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Wednesday, October 8. 2008

The myth of medical prevention

A piece on the subject in the NYT notes:

The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health.

Read the whole thing. Sadly, except at the margins, there is little we can to to prevent disease. The wishful thought that we can control fate and the gods never quits, though.

Posted by Dr. Joy Bliss in Medical, Psychology, and Dr. Bliss at 11:02 | Comments (8) | Trackbacks (0)

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A lot of the hysteria about health insurance (back when it was insurance) is the worry that you'll get very very very sick but won't die, and the resulting costs will wipe you out and your family and the dog.

In that unlikely case (sick enough to be very sick but not sick enough to die with proper care), you always have the option of dying. Just move that small probability into the die column.

Anyway that small probability fantasy is responsible for the initial imagined need for health insurance, and the huge costs it now imposes on everything.

No doctor can stay in business charging more than people are willing to pay.

Except for health insurance.
#1 Ron Hardin (Link) on 2008-10-08 12:00 (Reply)
RAND corporation did a study on medical care about 25 years ago and found that the amount of money spent on medical care had little effect on medical outcomes. It doesn't matter how much money you spend, you aren't going to be a lot healthier and live a lot longer.

Of course, this was only one study and not a very big one, but the outcome was surprising. This study should be repeated with a bigger sample size and longer time frame.
#2 Ray on 2008-10-08 12:23 (Reply)
Costs do not correllate with outcome because the vast majority of medical costs are spent on the elderly and frail, the very ill and the terminally ill.
#2.1 Dr. B. on 2008-10-08 12:59 (Reply)
In Oregon they will pay for your suicide pills but not your cancer treatment. (in rare cases) This trend, assisted suicide, is not much of a trend because only a couple dozen people go this way each year, however, who is waching the watchers?

"Suicide pills- they're for what ails ya'!"

Switching to Providence insurance from Kaiser has sucked mightily. Not only do I have to deal with no less than 3 entities with "Providence" in the name (who operate as separate entities) for each doctor visit- but when I picked a female doctor for my anal, uh, anual checkup, I was told that kind of thing is only approved with SYMPTOMS. Fine. My doctor at Kaiser did that all the time, maybe he was just having fun?
#3 Phil on 2008-10-08 13:38 (Reply)
Dr. Thomas Szasz wrote an article on health insurance that I found very informative. It's at http://www.szasz.com/iol23.html .
#4 Ray on 2008-10-08 13:52 (Reply)
I'm reminded of a T-shirt message I saw once: Eat Well, Exercise -- Die Anyway.

Marianne
#5 Marianne Matthews on 2008-10-08 14:24 (Reply)
I was on Kaiser insurance in CA. I thought they were great. Their was never any significant paperwork. You appeared, they diagnosed, they treated, end of story.

But opinions vary. I have met people who hated them.

Living now in AZ I have more conventional private coverage. Each visit involves about five bewildering forms before all is done. Months later I get cryptic letters explaining why something was done or not done. That is the way it is.

I would differ with those who think preventive care will not help. That was true years ago. It is rapidly becoming untrue. But the preventive care must be the best; the sort of examination and treatment far above the norm. Very few patients will ever encounter that quality.

The cost problem can only be solved by state medicine or by people dying much more quickly. I expect both but want only the latter. Given the choice most elderly people probably do too.

But there is no choice. When an independent life or recovery is no longer possible then guardians make the decisions. Often they are emotionally involved relatives who insist of prolonging life by any means. They are really prolonging agony.

When the patient actually wants to die it is taken to be proof of mental confusion. And patient's wishes are subsequently ignored.
#6 K on 2008-10-08 14:31 (Reply)
Insurance companies and patients have much to gain in preventive medicine. And doctors recommend it to keep law suits at bay. Think of a fifty-year-old man who gets a colonoscopy or a forty-year-old woman who gets a mammogram. It behooves insurance companies to have these tests done because it beats paying for the long-term care if either person is discovered to have cancer. For the patient, early diagnosis and treatment can mean the difference in life or death; for those a little older, it can mean the difference in quality of life. This is no myth: It is progress.

As for those 'kept alive' for whatever reason, you'd be surprised how easy it is to work around that if you know, say, your mother really wants to die. Most doctors are very sympathetic to that despite what you might think. Hospice is also known to help in that area. (I'm talking about those who are terminally ill and suffering.) It is a true blessing in most cases.
`
#7 Meta on 2008-10-08 18:13 (Reply)

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