Laissez-faire Healthcare Blog

The Crossover Health blog has fantastic commentary on Shannon Brownlee’s book “Overtreated: Why Too Much Medicine is Making us Sicker and Poorer.”  I haven’t read the book, but I understand it’s about waste in American Health Care.  The blog focuses on one particular chapter entitled “The Desperate Cure,” which chronicles the failure of Bone Marrow Transplantation Therapy for the treatment of breast cancer.

“The finally tally: $3.4 billion dollars; 42,000 transplants; 9,000 treatment induced deaths; and no difference in outcomes over standard breast cancer treatment.”  The extremely painful treatment could cost between $100,000 and $500,000 per patient.

There are two basic human dispositions that drove it: hope and greed.  Nothing is wrong with either of them…in an of themselves.  However, hope borne from desperation and unmitigated greed…really a lack of checks and balances on our health care system…is one of the primary reasons we spend so much money per person on medical treatments and have similar or worse outcomes than many other countries.   (The other main reason is obesity).

Hope:

the physicians:  encouraged by early evidence that Bone Marrow Transplantation Therapy increased survivability.  When scientifically valid evidence showed it didn’t work, they had already committed psychologically to the notion of a halcyon cure.  (See: man with a hammer syndrome).  They kept pushing it.

the patients:  I’ve never had cancer (G-d forbid), but I can imagine that if I contracted some form of it at a young age, and had a poor prognosis, I would be biologically committed to survival at all costs (literally)…even if just for a few more years.  I’d be with the docs.

Greed:

the physicians: docs are people too, and the potential profitability of a new treatment for one of the most common causes of death couldn’t be ignored…it complimented hope too well to warrant consideration of unflattering evidence.

the lawyers: If you’ve even read John Grisham’s “The Rainmaker” or seen the Francis Ford Coppola/Matt Damon/Danny DeVito film version, you probably know how easy it is to stick a sick person in front of a jury, make an insurance company look evil, and take a 30% contingency fee. Ok, to be fair, there are plenty of cases where legitimate claims are denied and people die.  However, there are also plenty of cases where a claim should be denied because the treatment hasn’t been shown to be effective…and talented plantiff’s lawyers have scared insurance companies into paying these claims or settling frivolous lawsuits, simply to avoid the bad press of being painted as murderers.  The costs are passed down to all the other patients….we all pay for it.  John Edwards, a notorious ambulance chaser, demonstrated his talent for this recently on the campaign trail.

Lots of insurance companies were bullied into paying for an expensive experimental treatment that didn’t work…and possibly harmed more than it helped.  It should be noted that Medicare, who is better protected from these types of lawsuits due to certain types of legal immunity, never paid for this treatment — the government always considered it experimental.

The medical field is competitive, hope and greed drive the industry to always be looking for the next treatment…when oftentimes, the next treatment is untested…and utilizing that treatment means foregoing an older treatment that IS effective.

Without guesswork, we wouldn’t have medicine…hope and greed are therefore highly adaptive qualities.  What we need is better data, more research, more effective ways of disseminating that research, and we need it faster.  Guesswork in a white coat, without scientific rigor…without statistical significance, is waste.