Medical Care isn’t like money: More isn’t Better

A long and excellent article from the New York Times on the dangers of overscreening for breast cancer raises a thought:

A coworker of mine, earlier this week, sent an email explaining that he was going to work from home because he felt he was coming down with a cold, and wanted to spare us the risk of infection.  Reasonable enough (though perhaps overcautious).  Later that day, he writes in an update: he is indeed getting a cold.  He will, he informs us, get a doctor’s appointment.

Wait.  Why?

The common cold isn’t curable.  A doctor, when he sees you, will do nothing besides perhaps writing you a prescription for the same medicines you can get over the counter, albeit at higher doses.  You can get the same effect by taking more pills.  All you’re doing is wasting everyone’s time and money.  You will get better on your own.

As the son of a doctor, I have started to realize that I have a different and perhaps more cynical approach to health care than many of my peers.  I never considered myself to have any more medical knowledge than the average (I never considered a medical career, and took no more life-science sorts of courses than were required), but I seem to feel considerably more confident than average in the natural powers of human recovery, and the essential helplessness of medicine to common diseases.

Colds go away on their own.  Take over-the-counter medicine for symptom relief.  Same with the flu.  The flu vaccine is usually useless.  If you do come down with a more serious illness, the overwhelmingly likely case is that it will become extremely obvious that this is not a mere flu in plenty of time for you to seek treatment.

There is a culture that believes in the almost magical power of preventive care and early detection.  My entire family is stocked to the brim with medical professionals.  I can not remember a single time that we prevented anything.  For the kind of medical crises that most of us deal with early in life (before, say, age 50), there is little prevention to be done, and equally little that early detection helps with.

(There are obvious exceptions.  Please do continue to use condoms when in any sexual situation that is not long-term monogamous.  Do not actively expose yourself to clearly disease-ridden situations.  Cook your meat, especially pork and poultry.  But does anyone need to be told that?)

Read the NYT article with an eye towards understanding the manifold ways in which costly, essentially ineffective diagnosis can be made to seem like it’s saving lives.  Particularly this bit:

Steve Woloshin, a colleague of Welch’s at Dartmouth and co-author of the Not So Stories column in The British Medical Journal, points to a recent Komen print ad that reads: “The five-year survival rate for breast cancer when caught early is 98 percent. When it’s not? It decreases to 23 percent.” Woloshin called that willfully deceptive. The numbers are accurate, but five-year survival rates are a misleading measure of success, skewed by screening itself. Mammography finds many cancers that never need treating and that are, by definition, survivable. Meanwhile, some women with lethal disease may seem to live longer because their cancer was found earlier, but in truth, it’s only their awareness of themselves as ill that has been extended. “Imagine a group of 100 women who received diagnoses of breast cancer because they felt a breast lump at age 67, all of whom die at age 70,” Woloshin said. “Five-year survival for this group is 0 percent. Now imagine the same women were screened, given their diagnosis three years earlier, at age 64, but treatment doesn’t work and they still die at age 70. Five-year survival is now 100 percent, even though no one lived a second longer.”

And, in general, live your life without useless trips to the doctor’s office.

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One thought on “Medical Care isn’t like money: More isn’t Better

  1. I was just trying to explain the same thing to some friends who visited us recently. They consider specialists to be like deities. Although they have no demonstrated cardiac disease, they take annual exams and treadmill tests from their cardiologist. But it is like religion to them…based on faith alone.

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