Saturday, December 1, 2012

The Other Reason We Spent Too Much on Healtcare

Bill

The Republicans aren't the only ones having trouble accepting science. Lots of us are equally guilty. The accumulated evidence in multiple venues examining various populations over long periods of time suggests that  screening mammography for all comers increases cancer incidence rates (because lots of small tumors are detected earlier) but does not reduce overall breast cancer mortality. Ditto for chemical screening for prostate cancer. Yet routine mammography is still hailed as some sort of magical bullet, and any evidence to the contrary is regarded as the work of evildoers.

Despite the revolution in evidence based medicine that has predominated for much of my career, magical thinking still persists. Just because something makes sense doesn't mean that it will turn out to be so. More is not always better. I still remember the dean's opening remarks my first day of  medical school. About 90% of patients, he reminded us, will get better on their own. An unfortunate 5% will worsen despite all efforts to help them. The real business of learning to be a doctor revolves around the 5% or so for whom one's skill will make the difference. After 25 years in the business I'd say that figure comes pretty close to the mark.

The country does 80 million CT scans a year. We only have 300 million people. One in four Americans doesn't need a CT scan

Eli

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