If you're interested in this, read up on the PSA (Prostate-Specific Antigen) test: it's the main test used to check for prostate cancer in males. You'd think that doctors would issue it to all males of a certain age annually, and up until recently most doctors did that. But there's been an interesting change of thinking in the past few years: someone noticed (and importantly, some insurance companies agreed) that the combination of an increase in the power of drugs/surgical techniques available to treat the disease and a stabilization of the relatively-high false-positive rate in the PSA test (and the dangers of what happens with a false-positive) means that unless someone has a predisposition to prostate cancer, it's often better not to test for it. The net result when the options are getting prostate cancer and taking the treatment vs. getting screened early and undergoing the invasive diagnostics needed to confirm a PSA test at that stage, it's usually a better choice just to get prostate cancer.
Note that this math goes out the window, however, if you have a family predisposition to prostate cancer. In that case, the risk of option #1 goes up (since it's predicated on the relatively low incidence rate of prostate cancer), and the dowsides of option #2 go down (since the probability of a false-positive is much lower).
http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car...
Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.
Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath.
PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.
This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended.
Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
In any case the original article was about a woman who went through a nightmare to get a hospital to not perform unwanted, unneeded and dangerous spinal surgery. So to my eyes I was bringing the discussion back to the example under discussion. And pointing out that it has been well known for over a decade that spinal surgery is a generally bad idea to me underscores the horror of what happened to her.
You don't specify what missed test killed your father.
There are, however, many symptoms where, given the uncertainty of all technology today, giving an operation or a drug prescription to might save X lives whereas NOT taking action would save Y lives, where X and Y are very uncertain.
The harder thing, though, the lives that are lost through giving the operation or the drug tend to be even harder to measure - people die through being prescribed 4,5,6...X drugs up to the point that interaction fry them without any one drug being "to blame". People die from complications of many surgeries, yet if the surgery is possibly necessary, people don't think to blame the decision to operate (the New Yorker figure that surgical accidents kill more than auto accidents is remarkable - auto accidents were once the 4th leading cause of death in the US). And there is a hidden if you test everyone for everything. False positives can kill people - false positives do kill many people today.
And as the New Yorker article mentions, physician incentives to make tests (or in other circumstances, to avoid them) can make a big difference.
[edit] Anticoagulation is the more common treatment because it has better long term odds. But, that assumes fairly early detection.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...
Atul Gawande argues that the problem with healthcare in the US is overutilization.
The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.
Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.
I am sure the pain will come back some day and then we will have to make another decision, but meanwhile we have avoided an invasive surgery.
... not to mention greater actual health.
When health care was the leading issue in Canada a few years ago and every politician was going around promising to expand it, I remember wondering if I was the only one thinking we need less of it, not more.
It might be helpful if we used a more accurate label than "health care" (perhaps "disease industry").
There are a couple of solutions to this, but no one really talks about them. (1) There are plenty of people that are qualified to be doctors, but because they did their medical school in India or China before immigrating to Canada, they aren't allowed to be certified as doctors. (2) Lots of doctors 'jump ship' to more profitable countries like the USA because they can just charge insurance and they aren't regulated from creating a 'factory practice' where no patient ever gets more than 5 minutes of the doctor's time.
In the US, a large number of people use the emergency room as a doctor's office because they have no other choice.
So, Canada: problematic. US: fail
But if Canada keeps using US logic, it might wind-up in our boat. Good luck to you...
How do you mean though? I'm saying that people with flu/colds/UTI/etc just go to the emergency room instead of a doctor's office (or even walk-in clinics at times) in Canada. I've been without healthcare, but I spent most of my life on a good healthcare plan through my parents. I don't have much experience with people that are off of the healthcare system (the only time I've had friends that were 'poor'[1] was in Canada where they were still covered for healthcare and social assistance).
[1] By poor I mean, barely making any money and living off of welfare and/or living in subsidized housing. I don't mean starving/homeless, though I was a couple of 'degrees' away from people that were homeless.
> But if Canada keeps using US logic, it might wind-up in our boat.
How do you mean?
> Good luck to you...
I'm currently living in the US, but I was living in Ontario for a time. It just irks me when people start talking about the 'problems with the Canadian system' when it's not a unified system as I understand it. The same when people start talking about 'socialized medicine,' since every country that has such a system has a different take on it.
Perhaps this is exactly why health care costs have gone up so dramatically. We have insurance, so the doctors take advantage of it -- needlessly. We very well could be spending a lot less money for the same amount of health care.
I think the solution to the health care problem is for someone to start saying NO, like in that other article on the front page now. No to more test, no to unnecessary treatments and surgeries and non-generic drugs.
Say no!