Medical Tuesday Blog

The inappropriate use or overuse of medical treatment

Oct 25

Written by: Del Meyer
10/25/2017 4:01 AM 

Now, for the first time, a leading healthcare clinician – the Chief Medical Officer of the American Cancer Society – Dr. Otis Webb Brawley is breaking ranks – literally and figuratively.  His new book is squarely aimed at the Hippocratic oath and aptly titled – How We Do Harm: A Doctor Breaks Ranks About Being Sick In America. . . the Editorial Reviews are noteworthy: . . .

CNN provided coverage on the book’s release here – and had these direct quotes by Dr. Brawley:

  • “There is often selective reading of the science, especially by those trained in a specialty wanting to advocate for it.”
  • “Medical gluttony, the inappropriate use and overuse of medical treatment, is not just adding unnecessary cost to health care. It can actually be harmful to the individual.”
  • “Health care providers and the public often overlook the emotional and financial conflicts of interest of health care professionals.”

The CNN article also recounted the story of a woman, Helen, who was diagnosed with early stage breast cancer.  As was fairly common in the early 1990’s – surgery was followed by high doses of chemotherapy – and a bone marrow transplant.  Quoting Dr. Brawley:

“The therapy Helen received was expensive and commonly given to women with breast cancer in the early 1990s. During this time, numerous women sued insurance companies who did not want to pay for the therapy and nearly a dozen states passed laws saying insurance companies had to pay for it.”

“There was one really good reason why the health insurers did not want to pay for high dose chemotherapy and bone marrow transplant for breast cancer:  No study had ever been done to prove it beneficial.

“Even without evidence, some patients and their doctors had faith that it worked. The procedure was common because some doctors taught that the transplant was beneficial to patients. Truth be told, it was very beneficial to the doctors and hospitals offering it.”

“By 1999, well after Helen had recovered, three well-designed clinical trials were completed. They showed that bone marrow transplant and high dose chemotherapy, a treatment now common for nearly a decade and a half, was not better than the standard therapy and there were indications it was more harmful.”

. . . all of this does suggest at least one more very large and systemic failing in our healthcare system.  It also adds a new clinical term that I had not heard before.  Medical gluttony.  Simply put, the healthcare system we have rewards expensive specialty care over primary preventative care.  In order to reduce expensive specialty care – you have to add primary preventative care.  I can’t help but agree with Dr. Brawley’s final prescription:  “The cold hard reality is America does not need to reform health care, we need to transform health care.”

Read the original report in Forbes . . .

Editor’s Note: The above failure is a product of insurance plans or government programs with the public insistence of treatment at any cost or benefit. The obvious solution of deductibles and copayments is seldom mentioned. By noting it in this context it may be understood. If Helen had to pay even a 10% copayment on her healthcare, it immediately places the patient in charge. There would have been an immediate and intense discussion of the benefits of this high-risk treatment. With a ball park cost estimated at $10,000 in additional healthcare cost, with Helen and her family having to come up with $1000, the value of the treatment may have brought Helen and her family into the discussion. Perhaps three-fourths of women would have opted that surgery and x-ray would suffice. Then only the oncologist would have lost because they couldn’t do a marrow transplant with its possible ugly consequences. In all cases of the deductible consequences, only the patient wins.

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Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.

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