A headline about lack of hospital beds or people missing out on care is always popular. Often statistics are used to show that certain sections of the population are getting less access to treatment than other sections. It reinforces the sense of crisis about the health system. There is one key assumption made in all this, which is that, the most amount of treatment and testing is best.
This needs to be fundamentally questioned.
Obviously there is little interest in this area because less treatment and fewer tests mean less cash flow for those in the medical industrial complex. Yet sometimes the truth does seep out.
A fascinating insight into this notion of more care equaling best practice was shown in a review of stenting of coronary arteries. This is where a blockage or narrowing in a heart artery has a tube placed through it to improve flow. There are other ways of treating narrowed arteries including medication or surgery. Some do not need treatment because they are not causing any problems.
A study was done comparing rates of stenting in women and minorities compared to white men in America. The assumption was that the men were getting better treatment. What was found came as a surprise to the researchers. According to Med Page Today “compared with women and backs, white men who live in the suburbs and are privately insured were more likely to receive a coronary stent when the indication was categorized as inappropriate according to the appropriateness criteria”.
In other words rather than receiving poorer care, those getting less stents put in were having better care! They are having less unnecessary procedures and obviously there is less cost to both them and society.
In Australia there has been a 276% increase in the number of cases of prostate cancer in the 20 years to 2007. This has also seen higher rates of surgery and other treatments. In turn it follows on from much more testing for prostate cancer with the PSA blood test (which is highly unreliable).
With a near four-fold increase in cases you might expect a dramatic decline in deaths. Maybe not a four fold decline but at least a halving. The result, a 27% drop. This might be a good outcome except for the collateral damage to men having needless surgery with the associated complications. For every 1000 men having the PSA test, one will have cancer found that would not other wise be found but 43 will suffer harm from impotence and incontinence to infection or even post operative stroke.
After pushing the get a test and save your life barrow for many years, the Cancer Council is backpedalling. Quoted in medical Observer, Professor Freddy Sitas of the NSW Cancer council concedes the increase in cancer rates is due to increased testing. But “This indicates that many men were diagnosed with cancers that would not have harmed them”
The same applies to many women who have had screening mammography.
I have written previously about over-diagnosis and how people are told they have had their life saved when it was never in danger!
With the huge increase in the number of people being treated with narcotic medication for chronic pain you would think there should be some improvement in pain management outcomes. Especially given the enormous problems these drugs create through addiction, overdose and deaths.
You would be wrong. There has been no improvement in outcomes!
And despite all the hand wringing about the lack of government resources for tackling obesity, life expectancy continues to rise. Figures in The Economist about New York at the start and end of Mayor Bloomberg’s term are revealing. Despite his nanny state initiatives (like trying to ban sales of large sodas) obesity rates have increased from 18.2% in 2001 to 24.2%. (Regular readers will know my views on use of BMI to determine obesity.)
Life expectancy has increased from 77.9 to 80.9 years in the same time!
The increase in life expectancy is something you never hear from those in public health. If people were living longer then why would we need money spent on a myriad of “programs”?
And how does increased life expectancy correlate with the doom and gloom messages about health?
So more screening tests, more prescriptions, more treatments and more programs do not equal better health.
Better health comes from judicious use of medical interventions coupled with looking after your wellbeing each day.