Sometimes when I’m lecturing, I talk a bit about conventional medicine. There are undoubtedly parts of orthodox medicine I am hugely enthusiastic about including, for instance, hip replacements and cataract surgery. The problem is, however, much of medicine is stunningly ineffective. And it’s not without risks either. It’s perhaps a personal view, but my opinion is that conventional medicine is not as effective as its image suggests, and it generally riskier too.
The reason for talking (or writing) such things is that I generally encourage people to se conventional medicine when they need to, but not to rely on it too heavily (better, I think, to wrestle control regarding one’s health into one’s own hands as much as possible). I also like to challenge the idea that the more money and resources we throw at healthcare, the better off consumers of it are.
A few years back I became aware of a curious phenomenon: when doctors go out on strike, death rates have been noted to fall. One potential for this is that conventional medical kill more people than it cures. This may seem utterly counterintuitive, but I believe it’s a phenomenon that should not be dismissed. Bearing in mind the ineffectiveness of much of medicine, and the hazards associated with it, perhaps medicine does actually kill more people than it cures.
If this is true, then we may perhaps need to revisit the notion that the more healthcare we provide to people, the better off those people will be. And this is precisely the theme of a editorial that appears in the latest edition of the Archives of Internal Medicine [1]
This editorial starts by citing evidence which shows that some measures of health are actually worse in areas where people receive more health services [2]. The editorial goes on to itemise just a small sampling of conventional medical care that at best, appears not to work at all well, and at worst, exposes individuals to unnecessary risks.
These include:
• Arthroscopic (key-hole) debridement (cleaning up) of the knee joint
• The use of antidepressants in individuals with mild depression
• Mammography (breast cancer screen via X-ray) in younger women
• CT scanning of kidney stones to ‘follow’ their progress (no benefits, but increases the risk of radiation-induced cancers)
The authors of the editorial make the case that there’s the potential for some cost-cutting, though this may be perceived as ‘rationing’. However, as they quite rightly point out: “Rationing implies that the care being withheld is beneficial and is being withheld simply to save money. But as we have noted above, there are many areas of medicine where not testing, not imaging and not treating actually results in better health outcomes.”
The authors also refer fleetingly to some of the reasons why doctors may provide more care than needed. These include:
• Payment systems that reward procedures compared with talking to patients
• Expectations of patients who may equate testing and treatment with better care
• The ‘glamour’ of technology
• The ease of writing a prescription or test order over explaining to a patient why they are not being treated
What the authors do not mention, though, is the sometimes cynical attempts of the pharmaceutical industry to paint their products as better and safer than they really are, to ‘invent’ illnesses for which they have the ‘magical’ solution, and to promote the use of their drugs for types of patients or even conditions that extend beyond what the evidence supports.
Excitingly, though, the authors announce that the Archives of Internal Medicine will be running a new series under the heading ‘Less is More’, which will highlight situations in which less care is likely to result in better health. My sense is that the Archives of Internal Medicine will be able to tap into a very rich vein, here.
I remember reading a piece some years ago about medical care which made similar points to this latest editorial. I don’t remember the detail. What I do remember, however, was the assertion that some doctors could do with being told: “Don’t just do something – stand there!”
References:
1. Grady D, et al. Less is More: how less health care can result in better health. Archives of Internal Medicine. 2010;170(9):749-750
2. Fisher ES, et al. The implications of regional variations in Medicare spending, part 1: the content, quality, and accessibility of care. Ann Intern Med 2003;138(4):273-287
