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Unnecessary medical care is harming patients physically and financially (2015)

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Re: Unnecessary medical care is harming patients physically and financially (2015)

#101

Post by DanBC »

s3nnyy wrote: post #85
DanBC wrote: post #71

Earlier quoted context omitted.

He's just regurgitating conventional medical wisdom that's routine in countries that aren't the US. We've been talking about the risks of over-testing, over-diagnosis, and over-treatment for many years. Mostly in the context of full body MRI scans for healthy people, or early testing for prostate cancer, but also many other things.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

They do cause harm. People find all kinds of lumps and shadows when they get an MRI done. So now they have this thing, no-one knows what it is, and the patient has to decide whether to just live with it or have a biopsy to find out what it is. The biopsy carries a risk of harm. And then you get the results of the biopsy. But that's not always clear. Maybe they find cancer. So, is it a rapid cancer that will kill you if left untreated? Or is it a slow growing cancer that's just going to sit there not doing much until you're 93? The treatment can be harsh and cause harm.

Here's some articles. (Note how old these are. This isn't new advice).

http://www.bbc.co.uk/programmes/articles/15g8LGyBzYvMHpq6qNh...

> The first problem she uncovers is that detailed but general scans, such as a full body MRI or CT scan, can frequently bring to light small abnormalities which have no implications for health at all. They are the equivalent of tiny moles, freckles or scars on the outside of our body. Yet if they are picked up on a scan, then they can cause worry and further, much more invasive, testing – usually for no reason.

> The second problem that she uncovers is that even for some very specific tests, such as ultrasound of the arteries to assess the risk of stroke, the treatment available to rectify any small issues found carries very high risks to the patient. In the case of the ultrasound of the Carotid arteries in the neck, surgery to help clear any blockages would not be advised unless the patient had already had a stroke, or mini-stroke, making a test on an otherwise healthy person pointless.

http://www.independent.co.uk/life-style/health-and-families/...

> An American patient who had a whole body scan described how it threw up an early warning of lung cancer. He had a lung biopsy after a nodule was detected but it turned out to be a healed scar, posing no threat. However, the investigation involved four days in hospital, a painful procedure, several weeks of recuperation - and a $47,000 (£25,000) bill at the end.

http://news.bbc.co.uk/1/hi/health/7150583.stm

> "Full body MOTs" may often find benign abnormalities - so-called false positives - while missing real problems, said Professor Nicholas Wald, a specialist in preventive medicine.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#102

Post by notyourday »

hidenotslide wrote: post #89
dharmapure wrote: post #38

In the book Antifragile Nassim Taleb cautions against medical care unless it's truly necessary. He argues that since so many things can go wrong in a hospital (you could get sick from someone else, mistakes could be made, etc), only go if the benefits outweigh the risks. And so if you have cancer, it's probably worth the risk. But if you have something that could just go away naturally, that's got a higher expected v…

Nassim Taleb is great at providing backward looking advice. My back got better, therefore I was right to ignore the expert advice. He has predicted about ten of the last two financial crises. I wouldn't take medical advice from a financial pundit who can't seem to go more than a day without picking a fight on twitter.

My wife professionally interacts with a lot of top level surgeons -- the ones that have institutes named after or created for. They universally say it is all about risk management and risk mitigation. Trauma and neuro and cardiac surgeons of today are likely to be able to fix amazing number of issues just to have patients become gravely ill from secondary infections/non-top-notch care after the surgeries.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#103

Post by astura »

jartelt wrote: post #96
s3nnyy wrote: post #85

Earlier quoted context omitted.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

MRIs should be safe. It's the unnecessary CT scans you want to avoid. Those blast you with x-rays and increase your risk of cancer by a non-negligible amount.

MRIs on healthy, asymptomatic individuals are not "safe," they cause harm due to overdiagnosis and overtreatment. I know TFA was a long read but it explains it, CTRL-F "turtle" to get to the part about tumors specifically. Here's a similar explanation: https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

Re: Unnecessary medical care is harming patients physically and financially (2015)

#104

Post by paulsutter »

astura wrote: post #97
s3nnyy wrote: post #85

Earlier quoted context omitted.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

They cause harm due to overdiagnosis and over treatment. https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

Scans don’t cause overdiagnosis. Eager checklist-driven doctors cause overdiagnosis. You will see incidentalomas, how you use that information is not preordained.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#105

Post by maroonblazer »

Growing up with a mom who was a non-working registered nurse, every time I or my siblings came down with symptoms like fever, nausea, vomiting, etc she almost never took us to the doctor. Instead it was rest and liquids, maybe an aspirin. I would always plead with her that we needed to seek professional medical advice. Now as an adult I realize that she knew too well the limitations of that advice when it comes to most minor maladies people suffer.

And yet today I still see friends and colleagues go to the Dr or call the "teledoc" when they have these symptoms. They usually get an antibiotic (which has its own issues) or told they simply need to rest.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#106

Post by tr0ut »

tdb7893 wrote: post #22
tr0ut wrote: post #11

Earlier quoted context omitted.

You have the wrong idea. A better example of what you're calling "free market" would be dentistry or something like Lasik surgery. You can shop around and figure out the prices because they are very much apparent since you pay out of pocket for the majority of the former and completely for the later. Would Medicaid/Medicare be "free market"? Why bother shopping around when someone else picks up the tab? Insurance com…

The underlying philosophy of mandating coverage for pre-existing conditions is the idea that everyone should be able to have basic medical care. With that idea it's really not that tricky to say pre-existing conditions should be covered.

I don't disagree with the philosophical purpose. Of course by simplifying the facts. You're leaving out the logistics of insurance companies that have to now take that responsibility on. Last I checked they dont work of the sake of goodness.

Better option would be single-payer. I digress...

Re: Unnecessary medical care is harming patients physically and financially (2015)

#107

Post by liqu0rice »

wdn wrote: post #81

There issue is two folds here. 1. Medical liability. Doctors must cover their basics or will get sue. 2. There is no cost relationship between doctors and patients. Doctors and patients work with 3rd party call health insurers. Worst, a lot of people (medicaid recipients) have no skin in the game. Obama could have fixed item #2 with a universal health care that require (1) doctors to list the price of their services…

Paying $20 per visit, at 10 visit, it is $200 out of pocket. They have have skin in the game. This will cut down a lot of abuse.

Germany had something like you propose from 2004 until 2012 (1). It was not particularly successful and therefore consequently abolished.

(1) https://de.wikipedia.org/wiki/Praxisgeb%C3%BChr?wprov=sfla1

Re: Unnecessary medical care is harming patients physically and financially (2015)

#108

Post by astura »

paulsutter wrote: post #104
astura wrote: post #97

Earlier quoted context omitted.

They cause harm due to overdiagnosis and over treatment. https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

Scans don’t cause overdiagnosis. Eager checklist-driven doctors cause overdiagnosis. You will see incidentalomas, how you use that information is not preordained.

Scans directly cause overdiagnosis.

It's very non-intuitive but scans and tests have the potential to cause more harm than good.

From TFA:

>Overtesting has also created a new, unanticipated problem: overdiagnosis. This isn’t misdiagnosis—the erroneous diagnosis of a disease. This is the correct diagnosis of a disease that is never going to bother you in your lifetime. We’ve long assumed that if we screen a healthy population for diseases like cancer or coronary-artery disease, and catch those diseases early, we’ll be able to treat them before they get dangerously advanced, and save lives in large numbers. But it hasn’t turned out that way. For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted.

>H. Gilbert Welch, a Dartmouth Medical School professor, is an expert on overdiagnosis, and in his excellent new book, “Less Medicine, More Health,” he explains the phenomenon this way: we’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference.

>Over the past two decades, we’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all. In South Korea, widespread ultrasound screening has led to a fifteen-fold increase in detection of small thyroid cancers. Thyroid cancer is now the No. 1 cancer diagnosed and treated in that country. But, as Welch points out, the death rate hasn’t dropped one iota there, either. (Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.) It’s all over-diagnosis. We’re just catching turtles.

Re: Unnecessary medical care is harming patients physically and financially (2015)

#110

Post by mhb »

astura wrote: post #97
s3nnyy wrote: post #85

Earlier quoted context omitted.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

They cause harm due to overdiagnosis and over treatment. https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

Shouldn't a distinction be made between asserting this for a population vs. for an individual? Yes, for a population it results in overdiagnosis and over treatment. As a personal decision, though, I understand this and will choose how to proceed with that in mind.
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