Wednesday, November 25, 2009

No Right Answer



One of the first promises of the Hippocratic Oath is “Do no harm.” New treatments of disease are coming along all the time, and I know that a great deal of a doctor’s time is spent in keeping up with the latest advances. But lately I would not be surprised if the average Family Practice Physician came down with a bad case of whiplash from tracking all the changes.
The Obama administration has contributed to this situation. I realize the chief is pretty busy trying to get some sort of healthcare plan through Congress, but perhaps it would be a good idea for him to forbid any new recommendations until he has succeeded. We are getting mixed signals, and unfortunately, if one compares recent releases to earlier ones, they appear to support to the accusation that his plan is going to 1.) ration service more than is now the case, and 2.) run up the deficit.
One of the highly publicized components of his plan is the idea of cutting down on treatment costs by diverting  more resources to prevention. It sounds good, but think of it this way. Suppose 10,000 women get mammograms, and 12 cancers are found. (This is the actual rate according to the Center for Disease Control 2001 – 2005.) 9,988 mammograms were negative, and 12 lives were saved. For the vast majority the whole thing was a waste of money, but for the 12 who were saved, no amount of money is too much. I personally agree, but I also understand that it is necessary to draw the line somewhere.
With the latest release, the administration appears to be backing down on prevention: the long-recommended mammogram, self-examination and Pap smear suggestions have been eased. Why? Because too much money is being spent on examinations of women who have no problem.
Of course, the new release is meant to be a “guideline,” but who wants to bet that the insurance companies will soon be changing their coverage to agree with the guide-line?
It appears that the government has decided to make a cost-benefit analysis on the cost of prevention. Normally that’s a good business practice, and organizations do it routinely to allocate their resources to the projects which are likely to pay off.
This is just one more of those problems that I can see both sides of. But it is a financial decision, and I would not want to be the one to explain to the families of the 12 women in my illustration why they couldn’t get the treatment which would have saved their lives because it cost too much. On the other hand, neither do I want to see huge amounts of money being spent on needless tests.

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