Interesting article by Margaret O'Kane over at the San Francisco Chronicle
of health services. I'll be excerpting but I highly recommend you read it. O'Kane writes:
The question is never "Doctor, how little can you do to treat my illness effectively?" And the answer is never, "Let's wait a while." Instead, it's a quick rush to the imaging room, to the surgical suite, or to the pharmacy downstairs. The costs are clear to us all: a $1.7 trillion annual health-care tab that is growing again, and as fast as ever. Today, millions of Americans are getting more and more care whose value is not clear, because it's not based on scientific evidence.
In terms of the "question", I highly recommend to all of you to always
ask "What would happen if I don't do this? And what are the other ways of doing it?". It's vitally important.
In terms of the rest, many people will respond that our health system isn't competitive enough to cut out a lot of waste. In this instance, the private sector is surely driving a good deal of unnecessary spending.
Take pharmaceutical companies. They want as many people as possible to take their medicines. Think of all the people that were on Vioxx and Celebrex who had no problem tolerating ibuprofen? And those meds were shown to be no more effective than ibuprofen in relieving pain. I just find it deceitful because Pharma seems to take this "health costs are so expensive but we don't have anything to do with it! We just provide medicine everyone needs!" approach which doesn't ring true to me. Does Pharma provide a necessary service? Of course. We clearly need drugs. Are they responsible for all unnecessary health spending? Absolutely not. But they contribute quite a chunk.
Kane goes on:
Just as we do in so many other areas of consumerism, we need to take a more active role in health-care decision-making, questioning the value or necessity of tests, treatments or procedures.
This a really interesting point. Can people take this role? I mean, considering the amount we spend on all sorts of pretty "useless" things -- ipods, clothing (my particular weakness), video games, etc -- it often feels like there's this culture of spend now, think later. And that's without the emotional vulernability of people with illness that might require surgery, which obviously adds a whole new element to the decision making.
Wasteful spending stemmed in consumerism obviously extends way beyond health care. Think of "branding" -- it's not about quality and price at this point (maybe it was when the brands were first established). I know I'm one of those people that goes to the grocery store and doesn't like to buy the store's brand of stuff --- I feel suspicious even when I know it's theoretically the same.
That said, how can we change these consumer attitudes, which are good for other sectors of the economy (through more spending, income, happiness, etc) in all these other goods, but decidedly not good where health is concerned? This is a place where I agree with CDHC (consumer directed health care) people -- one problem is that we, as patients, do not have enough information.
Evidence-based medicine is in short supply in too many cases. Just think about the doctors
who just won the Nobel for their research on ulcers. They knew it was caused by bacteria in the early 80's. The medical establishment refused to believe uclers were caused by a bacteria and it wasn't until the mid 90's that doctors finall woke up and started treating ulcers with antibiotics. It's 2005, and I guarantee if you polled the public (pre-nobel annoucement would have been preferable, but I think you'll find the same thing) on what causes ulcers, most would absolutely say stress.
And again the we have an unnecessary hysterectomy rate of 30% -- which is more tragic because it's automatic menopause and greatly reduces women's sexual function.
The first step is creating standards. We desperately need treatment standards for most every common illness (according to
symptoms, surely many people really do need that triple bypass) -- heart attacks, breast cancer, hip replacements, high cholesterol, birth (can we say completely inflated c-section rates?). I would argue for a federal agency to be responsible with this, but I'm open to other suggestions.
Knowledge is power, people.