It's only fair to share…

Three separate articles neatly summed up the issues facing healthcare as the year ends. None are exactly new. All three covered separate aspects of what are the central problems. And that is the medicalization of life with the extension of diagnosis to over diagnosis, the desire to “treat” everything as a medical condition and the shadow world of payments and conflicts of interests in health.

News site Pro Publica has run a page called Dollars for Docs since 2010. It has recently updated the site to include data up to December 2015. It notes US companies made general payments (covering consulting, meals travel gifts and royalties but not research) of US$ 2 billion to 618,000 physicians and another USD 600 million to teaching hospitals.

There is nothing wrong with anyone being paid for work that they do. We all need to make a living. Between August 2013 and December 2015 the four highest paid doctors earned over USD25 million each. At least five doctors were paid on over two thousand occasions.

One family physician is listed as receiving $43,859,981, in four payments in 2014 by three companies for promotional, speaking and other purposes. For the record I received AU$3000 for consultancy work to a company which was declared at the start of my talk for said company.

These amounts are staggering. Even if they are full time with the company it is a huge amount. What does one even do for this sort of fee?

Maybe the second article by MedPage Today/ Milwaukee Journal Sentinel investigation provides a clue. This looked at eight conditions, which have become part of mainstream medicine over the last 20 years. They include pre diabetes, binge eating disorder and intermittent explosive disorder.

The review found that these eight conditions are claimed to affect 180 million Americans or 77% of the adult population. None are life threatening and treatment benefits are described as marginal. The worst example of this would be Hypo sexual desire disorder – the medical condition term for “not tonight dear I have a headache”. The medication approved to treat this increases the number of satisfying sexual encounters by about one per month. The side effects include fainting and it can’t be taken with alcohol!

The review found that since 2013 there had been 65,000 reports of serious side effects involving medications used to treat five of these conditions including 1631 deaths!

Of course to sell any treatment you have to first convince people they have a problem. This is where the notion of expanding disease definitions and reclassifying normal, but perhaps not liked aspects of human life as an illness.

Once people believe they have a condition, selling them a treatment becomes straightforward. Better still if this treatment is not a cure and hence you get a life long customer. This is why so much effort and money goes into disease awareness.

Maybe this is where some of the payments to doctors go – disease awareness.

The third issue is over diagnosis. This is different to making no medical issues medical ones. It comes from lowering thresholds of “normal” and from screening tests. Thyroid cancer diagnosis has increased from three to fifteen fold in different countries. Sound great – finding more cancers early. The problem is the mortality rate has not changed. What are being found are small growths that would never kill people.

Benjamin Mazer and Manju Prasad wrote in the Boston Globe that we need an over diagnosis awareness month. This could be a counter foil to the myriad of awareness days weeks and months that we currently have. The authors quote Pathologist Elliot Foucar who says there are many “diagnosis survivors who are mistakenly regarded as cancer survivors”. This includes up to 40% of those diagnosed with breast cancer and a similar number with prostate cancer. On the plus side, the numbers of the latter are dropping, as screening is now not encouraged.

Medical science has made enormous advances through the last century. Many have benefited from this. Over reach is a problem but it is profitable. There is far more money in treatment (especially life long treatment) than in prevention.

Thus the money poured into awareness campaigns and disease definition pays off in spades making the payments to doctors a good investment.

Like fire, medical treatments are a tool. Used wisely they provide benefit. Out of control it can be damaging.

It does not have to be this way. It is up to all of us to be questioning. It is up to all of us to be responsible for our own health and not search for a medical reason for every minor discomfort or unpleasant experience.

As 2016 ends I am encouraged that there is movement in the right direction. This is the last of my article for the year. I will be back in January. A big thank you to all readers and supporters. Merry Christmas and Happy New Year.