By Jill Chapin
November 21, 2009
I recently read a book that shines more disturbing light on the latest healthcare debate; namely, the idea of being overtreated. If you were confounded before about the proper course of action on this volatile topic, be warned that the following will just add to your angst.
Shannon Brownlee’s Overtreated would agitate you if it were fiction; that it is fact will upend everything you’ve come to understand about our medical care. Written with no hyperbole, it is difficult to dismiss this book as inflammatory, as the facts speak for themselves.
Overtreated is laced with exhaustive, well-researched studies that give credibility to the true anecdotal stories peppered throughout the book. What you will discover will be quite alien to what you have been led to believe.
You will get the sense that we’ve all been had, that we have been seduced by all those hi-tech testing devices and medical procedures and designer drugs made so readily available to us. You will come to understand that more is not better. Yet in all of the discussions about health care reform, have you ever heard over-treatment being discussed? If you currently associate less treatment with rationing, you won’t after you read this book.
It is difficult to accept the concept of being overtreated. Haven’t we all believed that the most serious problem with our health care is that many are not getting enough? Yet extensive studies done all over the country have proven that in areas and hospitals where more drugs and procedures and tests were performed, patients did no better than in places where less was offered. And sometimes they fared worse.
The more medical procedures offered, the greater the chance for medical error. And increased drug consumption is not so much for saving lives or curing serious conditions as they are taken just to help us cope with ordinary existence. Except when they don’t and we become harmed by them. The odds simply increase that someone will make a mistake with procedures and prescriptions, and it is these odds that account for about 30,000 deaths each year from unnecessary care.
Research has shown that high rates of surgery in certain parts of the country were not driven by patient need, but by the doctors who perform them. Doctors who send patients for procedures or tests when they have a financial stake tend to order more than do doctors who don’t have a financial incentive.
Hospitals will first set up imaging centers or cancer clinics, and then hire doctors who will be richly compensated for bringing patients to them. This upside down version of supply and demand is unique to the world of medicine where supply dictates demand. Cars and computers are built based on a demand because an overstocked warehouse would necessitate a price reduction. This is not the case in medicine. Hospitals will simply recruit more doctors to send more patients. With a simple change in the definition of disease, healthy people can be instantly transformed into patients, with all of the overtreatment that being labeled sick entails.
Radiation for example is profitable. People are getting such excessive amounts of radiation in many of these procedures that even some radiologists are concerned that it is contributing to the skyrocketing rates of thyroid cancer. Yet contrary to popular belief, imaging devices simply are not as accurate as we are led to believe. This is corroborated in autopsies showing that rates of misdiagnosis have remained virtually unchanged since the turn of the last century.
The vast majority of invasive cardiology procedures aren’t life-saving; they are elective. Worse, according to cardiologists’ own rules, at least 160,000 annual stents or angioplasties should not have been done. Spinal fusion and arterial stents have actually been proven in many studies to either do no good or to do actual harm. But because American medicine values innovation and profit at the expense of caution, we the patients pay the price with both our wallets and our health.
As I came to realize after reading Overtreated, less really is more when it comes to optimum health care. And if we had better information, we would likely reject some of those treatments and tests and drugs. Therefore, we would be wise to question our doctors more often. Keep in mind what many deans tell their medical school graduates: Half of what you learned is wrong. But we don’t know which half.
We need to begin giving serious thought to the downside of being overtreated in order to better those odds.
The Hunger Site
November 21, 2009 at 3:28 pm
In defense of its practice of over prescribing, the medical profession would probably argue fear of lawsuits for medical malpractice for failing to do that extra test, etc.
Another problem is the dependence of the medical profession on the pharmaceutical industry. For one example, the drug companies have perfected a new and highly effective method to expand their markets. Instead of promoting drugs to treat diseases, they have begun to promote diseases to fit their drugs. The strategy is to convince as many people as possible (along with their doctors, of course) that they have medical conditions that require long-term drug treatment. Sometimes called “disease-mongering.”
To promote new or exaggerated conditions, companies give them serious-sounding names along with abbreviations. Thus, heartburn is now “gastro-esophageal reflux disease” or GERD; impotence is “erectile dysfunction” or ED; premenstrual tension is “premenstrual dysphoric disorder” or PMMD; and shyness is “social anxiety disorder” (no abbreviation yet). Note that these are ill-defined chronic conditions that affect essentially normal people, so the market is huge and easily expanded. It seems that the strategy of the drug marketers is to convince Americans that there are only two kinds of people: those with medical conditions that require drug treatment and those who don’t know it yet. While the strategy originated in the drug industry, it could not be implemented without the complicity of the medical profession.
Drug companies are not charities; they expect a profit in return for the money they spend. Physicians, medical schools, and professional organizations have no such excuse, since their only fiduciary responsibility is to patients. If the medical profession does not put an end to this corruption voluntarily, it will lose the confidence of the public, and the government will step in and impose regulation.