Research And Health Care Decisions
Something shy of ten years ago, after seeing a poster in his doctor's office about the PSA test for prostate cancer, Wonks Anonymous asked his doctor if he ought to get this simple blood test.
To which question the answer was: Not really. The test was cheap but all of the serious studies of the test had shown that there were no benefits. Men who did not get the PSA test lived just as long as men who did. Men who got the PSA test were more likely to be found to have cancer and to be "cured" of their cancer - with various interesting side effects some of which caused them to die earlier than they would have. Men who lived without the test continued in blissful ignorance and, most often, died of other causes.
The result has once again been confirmed.
This result is deeply offensive to all of our instincts. Of course knowledge is better than ignorance and of course treating things is better than leaving them alone. Except when our ignorance of proper diagnosis and treatment cause us to do more harm than good. This seems to be the case with prostate cancer.
Which makes a strong case for effectiveness research as an input in medical decisions, although Wonks Anonymous still insists that insurance providers have nothing to do with the process.
To which question the answer was: Not really. The test was cheap but all of the serious studies of the test had shown that there were no benefits. Men who did not get the PSA test lived just as long as men who did. Men who got the PSA test were more likely to be found to have cancer and to be "cured" of their cancer - with various interesting side effects some of which caused them to die earlier than they would have. Men who lived without the test continued in blissful ignorance and, most often, died of other causes.
The result has once again been confirmed.
This result is deeply offensive to all of our instincts. Of course knowledge is better than ignorance and of course treating things is better than leaving them alone. Except when our ignorance of proper diagnosis and treatment cause us to do more harm than good. This seems to be the case with prostate cancer.
Which makes a strong case for effectiveness research as an input in medical decisions, although Wonks Anonymous still insists that insurance providers have nothing to do with the process.
Bravo! You substantiate what I have suspected for years.
From PSA to hypertension to elevated cholesterol to "borderline" diabetes (how many folks do we know who are "borderline diabetics"), if you are found with an ailment, they have the tests and treatment. As you have pointed out, often there is no decrease in mortality. Christ! Sometimes I think the pressure and worry alone bring many folks to their end prematurely.
That is exactly why the sum-bidges aren't going to get their hands on me while I have a pulse and 98.6 going on.
I did have one medical victory recently.
The missus and I have the same primary care practitioner. I only appeared at heir door because I needed a re-write of a prescription for acid reflux, which requires a periodic blood test.
For years I waged a war with the dopey receptionist who required me, and everyone else, to re-fill out the initial survey form, you know, the one with the insurance information, address, and next-of-kin information? Yeah, EVERY year it had to be re-done, like a test or something.
Every year I protested knowing the form was used to update their database where the information was stored. Every year I made a fuss because I knew other medical service offices were printing the information for the patient to review and change IF changes were necessary. Does anyone else share my concept of the level of convenience this simple management practice provides? I do not want to be writing information on a form I have provided numerous times before. Our address has not changed in almost thirty years. All the other information items change on a similarly extended schedule...it should be one of the benefits of advancing age to not have to fool around with all this identification crap every time we walk through the door.
I'd really rather be relaxing; I appear on my own at these places once every five to ten years for some compelling reason.
Less sympathy from WA who happens to work for a major group. We don't ask for a form every year because our computers remember who you are.
Some test work and some do not. Some treatments are actively harmful and others are not. Our blood pressure treatments are cheap and, if you get the right one, have no side effects. Diabetes and cholesterol treatments are also beneficial.
The point is that all of these treatments need to be documented by careful statistical study. We can't just do stuff because it seems like it should work.
One good source of research the Department of Research at Kaiser Permanente.
The annual visits are not my idea of a sane way to spend half a morning. That being such, I would rather be looking over the selection of magazines than writing on a Xerox'd form, cock-eyed on the paper, information I know you ALREADY HAVE!
I know this is not just my crazy attitude about the “consumerization” of health care. On a visit accompanying someone else to the same practitioner, I spoke with a retired gentleman who had only recently returned from Florida. He had been in an increasing amount of leg pain during the trip. He needed immediate attention and was seriously distracted. While he waited for an exam room to open, he was handed the clipboard by the chubbie behind the window. The man made me look like Casper Milquetoast. I nearly applauded him as the door slammed behind him.
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(contintation of previous post-gotta work on staying under 3000 char.)
Last week, while accompanying the Spouse to this, her preferred practitioner, I stepped up to sign her in as she made use of the ladies’ room. I was handed “The Clipboard” which held a professional looking pre-printed form with all of my wife’s information. And it had a column for changes, if necessary.
I won!
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And in Grandpa's case, it did more harm than good. He got the treatment and became incontinent even though the Parkinson's was sure to kill him before the prostate could do much damage. Another case of needless (and expensive) medical care.
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Excessive diagnosis and treatment is often harmful through may channels.
An excellent, forcefully argued, discussion of this topic can be found
here:
http://www.dartmouthatlas.org/atlases/jsc80266.pdf
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