Bad Medicine

Finally getting around to reading Prescription for a Healthy Nation by Tom Farley and Deborah Cohen. The first chapter details how we overspend on healthcare, while confusing ourselves that we are spending on health. The two are not synonymous, as many, many, many others make clear. Farley and Cohen cite estimates that medical errors kill 50-100,000 persons per year, whereas iatrogenic deaths that result from appropriate medical care kill upwards of 250,000. Amongst these statistics are fun anecdotes like this one:

One of the more heavily publicized studies on this followed doctors’ strikes in 1976. Over five weeks, in a dispute about malpractice insurance, about half of the doctors in Los Angeles County cut back on services, and because anesthesiologists were the most militant, hospitals cancelled most elective surgery. For those five weeks no surgeons were doing non-emergency hysterectomies, tubal ligations, knee repairs, or face-lifts. As much as the strike must have caused panic in people who could not see their doctors, researchers afterward found that it actually prevented more deaths than it caused.

To some degree, the medical community has reacted to this information by moving towards evidence-based medicine; furthermore, physicians are coming around to the idea that price-transparent rationing is necessary for any rational health care system, universal or not. Nevertheless, while questions like this are batted around amongst economists and doctors with an interest in policy, my informal sense (talking to fellow students, and judging by the hubris of most of the doctors I’ve actually met) is that most physicians grossly overestimate the amount of good that they do (even if we ignore any one doctor’s place at the margin).

Why is this? One reason is that it’s easy for us to remember the patients we help, the ones for whom prospects were grim but recovery was profound, or even those whose life was never in danger but we helped recover more quickly or pass the illness more comfortably. On the other hand, amongst those 250,000 who died due to iatrogenic causes, a great many would have died anyways, and it’s easy to use that fact to elide those patients from our consideration. And as Farley and Cohen point out, it’s not just the memory of doctors that is so biased:

The newspapers trumpet the uplifting victories–such as Lance Armstrong’s beating testicular cancer before dominating the Tour de France–but muffle the losses in small obituaries.

So says Michael Daunt. Here’s a troublesome factoid (I haven’t been following the elections, really, so I wouldn’t be surprised if it’s old news). From the horse’s mouth:

In 40 years of medical practice, I never once considered performing an abortion, nor did I ever find abortion necessary to save the life of a pregnant woman.

Really? Because, according to Wikipedia, he was the only ob-gyn in his county, “reportedly delivering 40–50 babies a month and frequently busy with surgery.” And, while it’s rare that abortion is ever absolutely indicated to save a woman’s life, it’s relatively less uncommon that a woman’s life is threatened, or that the baby is fetus is crippled with a horrible genetic condition; therapeutic abortion should at least be considered as an option. To not do so is remarkably paternalistic (worse, for practicing medicine in a geographic region where his patients’ ability to choose a physician is limited).