Overtreated. Again.

Came across this story when a physician FB friend posted that he read it the day after getting a steroid injection for his back.  Sadly for him, he won’t even get the placebo effect now:

A randomized trial of steroid injections for back pain has shown that they are no more effective than a placebo.

Because the long-term benefits of surgery remain unproven and pain medicines often have serious side effects, doctors have increasingly turned to steroid injections to treat lumbosacral radiculopathy, a common cause of back pain. The condition stems from damage to the discs between the vertebrae that often leads to sciatica, numbness or pain in the legs.

Researchers tested 84 adults with back pain of less than six months’ duration, dividing them into three groups. They received either steroids, etanercept (an arthritis medicine) or an inactive saline solution in two injections given two weeks apart.

At the end of one month, they were assessed for pain.

Leg and back pain decreased in all three groups, but there were no statistically significant differences among them. The researchers conclude that steroids may provide some short-term analgesic effect, but that the improvement in all of the patients was mainly due to normal healing.

If only people realized how often doctors are just guessing without any research to back up what they are doing.  Unfortunately, when they are not sure whether something will work, it’s safe to say the very often err on the side of what may well be an unnecessary treatment.   This is actually a pervasive and serious problem in our overall medical system and culture in this country.   Alex has several great doctors whom I especially appreciate as they are so honest about how much they don’t know.  When in doubt, treat, may be great for doctors, hospitals, etc., bottom lines, but not necessarily for patients.  And, oh, for that back pain, this conclusion confirms what I’ve been hearing for years:

But for now, he said, “the strongest evidence for back pain relief is with exercise.”

Free, but hard (relative to getting a shot or popping a pill, that is).  In my case, I actually found that simply sleeping with a pillow under my hips (while sleeping on my stomach) was all the cure I needed for the back pain I developed a couple years ago.   Had that not worked, I was planning on working through the exercises in the Back Pain Book.

Why the Euro and dollar are so different

I was trying to explain the deal with the Euro to David yesterday and I realized that Matt Yglesias’ take on the matter is the most useful I have come across.  And certainly the most effective take for explaining the matter to a twelve-year old (and, of course, I think is generally on-target for all ages):

But if you look at a big place like the United States or China what you see are huge place-to-place divergences in economic vitality paired with large open-ended transfer programs. Even in smaller economies, the old West Germany has been subsidizing the old East Germany for a long time and will continue to do so for a long time. In Italy, the north helps carry the south. In the U.K., the south helps carry the north. Sometimes these things are formalized as place-to-place transfers (Canada, I believe, has large provincial equalization payments) and sometimes it’s person-to-person transfers that happen to have the net impact of letting Massachusetts subsidize Mississippi. The European Union does a little of this, but the scale is tiny compared to the continent as a whole. As we saw yesterday, most individual European countries have a lot of within-country transfer payments from rich people to poor people but Europe as a whole is marked by a high level of inequality and near-total absence of transfers. If in the United States every bailout of the poor parts of the country by the rich parts was marked by protracted negotiations and stern demands that West Virginia “reform” its underperforming economy we’d be in perpetual crisis. And of course you might ask yourself why the federal government does so much for low-income residents of the United States and so little for the poorer low-income residents of low-income Mexico. And of course the reason is nationalism. Nationalism inspires us to help our fellow American when we can and leaves us relatively cold about the plight of people living in Peru.

In short for the Euro to really succeed you need a real European nationalism.   And while Europe has come a long way, this just isn’t going to happen any time for a long time, if ever.  As different as people in Massachusetts and Mississippi are there is still a common language, and considerable shared common history and culture, and perhaps, most importantly, when thinking in geopolitical terms, the person from Massachusetts may think the Mississippian is a mouth-breathing redneck, but he’s still the “us” that is “Americans.”  That matters a lot.  Until Europeans start seeing each other that way (never?) the Euro would seem to have an uncertain future.

Photo of the day

Big Picture has a set of May Day (i.e., International Workers’ Day) photos that should really be themed: angry people versus police.  This was my favorite for the splash of color:

Riot policemen stand guard after getting splattered by paintballs from student protesters during clashes on International Workers Day, or May Day, at the central square of Bogota on May 1. (Jose Miguel Gomez/Reuters)

Mitt’s electoral college path

I just finished grading a bunch of papers predicting the results of the presidential election and a significant portion of the assignment was to analyze the electoral college.  So I especially enjoyed seeing Chris Cilliza’s recent piece on Romney’s narrow path to the electoral college:

A detailed analysis of Romney’s various paths to the 270 electoral votes he would need to claim the presidency suggests he has a ceiling of somewhere right around 290 electoral votes.

While Romney’s team would absolutely take a 290-electoral-vote victory, that means he has only 20 electoral votes to play with — a paper-thin margin for error.

Romney’s relatively low electoral-vote ceiling isn’t unique to him. No Republican presidential nominee has received more than 300 electoral votes in more than two decades. (Vice President George H.W. Bush won 426 electoral votes in his 1988 victory over Massachusetts Gov. Michael Dukakis.)

By contrast, Bill Clinton in 1992 (370 electoral votes) and 1996 (379) as well as Obama in 2008 (365) soared well beyond the 300-electoral-vote marker.

Much of that is attributable to the fact that Democrats have near-certain wins in population (and, therefore, electoral-vote) behemoths such as California (55 electoral voters), New York (29) and Illinois (20).

The only major electoral-vote treasure trove that is reliably Republican at the moment is Texas, with its 38 electoral votes. So while George W. Bush won 30 states in 2000 and 31 states in 2004, he never came close to cresting the 300-electoral-vote mark in either race.

Today, the Post has an article also taking a look at Romney’s “narrow path.”  I found the following most interesting (and I do like that Republicans as well as Democrats see NC as playing an important role):

The Romney campaign’s thinking about the electoral map, detailed in interviews this week with top campaign officials and advisers at Boston headquarters, as well as several Republican strategists, is akin to the “3-2-1” strategy authored recently by Bush strategist Karl Rove. Under that strategy, Romney would need to win three traditionally Republican states (Indiana, North Carolina and Virgina), plus two perennial swing states (Ohio and Florida), then one more state from half a dozen tossups.

Among the tossups is a trio of Western states that Obama carried four years ago: Colorado, Nevada and New Mexico. At this early stage, Nevada appears the most competitive because the state’s economy has been decimated by the housing crisis. And Romney’s team is counting on high turnout by Mormon voters there.

But in all the Western battlegrounds (as well as in Florida), Romney’s weak numbers with Hispanic voters pose a serious obstacle. Campaign officials said they will begin to address the problem by focusing on economic issues in their messaging to the Latino community, believing that will overcome damage done during the primaries by Romney’s hard-line stance on immigration.

There’s also this handy graphic:

Twelve states the Romney campaign is eyeing

Now, the electoral college is stupid because it is truly ridiculous that people in Ohio and Florida will see literally thousands of ads and have candidates desperate to get their vote whereas Americans living in Texas and New York will be totally ignored.  But as long as it’s stupid, I’m glad it looks like the stupidity will extend to NC this year.

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