When a pound of cure is too much

Another phase of the US healthcare crisis: patients who are overtreated.

from the January 2, 2008 edition

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Doctors, in turn, risk malpractice suits if they withhold a treatment requested by a patient, however unlikely it is to be of help. Sophisticated marketing campaigns by drug and medical device companies, aimed at both average Americans and their doctors, lobby hard to increase the use of new medicines and devices, even if they are no more effective, and possibly more dangerous, than earlier forms of treatment.

The result is that Americans spend about $6,000 per person on healthcare annually, roughly 2-1/2 times more than the median for the rest of the industrialized world. Americans also swallow 25 to 50 percent more prescription drugs per capita than do Canadians or Europeans. Yet the average life expectancy of Americans, at 77 years, is lower than in Western Europe, Canada, or Japan and closer to that of Cyprus, Costa Rica, and Chile.

The costs are more than merely financial. One estimate, Brownlee says, ascribes the number of deaths of Americans from unnecessary medical care at 30,000 per year. And an influential Institute of Medicine report released in 1999 called "To Err Is Human" estimated that as many as 98,000 Americans are killed each year by medical errors.

What this means is that ineffective medical treatments are more than just a waste of time and money: They raise the risk of harm to patients.

A lack of solid, unbiased information exacerbates the problem, Brownlee says. Patients rely on doctors for advice, and doctors rely on medical journals. But many physicians lack the training they need to assess the science in journal studies.

What's more, some 80 percent of the studies are funded by drug companies, which means that at the very least they need a thorough and skeptical review before publication. But peer reviews of journal articles, conducted by experts in the field, have seen embarrassing failures in recent years.

Even the news media has failed to play its watchdog role. Reporters are themselves courted by medical companies seeking favorable coverage. Brownlee quotes medical journalist Trudy Lieberman, who points out that reporters "share the American cultural belief in the inherent goodness of medicine and its corollary – that every new pill, every new treatment, works and should be treated as safe and effective until proven otherwise."

What can be done? Electronic medical records for each patient could ensure fewer hospital errors (such as the wrong drug or wrong dosage) and bolster best practices. (A shockingly low percentage of patients in hospitals actually receive what is considered the best treatment for their ailment.) The Veterans Health Administration has a model electronic-records system in place.

"Evidence-based medicine" – basing treatment on solid scientific research that suggests what really works and what doesn't – must become more commonplace. And hospitals and doctors must be paid for how well they care for their patients as a whole, not merely based on how many pills, surgeries, or tests they provide.

Americans, Brownlee concludes, don't need more medicine. They need better medicine.

• Gregory M. Lamb is on the Monitor staff.

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