Doctors tell patients, on a regular basis, that just because one pill works, two or three will not necessarily work better. And yet, when it comes to taking our own advice, we routinely don't.
Last year, we had a firestorm over recommendations made by the US Preventive Services Task Force (USPSTF) that while the benefits of mammography screening were clear in women over 50, and were clearly not indicated in those under 40, for women between 40 and 50, the benefits were not so clear. Radiologists were apoplectic, and nearly everyone who could sputter indignantly into a microphone, did.
Here is a very thoughtful analysis done at the time, and a more recent one here, of that controversy for those who are interested, but I'm really writing this because of what it says about us as Americans and our love-hate relationship with science.
So, researchers at USPSTF made an evaluation and recommendations that fly in the face of "common sense." Common sense in America being that more is always better, whether it be testing or surgery or whatever. You can't be over-tested, there are no downsides to excessive intervention. Except when there are. I will not go into the downsides of over-testing and over-diagnosing, but it really bothers me that we look to science to advance medicine, to make breakthroughs, to guide treatment and yet, we get a recommendation that falls outside of what we "know" to be true, we flip our collective gaskets.
Apparently, sensing opportunity, Glen Beck had on Bernadine Healy, whom I remember because she was in a position of responsibility in Medicine (she was the Director of NIH from 1991-93), and she apparently doesn't care much for scientific thinking that is contrary to her preconceived ideas. She trotted out the old saw about prostate cancer survival being better here in America than in the UK because, obviously, the British hate their citizenry.
I have this debunking here, and it is basically that screening finds things that don't need treatment, but treating all of these cases as if they are life threatening makes our numbers look good. For a better estimate of how the US really does in saving people for dying from preventable causes, go here to see we have the distinction of being 19th out of 19.
But we didn't get to that esteemed rank by cutting corners or being frugal. We outspend our peers by an impressive margin, spending more than 16% of GDP on health care, about twice per capita as others, and our costs are rising faster than anywhere else.
One of the larger issues of the health reform debate, both last year and again during this midterm election cycle is cost and spending. It is clear that you can have low costs and excellent outcome. Other countries are doing it. The question for us is, are we going to take this issue on as adults, or are we going to demagogue our way to the poor house?
Just last week, on ICU duty, I was discussing the prognosis and choices of an elderly man with his wife. He had end stage cerebrovascular disease, had no options for treatment, and was continuing to have cerebrovascular events. We were discussing what his wishes would be. We talked for quite a while, and were making progress, Catholic to Catholic, about benefits and burdens of treatment and so on. Finally she said, "I'm glad we're talking about this, but I worry because I know the government wants us to die."
I was stunned, but I hear the same concerns from my in-laws, because they watch fox News, and listen to high ranking Congressmen, people of actual responsible positions in our Government, saying the same thing!
I set her straight as best I could, and explained how I and many other folks have been, and continue to work for, better end of life care. Unfortunately, I don't think she was won over, but at least we did make some appropriate decisions for her husband.
Health reform proponents have been accused of trying to "gut" Medicare by $500 billion. The irony is that many of those against reform would dismantle Medicare, Medicaid and Social Security if given half the chance! This is going to be a continual uphill battle.