Friday, November 20, 2009

No reality here...

The uproar over mammogram guidelines is discouraging for anyone who thinks the cost over over-medicating and defensive medicine cannot continue.
In the midst of the debate over health care reform, we have been handed the perfect example of why America will never get health care costs under control: The furious reaction to new guidelines that recommend most women should get mammograms later in life and less frequently. [More]

As long as we cling to the idea that one life is worth all the wealth in the world and millions in the future should suffer for my well-being in the present we will be unable to adopt common sense measures like this recommendation. It's also why too many of us men will have unnecessary prostate surgery.
Doctors have routinely recommended prostate cancer screening for men over 50 using a blood test for prostate specific antigen, or PSA. The belief was that early diagnosis and aggressive treatment for any cancer is better than standing by and doing nothing.
But many prostate tumours are slow-growing and take years to cause harm. Some studies suggest many men are living with the side-effects of aggressive treatment with surgery and radiation for a cancer that may never have killed them.
The researchers said in the United States, fewer than 2 per cent of men with under age 65 opt to forgo prostate surgery in favour of regular testing for their cancers. And 73 per cent of those ultimately have surgery within four years.
But a separate study in the journal Cancer by researchers at the Erasmus Medical Centre in Rotterdam, the Netherlands, found that men with early stage prostate cancer who put off the surgery in favour of regular checkups were not overcome by anxiety. [More]

Oddly enough this individual failure is precisely why we will eventually devolve to a system where the government makes such allocations.  Just as other developed nations have discovered.

One more time: we can't afford all the health care everyone wants.  If we can't devise a system to ration health care effectively, that's all our economy will be about. And yes, that is the correct verb.

And we will still have a mortality rate close to 100%.

8 comments:

Anonymous said...

I think your right, but I don't know of anyone that has the guts to be the "Healthcare Rationing Czar." If that't the case what's next best??

buffalobill said...

Hmmmm....wouldn't the mortality rate BE 100%. Or do you know someone who has lived forever??? I am sure that I will be the first ever to live forever. Or NOT! (but I am doing alright so far!)

John Phipps said...

bbill:

I was counting vampires.

Jay said...

Can't forget about the werewolves, either.

And there may be a few Dorian Gray characters out there, too

Anonymous said...

"One more time: we can't afford all the health care everyone wants."

...Right, which is why if we could "free up" the system and allow people to shop more freely for their insurance and Dr.s, costs would come down. When people have to be more involved with the costs associated with their health care, they are more careful about how much they consume! Converting everything to a government run regulations boondoggle is just the opposite.

Brandon

Ewan R said...

Isn't there a rather persuasive arguement to be made that catching breast cancer earlier rather than later can in fact decrease healthcare costs?

I'm not sure how strong the figures are around the arguement, but it seems sensible that a quick treatment would be less costly than a late catch and more extreme treatments.

John Phipps said...

Ewan:

There is a point of diminishing returns and rising costs with earlier detection. In the cases of breast and prostate cancer, we often focus on the grateful lives saved and ignore the lives subjected to unneeded fear and discomfort to balance.

Not to mention the astonishing costs. We could start screening at 30 - it's not like 40 is a magic number.

As long as there appear to be no costs (insurance converage) for most consumers it is understandable that they will opt for the most assurance they think they can get. But even that benefit is illusive. What the report showed is 1900 women's lives hassled (and dollars spent that could be more productive elsewhere) to spot one early cancer. Of course that one advocates for earlier screening, but what about the 1900? What do their opinions matter?

This is also a really bad precedent to adopt when an entire range of genetic tests loom on the horizon. To save one life from some rare disorder, should all babies be screened for genetic markers and parents left to cope with heartbreaking and confusing choices?

Behold, the precautionary principle in action.

Brett said...

My thought is: there is a disconnect between the concept of "insurance," verses "pre-paid medical care."

My major-medical "insurance" is supposed to be a blend of the two.

One should never fault those who possess major-medical coverage and seek preventive testing. Those tests are supposed to be essentially "pre-paid" by the higher premiums of the major-medical plan.

This differs from straight "insurance," which is what we all have on our automobiles. Oil changes and tune-ups are not covered - however accidents and collisions are covered, albeit with a deductible.

I do not agree with the notion that those who possess comprehensive health coverage and actually use it are THE PROBLEM! The ability to have access to preventive care should be part of the solution, not the problem.