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Posted May 27, 2011: by Bill Sardi
Having written an e-book on The Collapse of Conventional Medicine about all the needless and ineffective care thrust upon naïve patients, and then having watched the public clamor for more of the same in their opposition to rationed or delayed care has been very perplexing. It’s like the masses are saying “don’t cut Medicare even if it’s killing us.”
Certainly modern medicine is impoverishing America as health care is now beyond affordability. Revelations today in The New York Times and The New England Journal of Medicine are sobering. A great portion of the financial collapse of America can be pointed towards the high cost of ineffective medicine. To make matters worse, the now common combination of unemployment and illness certainly devastates most families. Yet doctor bills keep rising.
You can read the litany of unnecessary diagnostic procedures and treatments here.
The list includes colonoscopies for the elderly, prostate screening for men, and placement of stents (arterial props) within coronary arteries that are among the many over-prescribed procedures performed. Modern medicine is simply gouging the system and the American Medical Association as well as State medical boards have sat idly by watching all this happen. An estimated $75 to $150 billion of services could be cut from Medicare without depriving patients of needed care. Apply that money to the needy and immediately realize its impact upon those who cannot afford health care.
Predictably, doctors will rally their patients to object to any Medicare cutbacks despite the fact that Medicare faces $66 trillion of future care that is beyond its budget. As Rita F. Redberg, a cardiologists and professor of medicine at the University of California, San Francisco says today in The New York Times, “Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.” Maybe if patients had to pay out-of-pocket for this excessive care they would think twice before signing a consent form.
Howard Brody, MD, PhD, writing in The New England Journal of Medicine, says “the myth that innocent doctors are bystanders merely watching health care costs zoom out of control cannot be sustained.”
The real rub comes when it is realized doctors are ordering tests and treatments that are simply ineffective and even problematic. Dr. Brody challenges each medical specialty to make a “top five” list of tests and treatments that are not “evidence based” and eliminate them.
Dr. Brody says doctors may object to self regulation, but then government will have to step in. If doctors want autonomy, they had better do something about the 30% of health care costs they control that are unnecessary.
Oncologists Thomas J. Smith and Bruce E. Hillner at Virginia Commonwealth University respond in the New England Journal of Medicine to Dr. Brody’s challenge by conceding that a great deal of cancer care delivered today does not meaningfully extend survival and is costly beyond belief.
Most new cancer drugs cost $5000 per month or more yet are not cost effective. Drs. Smith and Hillner say: “We must find ways to reduce the costs of everyday care to allow more people and advances to be covered without bankrupting the health care system.”
In remarkably candid fashion, these cancer doctors concede that most treatment follow-up using cancer markers or imaging studies are of useless value and do not prolong survival. Yet patients cling to these studies as if their life depended on them.
They challenge their colleagues to withhold chemotherapy for patients in their last two weeks of life. They suggest limiting chemotherapy to patients who are still well enough to walk unaided into a clinic.
They plead with their colleagues to cease prescribing costly drugs that stimulate white blood cells following chemotherapy. By the way, these drugs (hematopoietic colony-stimulating factors) boost neutrophil count, which is a white blood cell that could be stimulated by something as inexpensive as vitamin D. But oncologists are not given to using something like vitamins because they are making big money off of cancer drugs administered in their offices.
This drug costs about $3,500 per injection and generates $1.25 billion a year in sales. One oncologist’s office was found to bill Medicare $141 per injection, private insurance $611-to-$1312.
But Drs. Smith and Hillner bring up the plea that will inevitably arise from patients and their families – that something must be done, and they will obtain 2nd and 3rd opinions till they find some doctor who will treat their loved one.
Most cancer patients’ optimism exceeds what is expected from cancer care says the New England Journal of Medicine article. One survey showed most lung cancer patients expect to live more than 2 years beyond their date of diagnosis when average length of survival is about 8 months.
The doctors go on to say: “We understand that this will be extraordinarily difficult, since one person’s cost constraint is another person’s perceived lifesaving benefit and yet another’s income.”
Modern medicine has become a jobs program for doctors. It proceeds with impunity in delivering costly and ineffective care that patients cannot perceive because the cost is being borne by another party – insurance. Maybe this is the start of a return to sanity to modern medicine. Whether a profession as self-serving as medicine now has become will be able to take money out of its own pocket is still in question. © 2011 Bill Sardi, Knowledge of Health, Inc.
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