Are YOU Getting
Too Much Healthcare?
Thursday, December 13, 2018
An essay in the BMJ (formerly British Medical Journal) echoes much of what I report in Our Healthcare Sucks,albeit with far more eloquence and erudition.
Entitled “Overdiagnosis: when good intentions meet vested interests”, the author, Dr. Iona Heath – a retired general practitioner – summarizes the ethical, political, and human factors and consequences of the global phenomena of overdiagnosis and overtreatment.
Because this essay is so eloquent, i’ll be quoting it more liberally than is my normal practice. I recommend you click through to the source article itself for a better appreciation of its full message.
Essentially, the author explores the human and financial drivers of the pernicious trend in our healthcare from treating disease to expanding its definition to symptom-less conditions like high cholesterol and other biometric measures that may or may not have clinical consequences.
The reasons for this trend to overdiagnosis and the overtreatment it produces are often well-intentioned, but are also often rooted in greed – not just the lust for greater incomes by many doctors and their suppliers, but by patients not satisfied with merely living longer than any generation before them.
We don’t usually think of this primal urge to survive as greedy, but for many who’ve lived long and full lives, there is that element to it, isn’t there?
They can more easily be forgiven, however, than those who exploit them with often dubious promises of longer life while disregarding the harms of their medical interventions. As the BMJ essay notes,
“It has become difficult to question the means because the end of curing and preventing disease is so obviously worthy. Nonetheless the means are damaging…from too much of what health professionals do and healthcare systems provide is wasteful, futile, and harmful.”
I speak of these things here and in Our Healthcare Sucks in more prosaic terms, but the message is the same. And if you’re not offended by the waste and futility, you should a least be alarmed by the harm. More patients die every year from their healthcare than from virtually any disease.
Our Polluted Healthcare
Here are some further excerpts from the BMJ essay worth considering…
“Overdiagnosis and overtreatment are now deeply embedded within our healthcare systems across the world. They have permeated and polluted the drug and medical technology industries, medical research and regulatory bodies, clinical practice, payment systems, guideline production, and national healthcare systems. They are the cause of an astonishing amount of waste and harm…
“A toxic combination of vested interest and good intentions produces continual pressure to extend the range of abnormal, shifting the demarcation point further into the territory previously considered normal…(we) have created an epidemic of disease without symptoms, defined only by aberrant biometrics…
“Extending the range of what is considered abnormal expands markets for pharmaceuticals and other interventions, and thereby the possibilities of maximizing commercial profit (emphasis added).”
Now the notion of “disease mongering” is nothing new. Critics of the pharmaceutical industry have long accused it of over-promoting disease risks so it can create new drugs to “treat” conditions previously accepted as normal. Statin drugs to lower cholesterol are probably the most debated example today, although there are plenty more occupying the same disputed space.
But there’s been little actual progress in stemming this tide. Demonstration projects like sending “counter-detailers” to offset the one-sided “education” of prescribing doctors by drug company reps (sometimes called drug detailing) has met with some success. But there’s no money available to fund these efforts on the scale that pharmaceutical companies can mount.
Nor is there the kind of large-scale public service campaigns to counter the ubiquitous direct-to-consumer (DTC) commercials and ads targeting the worried well (who apparently tune out litanies of side effects that would make most people say “No thanks”). Indeed, the subject is considered too controversial – and too damaging to state and local economies dependent on pharmaceutical and device manufacturers – to even be seriously considered.
Even the most aggressive consumer proponents like Massachusetts Senator Elizabeth Warren – not known to be shy about the need for greater consumer protections – shies away from this topic because her state is home to so many of its profit centers.
That’s what is meant by “vested interests”.
Health is Disease?
Here’s more from the BMJ essay…
“At every level this is a story of unsustainable greed: the greed of those living in the richer countries of the world for ever greater longevity and, most particularly, the greed that drives the commercial imperatives of the pharmaceutical and medical technology industries…
“The 2012 World Health Organisation Global Health Expenditure Atlas reported that countries in the Organisation for Economic Cooperation and Development (OECD) consume more than 80% of the world’s healthcare resources but experience less than 10% of the world’s disability adjusted life years.”
The essayist compares the current state of affairs to an Orwellian unreality in which…
“War is peace, ignorance is strength, freedom is slavery – and now we have the latest example of Orwellian doublespeak – health is disease…
“This kind of utilitarian medicine that treats every individual as identical can easily erode the stature and autonomy of patients…We are developing a culture of conformity which pays lip service to autonomy and choice but within which the individual is only really free to make the choice that is approved by the state…
“It is assumed that once the ‘healthy choice’ is pointed out, everyone will select it and no account is taken of the very differing circumstances and aspirations of different people’s lives (emphases added).”
“Thinking Differently and More Deeply”
I’ve reported on my own need to “take a stand” in refusing medications for “prevention” (see “Can You Say No to Your Doctor?“). Dr Heath puts it more eloquently in her BMJ essay…
“The only solutions to these profound existential challenges are to be found in courage and endurance and acceptance of the limits of life. They are to be found in thinking differently and more deeply.”
This means challenging the conventional wisdom, even when it’s coming from your doctors’ lips.
Of course, it’d be nice if more doctors also challenged the conventional medical wisdom. As Dr. Heath concludes…
“Much of what we regard as standard, and even excellent (medical) practice today will eventually be compared to …’medicine’s vast graveyard of discredited speculations’. It is so easy to see the mistakes of previous generations, so much more difficult to see the errors of your own…
“In a world where it has become acceptable to treat risk factors, however weak, as diseases in their own right, we must learn to resist overdiagnosis.”
Rather than wait for our doctors to come to this realization, it will behoove us as patients to do more resisting of our own.
Comment below with any of your own experiences
with medical overdiagnosis or overtreatment.