A friend of mine who is an avid reader of both The New Yorker and my blog sent me the following link: Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
The author is Atul Gawande, MD, one of my favorite surgeon/writers. It’s a long article, but if you are interested in saving money on your health care (and possibly saving your health), I encourage you to take time to read it.
I have posted many times about America’s obsession with overtreatment—too many tests, too many specialists, too many … Continue reading
Healthism is a term coined in the early 1990s that describes the government’s use of “propaganda and coercion to establish norms of health” and its attempts “to impose norms of a ‘healthy lifestyle.'”
Think about the cities that have chosen to ban smoking or trans-fats or super-sized sodas.
Or the new federal school lunch program’s rather rigid nutrition standards.
Or the Affordable Care Act. It mandates coverage of multiple “essential benefits” such as annual “wellness visits” and screening exams of debatable value. It also requires health care providers to document that they’ve talked to every patient about weight … Continue reading
I’ve mentioned in several posts that I think screening tests, especially mammograms, are used too widely in this country. Every woman over age 40? Every year? It’s overkill.
Even the US Preventive Services Task Force (USPSTF) only recommends a screening mammogram every other year between the ages of 50 and 75.
But most women still think the yearly mammogram is health care at its finest.
Related post: Screening mammograms—benefits vs harms
The British medical journal, Lancet, recently published a study that shows women who are better informed about the risks and benefits of screening mammograms are less likely to … Continue reading
I’ve written a couple of posts about the Number Needed to Treat, aka the NNT. That’s the number of people that must be treated with a drug, a procedure or a screening test to save one life.
The lower the number, the better.
Related post: Number Needed to Treat
Well, the dark twin of the NNT is the Number Needed to Harm, or the NNH. How many people can be treated before one person is harmed? In this case, the bigger the number, the better.
Aaron Carroll, MD, of The Incidental Economist blog, wrote a terrific piece in The New … Continue reading
The Journal of the American Medical Association (JAMA) published a short article on screening mammograms that included a spiffy infographic on the benefits vs. the harms.
Looking at the graphic I can easily see that if 10,000 50-year-old women are screened, 10 will be “saved”, but 940 will undergo an unnecessary biopsy and 57 will be overdiagnosed. (For copyright reasons I can’t reprint the graphic here, but you can view see it yourself by clicking on the above link.)
The author of the article explains:
Another possible harm of screening is overdiagnosis. This means finding something on a mammogram
… Continue reading
Profits stay high, too
On Monday, the New York Times published another brilliant piece by Elisabeth Rosenthal in her series “Paying Till it Hurts.”
Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups. From a medical perspective, blood work, tests and scans are tools to help physicians diagnose and monitor disease. But from a business perspective, they are opportunities to bring in revenue.
And American doctors, clinics and hospitals tend to order lots of tests. “It’s one of the most lucrative revenue streams they
… Continue reading
Lack of support for vitamin D
I’ve written several posts on vitamin D. That’s because it’s one of my pet peeves.
Because there was a lot of hype surrounding it several years ago when it became the latest health care fad. Suddenly a low vitamin D level was suspected of contributing to many types of cancer and chronic diseases. Physicians began testing everyone’s vitamin D levels and recommending vitamin D supplements, either over-the-counter or a stronger prescription form.
Further research on vitamin D, however, has not provided evidence that general screening for low vitamin D levels is helpful, … Continue reading
New treatments for hepatitis C
I read an article online the other day in which the author practically shouted at her readers to “Run as fast as you can to your doctor’s office and get screened for hepatitis C!”
OK, what she actually wrote was:
Overall, the outlook for patients with hepatitis C is much better than it was just a couple of years ago. So if you’re a baby boomer who hasn’t been screened for hepatitis C yet, don’t wait.
Still, let’s step back and look at the big picture.
Hepatitis C screening has been in the news a … Continue reading
Be a proactive patient
In addition to talking to my doctor friends, I spend a lot of time reading various doctor blogs because I want to better understand our health care system from their unique point of view.
The majority of those I read seem to agree with me that the industry has morphed into a giant profit-making machine—profits first, patients second. Many physicians write of their loss of autonomy and the ability to treat patients in a thoughtful, patient-centered and cost-effective way.
More than ever, they say, patients need to be informed and take control of their health care. … Continue reading
Are annual exams a waste of money?
Based on the most recent evidence, I would argue yes. I posted about annual exams a few months ago, and quoted the following from the Society for General Internal Medicine (a primary care specialty group):
Routine general health checks are office visits between a health professional and a patient exclusively for preventive counseling and screening tests. In contrast to office visits for acute illness, specific evidence-based preventive strategies, or chronic care management such as treatment of high blood pressure, regularly scheduled general health checks without a specific cause including the “health maintenance” annual
… Continue reading