IS MODERN MEDICINE QUACKERY?

I recommend Money Driven Medicine by Maggie Mahar for those who believe that modern medicine is driven by science. The author does a truly chilling job of showing that modern medicine is in very serious trouble.

Among the most serious myths is that idea that modern medical practice is dictated by science and that evidence based medicine is the standard. In reality, the amount of care a patient receives is largely due to the number of doctors available. Those who receive more care actually have less quality of care given and tend to die sooner. Dartmouth has done a wonderful job of documenting this year after year, and skeptics should go to www.darmouthatlas.org. Here is a brief excerpt from p.4, atlas and reports, Chronic illness atlas:

"The study of regional outcomes was repeated, restricting the analysis to patients who received their initial care at academic medical centers. The results were similar: academic medical centers in high input rate, high spending regions provided more supply-sensitive services than those in low input rate, low spending regions. For example, during the first six months following hip fracture, patients using academic medical centers in high-spending areas had 82% more physician visits, 26% more imaging exams, 90% more diagnostic tests, and 46% more minor surgery. Nevertheless, patients in high-intensity regions had higher mortality rates and worse quality scores."

The second myth that patients experience is that all of the technology they are subjected to will give them an accurate diagnosis of their illness. Most patients are aware that the treatments for their illness, if any exist, have side effects. But we are assured that at least the diagnosis will be accurate. But autopsies tell a different story:

"One hundred eleven malignant neoplasms in 100 patients had been either undiagnosed or misdiagnosed, and in 57 patients, the immediate cause of death could be attributed to the malignant neoplasm. The discordance between clinical and autopsy diagnoses of malignant neoplasms in this study is 44%, which is similar to previously reported studies." (JAMA. 1998 Oct 14;280(14):1245-8. )

An analysis all autopsy reports found: Twenty-six autopsy series reported both major and class I error rates. The median error rate was 23.5% (range, 4.1%-49.8%) for major errors and 9.0% (range, 0%-20.7%) for class I errors. (JAMA. 2003 Jun 4;289(21):2849-56.) (A major error is a disease that contributed to death and a Class I error is a probably cause of death.)

If we paraphrase the information, we find that doctors vary widely in how they treat and vary widely in how accurately they can predict even the correct disease. Those that treat more, rather than making the patients better, kill the patients off faster. When this situation existed in the past, at least patients had the common sense to stay as far away from medical doctors as possible.

For those of you more interested in healthcare, I offer these ideas from Money Driven Medicine (I have no connection to the book, and receive nothing for endorsing it).

Health care in the U.S. costs twice as much as what is spent in Japan, which has a higher life expectancy and a lower infant mortality rate. P. XV.

Why?

Argument one: we do not ration care. They do.

John Hopkins found that for that the top fifteen procedures that are rationed in other countries account for just 3% of U.S. health care spending, not enough to make a major difference. P.XVI

We also do not have as many hospital beds as in rationing countries. P. XVI

Argument two: malpractice insurance.

We do file 50% more malpractice claims than in the UK or Australia and 350% more than Canada, but awards for U.S. citizens are lower than those given in the UK or Canada. Malpractice payments have been growing at 5% a year in the U.S. while in the UK and Canada they have been growing from 10-28%. Overall, malpractice payments represent less than 1% of health care spending. P. XVI

Karen Davis of the Commonwealth Fund says why we pay more: we pay higher prices for the same services, we have higher administrative costs, and we perform more complex, specialized procedures.

A history:

Up until the 1930s patients paid out of pocket for services. The poor went to the hospitals.

In 1929, people could not pay for the hospitals at all. Blue Shield was created as hospital insurance simply to keep the hospitals from closing. It funded hospitals based on their costs, so they had no incentive to cut down and every incentive to increase costs. The AMA set up Blue Cross because it agreed to pay the provider whatever he asked and headed off any move toward a mandatory, government run insurance program.

During World War II, wage controls made it possible to incease wages only by adding benefits. Hospital plans went from seven million to twenty six million subscribers. By 1954, sixty percent of the population had some type of hospital insurance, fifty percent had surgical insurance and twenty-five percent had medical insurance, but only for in hospital services. Employer based health care meant that only the healthy could have health care. The old and sick could not hold down the jobs necessary to apply.

By 1965 seventy percent of the country had hospital insurance, but more than half of seniors had no insurance. In 1962, President Kennedy had pushed for medicare, but the AMA opposed medicare and it was defeated. President Johnson compromised by allowing hospitals and doctors to set whatever price they needed to charge. By the time it passed in 1965, the bill covered seniors for hospitals and doctors and also included poor families. By 1970, the amount paid out by taxpayers had tripled. In the years from 1960 to 1970, the overall health bill rose from $27 billion to $73 billion. (p. 17). President Nixon passed the first HMO act and set up a national health insurance plan. But his impeachment derailed the process. By 1980, health care spending was up to $257 billion. Medicare and Medicaid had grown by 600 percent. President Reagan stopped the blank checks in 1983 by dividing up payments based on procedures.

The market was given its sway, and for a time HMOs became the most hated non-caregivers as they attempted to ration care. In 1990 the nation spent $700 billion on care. In 2000 they capitulated and the cost of family coverage rose 73% from 2000-2005 as they passed on increased costs to the consumer. By 2006, the nation spent three times what it had in 1990. (p.46)

Do we need a prescription drug plan?

The drug makers spent $19 billion on research and $45 billion for advertising, while pocketing $31 billion in profits. (Families USA, 2002)

For profit hospitals are beholden to their stockholders. Not-for profit hospitals are beholden to their bond issuers. Both need to be in the black and make a decent profit.

p.151 (EBRI) Half of U.S. workers have less than $25k in savings. Two thirds have less than $50k. The average person in 40-50s is $20k in debt (not including mortgages). One in ten workers and one in five retirees has more than $250k.

PDUFA: drug companies provide more than half the FDA's financial support through user fees. 79% of the drug unit time is spent on new drug reviews. (p.312)