Overtreated: Overdone medicine, from bloodletting to watching your toes in shoe store X-raysBy Randolph E. Schmid, AP
Sunday, June 6, 2010
Overtreated: Bleeding for colds, X-rays for shoes
WASHINGTON — Bloodletting for a cold? X-rays to see if your shoes fit?
Medicines, tests or procedures that can be useful in the right situation, yet dangerous if overused — it’s been a recurring theme through history.
From the 1930s to the 1950s, thousands of U.S. children getting new shoes would climb onto wooden contraptions, press a button and look at the bones in their toes, glowing in eerie green light.
In the ritual, shoe stores had fluoroscopes, a sales tool that supposedly helped to make sure shoes fit correctly by X-raying them for five seconds to 45 seconds — while they were on a kid’s feet.
The device fit into a “culture of artistic persuasion and scientific blather like Cinderella into her glass slipper,” wrote Dr. Jacalyn Duffin of Queens University in Kingston, Ontario, in her study of the history of the machines.
At first, people weren’t worried about a possible hazard, but that changed after the first atomic bombs were detonated and the risks of radiation became more widely known, according to Duffin.
The machine originally lured people into stores, but “once it stopped working as an advertisement, when it served to drive people away, the store owners got rid of them,” she said.
Reports of injuries from the devices are hard to pin down, Duffin said. No formal injury studies were done, though tests showed many machines produced unnecessarily high levels of X-rays.
There was a report of a woman who had chronic skin problems on her feet after working several years demonstrating the safety of the machines. Pennsylvania banned the devices in 1957 and other states followed.
And what about the idea that drugs sold in the U.S. actually work? Not until the early 1960s was there a law that required that.
Before then, pharmaceutical products had to be safe, but there was no requirement for drugmakers to prove their products did what the companies claimed.
That created a situation in which a company could market a product for all sorts of conditions and people took oodles of pills and potions they didn’t need.
What constitutes overuse?
It may not have been known at the time that a product was being overused, “but you look back and say ‘Wow,’ we used too much of that,’” said John Swann, historian at the Food and Drug Administration.
One example is Phenacetin.
It was the “P” in once-popular A-P-C pills that also contained aspirin and caffeine. They served to ease pain and fever and give a boost.
“It was a very effective fever reducer and had been around a long time,” Swann said. “It was a pretty common medicine at the time.”
But after long-term use, it also turned out that women who used Phenacetin were subject to urinary and kidney disease, as well as high blood pressure. Phenacetin was banned in the U.S. in 1983.
Another “drug” noted by Swann was Marmola, which was desiccated thyroid tablets sold early in the 20th century as a diet product. People took them like candy, Swann said, but it wasn’t safe. It, too, was taken off the market.
For many people, thinking about discredited medical care conjures up images of medieval bloodletting, a medical treatment popular for thousands of years for all sorts of illnesses.
It’s still used for some rare diseases.
Duffin, a hematologist as well as medical historian, says she still uses it for diseases that cause an overloading of iron or red blood cells.
But bloodletting was wildly overused throughout history and, in most cases, did more harm than good.
George Washington, for example, caught a cold and suffered severe respiratory distress in the hours before he died. During that time, he was bled several times by a series of doctors — a total estimated later at between five pints and seven pints in less than 12 hours.
Even a big, sturdy man like Washington must have been weakened by losing that much blood.
Background on fluoroscope: tinyurl.com/22woqu4
George Washington and bloodletting: tinyurl.com/23wz4o5
Tags: Diagnosis And Treatment, Diagnostic Tests, Health Care Industry, North America, United States, Washington