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This is essentially the thesis of Arnold Kling's "Crisis of Abundance": http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Care/dp/1930865899 http://www.

by kmavm 17y ago

This is essentially the thesis of Arnold Kling's "Crisis of Abundance": http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Care/dp/1930865899 http://www.amazon.com/Crisis-Abundance-Rethinking-Health-Car... Except for a few blockbuster interventions (antibiotics for bacterial infection, orthopedics, reading glasses), the expected return of many health care interventions is negative; they cost so much, and have the potential to do so much harm, for such uncertain good, that we're better off avoiding them. The only reason individual consumers subject themselves to so many negative-expected-value treatments is that they do not bear their full costs, sharing the financial part of them with their insurers.

Retric 17y ago
The problem with that philosophy is there are thousands of "blockbuster" treatments, everything from a simple filling, to a Tylenol would be miraculous if you steeped back a few hundred years. Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath. PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.
- btilly 17y ago
  Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off. This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended. Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
  - Retric 17y ago
    You just swapped your argument from the majority of modern medicine to a specific case. Spinal surgery is also a moving target, the risk / reward line keeps shifting as better treatments shows up. Still in a wide range of cases it's a bad idea, for now.
    - btilly 17y ago
      I just swapped whose argument? Look at the names of the posters in this thread... In any case the original article was about a woman who went through a nightmare to get a hospital to not perform unwanted, unneeded and dangerous spinal surgery. So to my eyes I was bringing the discussion back to the example under discussion. And pointing out that it has been well known for over a decade that spinal surgery is a generally bad idea to me underscores the horror of what happened to her.
      - Retric 17y ago
        Ops, sorry.
- btilly 17y ago
  Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off. This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended. Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
- joe_the_user 17y ago
  Hmm, You don't specify what missed test killed your father. There are, however, many symptoms where, given the uncertainty of all technology today, giving an operation or a drug prescription to might save X lives whereas NOT taking action would save Y lives, where X and Y are very uncertain. The harder thing, though, the lives that are lost through giving the operation or the drug tend to be even harder to measure - people die through being prescribed 4,5,6...X drugs up to the point that interaction fry them without any one drug being "to blame". People die from complications of many surgeries, yet if the surgery is possibly necessary, people don't think to blame the decision to operate (the New Yorker figure that surgical accidents kill more than auto accidents is remarkable - auto accidents were once the 4th leading cause of death in the US). And there is a hidden if you test everyone for everything. False positives can kill people - false positives do kill many people today. And as the New Yorker article mentions, physician incentives to make tests (or in other circumstances, to avoid them) can make a big difference.
  - Retric 17y ago
    http://en.wikipedia.org/wiki/Pulmonary_embolism http://en.wikipedia.org/wiki/Pulmonary_embolism it's an accute problem and highly treatable. He had a collapsed lung and went to the doctor 4 days before he died. It's a common killer because it masks as other things, but you can do a fairly cheep pretest. Mortality from untreated PE is said to be 26%. [edit] Anticoagulation is the more common treatment because it has better long term odds. But, that assumes fairly early detection.

by kmavm 17y ago

Retric 17y ago

The problem with that philosophy is there are thousands of "blockbuster" treatments, everything from a simple filling, to a Tylenol would be miraculous if you steeped back a few hundred years. Finding the right balance between cost and heath is hard, but blaming everything but the blockbusters is the wrong place to start. Two years ago my father went from fine to dead in one week in part because the doctor failed to ask for a single test. He had health inshurance, went to a doctor who liked to avoid extra tests and died. A hundred years ago, dieing at 62, could have been seen as living a long life, but today a simple test and a quick surgery and he could have lived another 20 years in good heath. PS: If you really want to look for waste in heath care figure out where the money goes. Starting with the payments to your heath insurgence company and how little get's back to actual treatments.

btilly 17y ago
Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off. This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended. Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
- Retric 17y ago
  You just swapped your argument from the majority of modern medicine to a specific case. Spinal surgery is also a moving target, the risk / reward line keeps shifting as better treatments shows up. Still in a wide range of cases it's a bad idea, for now.
  - btilly 17y ago
    I just swapped whose argument? Look at the names of the posters in this thread... In any case the original article was about a woman who went through a nightmare to get a hospital to not perform unwanted, unneeded and dangerous spinal surgery. So to my eyes I was bringing the discussion back to the example under discussion. And pointing out that it has been well known for over a decade that spinal surgery is a generally bad idea to me underscores the horror of what happened to her.
    - Retric 17y ago
      Ops, sorry.
btilly 17y ago
Whether or not you like that philosophy in general, and despite your father's tragedy, it is extremely appropriate for spinal surgery. Spinal surgery costs a lot of money, frequently goes very badly, and even "successes" tend to be temporary and are followed in a few years by being worse off. This is why in the mid-90s the Agency for Health Care Policy Research (AHCPR) looked at the subject and concluded that back surgery was inadvisable if any other options were available. Unfortunately for the AHCPR back surgeons are a fairly well off group, got the AMA on their side, and the result was that Congress nearly destroyed the AHCPR. The remnants have learned not to issue politically controversial opinions, no matter how well-founded in fact they may be. Thus a well-meaning attempt to actually evaluate expensive medical treatments for effectiveness ended. Incidentally experts claim that the vast majority of the gains in life expectancy over the last 150 years have been due to improvements in public health, not medicine. Each of vaccination, sanitation and clean water supplies has done more to contribute to longevity than any medical advance you care to name, including antibiotics. Yet people are unaware of the contribution of public health. I find this odd.
joe_the_user 17y ago
Hmm, You don't specify what missed test killed your father. There are, however, many symptoms where, given the uncertainty of all technology today, giving an operation or a drug prescription to might save X lives whereas NOT taking action would save Y lives, where X and Y are very uncertain. The harder thing, though, the lives that are lost through giving the operation or the drug tend to be even harder to measure - people die through being prescribed 4,5,6...X drugs up to the point that interaction fry them without any one drug being "to blame". People die from complications of many surgeries, yet if the surgery is possibly necessary, people don't think to blame the decision to operate (the New Yorker figure that surgical accidents kill more than auto accidents is remarkable - auto accidents were once the 4th leading cause of death in the US). And there is a hidden if you test everyone for everything. False positives can kill people - false positives do kill many people today. And as the New Yorker article mentions, physician incentives to make tests (or in other circumstances, to avoid them) can make a big difference.
- Retric 17y ago
  http://en.wikipedia.org/wiki/Pulmonary_embolism http://en.wikipedia.org/wiki/Pulmonary_embolism it's an accute problem and highly treatable. He had a collapsed lung and went to the doctor 4 days before he died. It's a common killer because it masks as other things, but you can do a fairly cheep pretest. Mortality from untreated PE is said to be 26%. [edit] Anticoagulation is the more common treatment because it has better long term odds. But, that assumes fairly early detection.