Smart Bombs: A dose of health skepticism

At a Thursday public presentation on overtreatment in medicine, Dr. Richard Deyo displayed a New Yorker cartoon with a doctor saying to a patient, “You may believe you’ve been overcharged, but remember you’re overmedicated.”

That’s as funny as it got, as Deyo politely but firmly pushed the concept of evidence-based medicine at his Riverpoint Campus speech. Deyo is the Kaiser Permanente professor of evidenced-based medicine at the Oregon Health & Science University. Before that, he was a professor at the University of Washington.

In 2005, he co-authored a book with Donald Patrick, another UW professor, called “Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises.” Eight years later, he’s still imparting the important truth that more medicine doesn’t necessarily mean better medicine. If the medical community would rally to the cause, the United States could finally corral its metastasizing health care costs.

Fully one-third of what we spend is on useless treatments, tests, drugs and other “care.” That amounts to about $700 billion a year. This helps explain why health care costs as a percentage of the total economy was 17.6 percent in 2010, according to the Organization for Economic Co-operation and Development. The second-place country was the Netherlands, at 12 percent. The last time our spending was that low was in 1989. This would be acceptable if our care was dramatically better, but it isn’t.

So why do we put up with this? Deyo said we are preternaturally optimistic about health care, noting that in an international survey, 34 percent of Americans agreed with the statement that modern medicine can cure just about anything. Only 27 percent of Canadians and 11 percent of Germans displayed such overconfidence. Both countries have longer life expectancies.

Maybe it’s Dr. Welby, or all those heroic rescues on “ER.” Maybe it’s the drumbeat of direct marketing to patients, which is allowed only in the United States and New Zealand. Whatever the reason, Deyo suggests that unless patients become more skeptical, prices will remain sky high.

One misconception is that treatments are based on sound science, but that is often not the case. Deyo had some examples:

Bone marrow transplantation became widespread in breast cancer cases. About 20 years ago, an HMO wouldn’t pay for it because it was experimental. But after a high-profile lawsuit and a “60 Minutes” segment following the death of a woman who was denied the transplant, states passed laws requiring insurers to cover it. As it turns out, the South African research that endorsed the procedure was based on cooked data. Subsequent studies show that the older, less aggressive treatment was just as effective, but by then 42,000 women had been subjected to transplantation at a cost of $3.4 billion.

Arthroscopic surgery to remove old or infected tissue from knees became common for patients with osteoarthritis. But this proved to be no more effective than sham surgeries during which surgeons only pretended to operate. Cost: $3 billion a year.

The painkiller Vioxx was recalled after 140,000 avoidable heart attacks. Most patients would’ve done just as well with ibuprofen or other older drugs.

This type of waste could be avoided if doctors, pharmaceutical companies and device makers had to produce solid scientific evidence that what they’re peddling is good for patients. Medicare isn’t allowed to consider the cost-effectiveness of treatment. The Food and Drug Administration doesn’t compare the efficacy of new drugs to existing ones. Drug makers just need to prove that there’s some value to their product and that it’s relatively safe. Device makers have an even lower hurdle to cross, since a couple of government agencies that used to oversee them have been eliminated thanks to special-interest lobbying.

Deyo points to some progress. The American Academy of Physicians and the American Academy of Family Physicians have adopted the “Choose Wisely” public relations campaign, which lists some old habits in need of breaking.

But there’s a lot of money to be made in useless medicine, so it’s inevitably going to be up to patients and political leaders to pull the plug on the expensive fallacy that more is better.