Sunday, July 20, 2008

Newer Isn't Better. It's Unproven and Expensive.

There is a small trend among the media which is actively questioning the latest medical treatments and therapies on whether there is enough scientific evidence that would justify all of the increased costs. In an excellent piece in the NY Times titled - The Evidence Gap - Weighing the Costs of a CT Scan' Look Inside the Heart, Alex Berenson asks a simple, yet hard to answer question - is using heart CT scans worth it? The timing of the article was coincidental but was at the same time of Tim Russert's unexpected passing. Unlike many articles since Mr. Russert's death, this one asks us to think before we blindly believe that newer is better. Is there evidence-based research that says these procedures will save lives? From the article:

  • Increasing use of the scans, formally known as CT angiograms, is part of a much larger trend in American medicine. A faith in innovation, often driven by financial incentives, encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older techniques. Patient advocacy groups and some doctors are clamoring for such evidence. But the story of the CT angiogram is a sobering reminder of the forces that overwhelm such efforts, making it very difficult to rein in a new technology long enough to determine whether its benefits are worth its costs.
  • Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care.
  • No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments.
Bottom line? You and I are paying more for very expensive therapies that may not be better for us, but certainly appear cooler and sexier because they are newer. Those doctors and patients who dare to ask for proof will feel shunned. The former will be unable to make a living because the public demands these newer tests and will take their business to those who they perceive are giving them the best care even though there nothing to support that belief. The latter will feel like something is amiss even as their colleagues and friends flock towards these treatments even though it won't make a difference in their health, except for making them poorer. The pressure not to follow through is intense.

What to do? Be very skeptical. Align yourself with doctors who don't tout the latest therapies, except in the case of cancer treatment where the newest can be the difference between life and death. Seek out information. Hope that reporters like Mr. Berenson and authors like Shannon Brownlee can make their voices heard loud and clear, because it is unlikely that doctors as a group can avoid the seduction of new technologies, particularly since it drives more business and revenue.

Because if the media can't get enough of us to ask these important questions, is newer better, is it proven, you and I will simply pay more thinking we are getting better care, when in fact we are simply wasting money and getting no better care.

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