"The most costly of all follies is to believe passionately in the palpably not true."
HL Menken
A recurring theme of mine is the maddening, confounding and fascinating complexity of human health and disease. Common sense, unifying principles, and single-explanation theories cannot encompass the diversity of the human organism. Easily understandable, common sense approaches to health care can often be ineffective or counterproductive. Lay people and their political representatives rarely grasp these intricacies, which leads to poor individual choices and public policy.
Obamacare panders to these tendencies by stressing "preventive care" as a core principle. What could be more sensible and cost-effective than preventing disease by finding it early? Two papers published last week seriously question these underlying assumptions and raise fundamental issues about the integrity of the medical foundations of Obamacare.
The first paper is about prostate screening. The conclusion is that finding tumors early has no impact on the life or health of the people screened. This counter-intuitive outcome is based upon the unusual behavior of some of the prostate cancers found. It appears than many cancers never progress far enough to cause any actual problems. Screening finds these harmless tumors, and treating them results in no benefit, and greatly increased cost. Waiting to treat those cancers which actually do cause problems is just as effective. Needless to say, this kind of result is difficult for many people, even some physicians, to accept.
The second paper is about mammography (disclosure: I derive income from billing for radiologists performing mammography). This detailed study questions the role of mammography in the reduction of breast cancer mortality. Although there has been a substantial reduction in breast cancer mortality since mammography has become widespread, there has also been dramatic improvement in various therapies. The study questions the portion of survival benefit attributable to mammography, which may be smaller than either simple reasoning or prior studies suggest. Again, this finding is strongly counter-intuitive. Common sense would dictate finding a cancer earlier would be of great benefit, but common sense might be wrong.
Other "preventive" measures, mandated by Obamacare, including weight loss and smoking cessation counseling, are also essentially worthless. A strong anti-smoking lobby and weight loss industry has influenced Congress to include expensive counseling and education programs in the mandated insurance coverage, which have been proven by many studies to be ineffective. Demanding insurance companies pay for such services will be costly and of little benefit to all but those selling the services.
From a health care policy viewpoint, the money, time, and effort spent on these "preventive" measures will be wasted. Compelling insurance companies to cover such services, cost free under Obamacare, is not supported by "evidence based" medicine. Obamacare's backers hypocritically reject overwhelming evidence if it does not support their political agenda. However, they are quick to accept borderline data in order to malign therapies not so politically popular. Removing Tonsils and Adenoids was singled out by President Obama as a wasteful and expensive therapy. In actuality, the evidence about this surgery is not conclusive, and many children (including my own) demonstrate great benefit. It seems the political connections of the supporters of a therapy are more important than the medical evidence.
These ill-conceived policies represent the triumph of politics and lobbying over medical science. Obamacare is not about health, but reflects the economic and political power of the constituencies trying to manipulate the dollars behind it. The process has also further eroded what little trust Congress held for the American people. Costly, useless, fanciful, and doomed to fail, not a good prognosis for Obamacare, or the health of America.
Eva von Schaper, "Prostate Screening Fails to Cut Cancer Deaths, Study Says. Bloomberg news, September 14, 2010 Anthony B. Miller, MB, FRCP; Teresa To, PhD; Cornelia J. Baines, MD; and Claus Wall, MSc, "The Canadian National Breast Screening Study-1: Breast Cancer Mortality after 11 to 16 Years of Follow-up - A Randomized Screening Trial of Mammography in Women Age 40 to 49 Years," September 3, 2002, Annals of Internal Medicine, Volume 137, Number 5 (Part 1) E-315 How to Choose the Best Medical Billing Service CMS Announces "Meaningful Use" Rules Medical Billing And Coding Service - Reasons To Pick As Your Career Option How Under-Coding Affects the Financial Well-Being of Your Medical Practice TV Medical Leads
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