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Metal on Metal Hip Replacements

If someone outside of medicine kept track of what happens to patients, even in a single community, it would have been possible to see that some patients have health problems after getting hip replacements. But no one tracks outcomes.

For 20 years medicine had been aware that some of these procedures produce levels of blood colbolt in patients beyond what is tolerated in industry, but in medicine they felt that this wasn't a problem.

On the basis of what?

Early on patients with these toxicity levels usually present with vague constitutional symptoms that include poor apetite, poor sleep, fatigue, and weight loss. Later they report disordered mood on either side of the mood spectrum, changes in taste or smell and problems with balance. With time accumlative issues include nuerological hardening, usually beginning with cranial nerves, so hearing and sight commonly are affected, and eventually blindness, cardiomyopathy, rampant Parkinsonism, dementia, goiter with airway compromise, seizures, and psychological issues including suicide attempts.

With no one tracking outcomes for patients, all of these can be seen as just more care needed by patients who are sick for no reason anyone can discern. A little data mining would reveal the reason no one in medicine could discern, but they don't do that.

A surgeon, Steven Tower, MD, got a hip replacement and experienced the effects of cobolt poisoning that were the same as experienced by a patient in which he had implanted the same device. He had hers taken out and she recovered. He had his taken out and he recovered. It only took 20 years and millions of patients to figure it out.

"This isn't the unlucky failure to spot the misdemeanours of one rogue company or the occasional unforeseen breakdown of a small number of devices," said Deborah Cohen, an investigator for the British Medical Journal. "It is the inability to prevent a whole class of failing hip implant from being used in hundreds of thousands of people globally."

In fact, millions of patients have had the kinds of hip replacements that expose them to cobolt toxicity.

Medicine focuses on processes, not on outcomes. They would be the wrong people to rely on for assessing outcomes anyway because, in spite of how vehemently they argue this point, they are not objective. But if they tried it at least would help.

The surgeon, Steven Tower, MD, who had gotten the implant himself, started a campaign to curb the use of metal on metal hip implants, but it was like Semmelweis's campaign to get treatment providers to wash their hands. 160 years later they still don't meet hand hygiene requirements most of the time.

If someone were monitoring outcomes for patients, it would be possible to determine where the worst problems with iatrogenic infections are too. And then patients could avoid those too.