorias wrote: post #17

That's great to hear. However, keep in mind that appendicitis is still an extremely serious condition that will kill you if left untreated. The fact that you can avoid surgery in some cases doesn't mean that surgery is not an adequate treatment. It's amazing how medicine has advanced: We can now cure illnesses with very minimal amount of invasiveness required in most cases. Even before this news, open surgery was alr…

Appendicitis will kill you! And the surgery in most cases will save you. :) At least in my case. I technically died from a ruptured appendix and spent 9 days in ICU. The doctors delayed surgery to see if the antibiotics would work. This was ~10 or so years ago.

They delayed surgery before or after the rupture? Was it already ruptured when you arrived?

Re: After century of removing appendixes, doctors find antibiotics can be enough

#160

Post by cimmanom »

sureaboutthis wrote: post #34

This reminds me of when tonsils were removed at the first sign of trouble. When I was in my early 20s, in the 1970s, I went to my doctor about a bad sore throat. He advised me to see an ENT who barely bothered to look down my throat for more than a second and automatically declared I needed mine removed. That bothered me but I very much respected my personal doctor who said he respected this ENT. When I mention this…

Are there hypotheses now for the purpose of the tonsils the way they've developed some for the purpose of the appendix?
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