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America's Doctors Are Performing Expensive Procedures That Don't Work (vox.com)

Posted by EditorDavid on from the https://www.nytimes.com/2017/11/02/health/heart-disease-stents.html dept.

"The proportion of medical procedures unsupported by evidence may be nearly half," writes a professor of public policy at Brown University. An anonymous reader quotes his article in Vox: The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking. Each year, hundreds of thousands of American patients receive stents for the relief of chest pain, and the cost of the procedure ranges from $11,000 to $41,000 in US hospitals. But in fact, American doctors routinely prescribe medical treatments that are not based on sound science.

The stent controversy serves as a reminder that the United States struggles when it comes to winnowing evidence-based treatments from the ineffective chaff. As surgeon and health care researcher Atul Gawande observes, "Millions of people are receiving drugs that aren't helping them, operations that aren't going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm"... Estimates vary about what fraction of the treatments provided to patients is supported by adequate evidence, but some reviews place the figure at under half.

35 of 233 comments (clear)

  1. No Money by Anonymous Coward · · Score: 5, Insightful

    Duh, there is no money in actually healing people. Take the profit out of medicine and it will start actually work again.

    1. Re:No Money by VeryFluffyBunny · · Score: 5, Interesting

      In the UK, where the NHS is the only real game in town and health insurance is a national govt. system, doctors are allocated budgets for the numbers of patients that they have enrolled on their books. It's in their interests to spend as little as possible on keeping their patients as healthy as possible in order to conserve their budgets. The NHS is one of the best health services in the world in terms of outcomes for per capita spending. Well, that's the last time I heard. The current UK right-wing* administration are doing their best to wreck it.

      *right-wing in the UK is still thankfully far left of the Democrats in the USA.

      --
      Debate is a form of harassment. Do not question my truth.
    2. Re:No Money by VeryFluffyBunny · · Score: 2

      Religion is merely one of many tools of the state used to exert control over its population. Thankfully, rates of atheism, agnosticism and religious non-observance are much higher in Europe than in the US and therefore its impact is lesser. I don't think many countries do rabid fundamentalism and legislation based on moral outrage better than the USA.

      --
      Debate is a form of harassment. Do not question my truth.
    3. Re:No Money by hazardPPP · · Score: 2

      I've heard that the right/left difference in Europe is just whether one wants to be controlled by the church or by the state. In the US it is whether one wants to be controlled by the state, or by themselves.

      The difference between left and right in the US is whether one wants to be controlled mostly by the state and moderately by giant corporations, or moderately by the state and mostly by giant corporations.

      Those in the political arena who advocate actually for people being controlled mostly by themselves are a minority on both continents: "libertarians" in the US and "liberals" in Europe.

    4. Re:No Money by hazardPPP · · Score: 2

      If you want to wait for years for procedures I could get done with in a week in the US. What's the lead time for a knee replacement in the U.K.? 3 years or something, right?

      Yeah you could get it done in a week - assuming you have insurance (or the cash to pay upfront). What about all the people who can't afford it? And for those who can afford it, how much does it cost them?

      The "waiting time" red herring is invoked every time by Americans who have been brainwashed to think that socialized medicine means "death committees" (leading to such profound statements as "get your government hands off my Medicare" - a, uh, government program) or whatever. Yes, waiting times are a serious problem in poorly funded government-run health systems, mostly in poor countries (think, I don't know, Serbia?). In properly funded health systems in rich countries (Canada, UK, etc.) things that need to be done now will indeed be done now. If you're dying of a heart attack, there's no "wait time" for a bypass, it's done immediately (or as soon as medically possible). Similarly, if someone needs a knee replacement ASAP they will get it ASAP. If someone is waiting for it for 3 years, it means it's not urgent. Also, there is something called common sense - if your doctor thinks you will most likely need a knee replacement in 3 years (even if you don't need it that very moment) you'll be placed on a waiting list. Now think the other way - how many of those instant knee replacements in the US are totally or mostly unnecessary? How many of them are replacing knees in patients who can go on just fine for a couple of more years without it, while submitting them to unnecessary risks that accompany every type of surgery?

  2. better than getting sued by known_coward_69 · · Score: 2

    People want to destroy their bodies then run to the doctor looking for magic. Then they complain it costs money and doesn't fix the root issue and sue the doctors if they don't like the results

    1. Re:better than getting sued by whoever57 · · Score: 3, Insightful

      This simply isn't the real problem.

      Doctors in the US over-treat illnesses, use outdated and ineffective treatments and generally run up the costs of medicine.

      The above statement is based on my wife's treatment in the USA and in the UK.

      In my own case, I had a problem for which one of the treatments is surgery. I was referred to a hand specialist who only discussed the surgical option with me. When I asked about the alternative treatment that I had discovered using Google, his response was that he didn't do that treatment and I would have to see another doctor. Had I not researched it for my self, I would never have known that there was an alternative. That's on top of the fact that I had to pay for a completely useless consultation with the hand surgeon.

      Summary, even if you have good insurance in the USA, you may not be getting the best treatment.

      --
      The real "Libtards" are the Libertarians!
    2. Re:better than getting sued by Shoten · · Score: 2

      This simply isn't the real problem.

      Doctors in the US over-treat illnesses, use outdated and ineffective treatments and generally run up the costs of medicine.

      The above statement is based on my wife's treatment in the USA and in the UK.

      In my own case, I had a problem for which one of the treatments is surgery. I was referred to a hand specialist who only discussed the surgical option with me. When I asked about the alternative treatment that I had discovered using Google, his response was that he didn't do that treatment and I would have to see another doctor. Had I not researched it for my self, I would never have known that there was an alternative. That's on top of the fact that I had to pay for a completely useless consultation with the hand surgeon.

      Summary, even if you have good insurance in the USA, you may not be getting the best treatment.

      Question...and this is a real question, not a retort, because I am curious. Did the alternative therapy work? I don't know what the problem was with your hand, or what the alternative to surgery was, and I could see this going either way.

      I see and hear all the time about alternatives to X or Y medical procedure, but usually I haven't seen them turn out so well. But on the other hand, I totally agree that a lot of doctors follow a narrow path and get a bit heavy handed with surgery and drugs. I think I've been lucky; my doctor is fairly conservative and keeps things simple and it's been working very well for me.

      At the end of the day, doctors are service providers...they are vendors. Just as with buying a car, a house, or even a pizza, you have to consider your vendor and choose wisely. The fact that they have all taken the Hippocratic Oath does not guarantee quality, intelligence or skill. The good ones are doing the best they can now, and always trying to improve the definition of "best." The bad ones can be lazy, narrow-minded, or just plain greedy.

      --

      For your security, this post has been encrypted with ROT-13, twice.
    3. Re:better than getting sued by arth1 · · Score: 4, Interesting

      Doctors in the US over-treat illnesses, use outdated and ineffective treatments and generally run up the costs of medicine.

      Running up the costs is an inherent problem with for-profit medicine.
      The last time I went to a doctor, it was for a broken arm. They wanted to do full blood panel and urine tests and follow-up appointments for those. I asked them what for, and they said that they always had to do that if there weren't recent results on file. I asked whether it would change the treatment of the broken arm from a sling to something else, and the doctor said no, but it could discover unrelated issues. Well, I was not there for unrelated issues or to look for could.
      I ended up switching doctors, because of the money grab.

      Fuck the doctors and their affiliations.

    4. Re:better than getting sued by F.Ultra · · Score: 2

      Is Xiaflex not one of the standard procedures in the US? It's been approved as a standard procedure here in Sweden since 2011 due to overwhelming scientific evidence that it works.

    5. Re:better than getting sued by whoever57 · · Score: 3, Insightful

      It's approved, but the first doctor I consulted about my hand did not mention it as an option. That's my point: medicine in the USA is frequently bad.

      --
      The real "Libtards" are the Libertarians!
    6. Re: better than getting sued by Altrag · · Score: 2

      That's kind of the problem. We're not nails, and they're not hammers. Treating healthcare as a for-profit business means the doctors' primary motivating factor is not your health.

      Obviously doctors go through a lot of school and other hassles and nobody would argue that they shouldn't be compensated fairly for their work. But there's a difference between "compensated fairly" and "causing patients unnecessary harm and suffering in the blind drive for dollars."

  3. Follow the money by mspohr · · Score: 4, Informative

    Unfortunately, we have an unrestrained free enterprise system for medicine in the US. Doctors have rigged the payment system (CPT codes) so that specialist procedures are reimbursed many times their worth in time and training. The result is that most doctors train to become specialists and focus on doing highly remunerated procedures such as those enumerated in this report. There is no effective regulation of these procedures and so as long as you're not killing a large number of patients, anything goes. It means big bucks for the doctors and hospitals (insurance companies pay but then just tack on their % O&P so they don't really care either).
    Of course, people pay more for inflated cost of medical care and insurance and taxes to subsidize the whole system. The result is that we pay about twice per capita what other developed countries pay for health care but end up with poor quality care (lower health indicators than most other developed countries).
    Totally corrupt system.

    --
    I don't read your sig. Why are you reading mine?
    1. Re:Follow the money by Solandri · · Score: 2

      Doctors have rigged the payment system (CPT codes) so that specialist procedures are reimbursed many times their worth in time and training.

      The doctors didn't rig it. They're reimbursed far over cost because hospitals are required by law to treat emergency room patients regardless of ability to pay. Consequently, when you (with insurance) pay for a procedure, you're not just paying for your own procedure. You're also paying for the same procedure for the uninsured guy who was carted into the emergency room last night with the same problem.

      One solution to the problem is to free hospitals from the legal requirement to treat all emergency patients (thus making health insurance much more valuable so presumably more people would get it). Another is some sort of universal health care system where everyone is covered.* That's what's baffled me (a conservative) about the opposition to universal health care - for all intents and purpose we've already had it. Anyone with a severe medical problem can simply walk into an emergency room and (after waiting) get treated, leaving the rest of society to pay for it. Requiring hospitals to treat patients regardless of ability to pay has the same net effect as universal health care, just the accounting is a bit different.

      Aside from inefficiency, this doesn't affect costs though. If you want to find added costs, look to the lawsuits. My dad was family practitioner with his own medical office, and was never sued until just before he retired. Malprractice insurance ate up 30% of his gross income. There are a ton of tests and procedures which mostly aren't necessary, but doctors do them anyway just to cover their butts in case they get sued. Doctors implant the stent even though research says it doesn't help, because if they didn't and the patient died of a heart attack, the next of kin would sue them for failing to use the "time-proven practice" of implanting a stent. Add the malpractice insurance cost to the cost of "cover your butt" tests and procedures, and you're right around the 2:1 ratio of per capita healthcare costs in the U.S. vs other developed countries.

      At some point we're going to figure out that a courtroom with a jury of 12 who have zero medical or scientific training is a terrible place to decide which medical tests and procedures are worth doing.

      * It should also be noted that the "universal" in universal health care only applies to who is covered. It doesn't apply to which treatments are offered. Every country with universal health care has a board which looks at the cost of a treatment vs. its efficacy, and decides whether or not that treatment is cost-effective and so should/shouldn't be offered (the so-called "death panels"). So cost still plays a role in determining which services are available even with universal health care. Sometimes these standards are not applied uniformly either. When my Canadian friend's father was dying of late stage cancer, he was adamant that the hospital do everything and anything to try to extend his life, despite the numerous visits from Canada Health Services representatives trying to convince him that it was over and to let go. People like him who complain and refuse to sign off get better/costlier treatment. Conversely, you can purchase supplemental health insurance in countries with universal health care, which you can then use to pay for a procedure the government has deemed not worth the expense, so it's not like universal health care completely supplants market forces.

    2. Re:Follow the money by beckett · · Score: 2

      despite the numerous visits from Canada Health Services representatives

      Unless you are referring to Health Services in correctional facilities, There is no such federal governmental organization named "Canada Health Services".

      Additionally, In Canada, the responsibilities of healthcare management are devolved to the provincial government, not the federal government. I can't speak to any of your other anecdotes, but your Canadian info is incorrect.

  4. Damn stupid story by Anonymous Coward · · Score: 5, Insightful

    Stents WORK for heart disease - that’s proven and the story stupidly misleads it for click bait (and slashdot editors happily repeat)

    The study in question showed that stents don’t necessarily reduce heart pain in patients with narrowed arteries which is contradictory to the theories about how heart pain/disease work.

    Regardless a clogged artery will still kill you and a stent resolves that problem!

    More piss poor science “reporting”

    1. Re:Damn stupid story by sjames · · Score: 5, Informative

      Somebody didn't RTFA! The study was looking specifically at stents used in cases of stable angina that is responsive to medication, and found that the stents were higher risk but provided no benefit over medication in the case of stable angina. The study did not attempt to address the effectiveness of stents in other cases including cases where medication did not control stable angina.

      That still represents a lot of excessive costs for no benefit.

  5. Save big bucks! by kenh · · Score: 2

    The recent news that stents inserted in patients with heart disease to keep arteries open work no better than a placebo ought to be shocking.

    So we will suspend all stent treatments, save tremendous amounts of money AND survival rates will be EXACTLY the same?

    Sounds great - one question though, why are insurance companies reimbursing for these expensive, ineffective treatments? Perhaps there is evidence they are effective after all?

    --
    Ken
  6. Same thing happens in dentistry by ravenspear · · Score: 5, Informative

    The medical literature clearly indicates that the US is one of the few western countries remaining that routinely extracts nearly all asymptomatic wisdom teeth.

    There is no medical reason why this is necessary unless the teeth are severely impacted or arranged in such a way that it is difficult to brush them.

    Yet wisdom teeth extraction is a huge multibillion dollar industry for the dentistry practice in the US.

  7. All about lawyers by Vinegar+Joe · · Score: 2

    Doctors call this situation "defensive medicine"..........When lawyers make the rules, everyone ends up paying.

    --
    "The average reporter we talk to is 27 years old......They literally know nothing." - Ben Rhodes
    1. Re:All about lawyers by modmans2ndcoming · · Score: 3, Insightful

      The only way to fix that is to give Doctors the ability to have the case dismissed if they show that they treated the patient according to evidence based practice.

  8. Re:We're the best...at Marketing. by ceoyoyo · · Score: 2

    I don't think anyone says the US has one of the best medical systems in the world, except maybe the US. The WHO says you're #37, behind Costa Rica and ahead of Slovenia.

  9. Wrong: Here's the original story by DogDude · · Score: 3, Informative

    This is the original story that should have been linked to. Not that stupid Vox shit.

    https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

    --
    I don't respond to AC's.
  10. Infant circumcision by Stormwatch · · Score: 3, Interesting

    Pointless procedures? Infant circumcision comes to mind. Medically worthless, known to reduce man's sexual capacity, occasionally very destructive or even fatal. Without any doubt, it is a heinous violation of one's essential human right to bodily integrity.

    --
    Circumcision is child abuse.
    1. Re: Infant circumcision by Stormwatch · · Score: 2

      You must like the taste of dick cheese.

      Fact: women produce more smegma than men do.

      Penile cancer is unknown in circumcised men.

      Fact: penile cancer is extremely rare, except among older men who are smokers or have HPV.

      No male infant even remembers circumcision.

      So rape with roofies is fine and dandy, then?

      --
      Circumcision is child abuse.
  11. A long article filled with anecdotes by SlithyMagister · · Score: 3, Informative

    and not much else.
    I was hoping for a list of treatments and statistical comparisons of their outcomes.

    Best wishes for a peaceful, prosperous 2018,

  12. Re: Kind of like when Russia rigged the US electio by mbkennel · · Score: 2, Insightful

    Clinton called one third of Trump supporters, not all Republicans, "a basket of deplorables".

    I think this is quantitatively and qualitatively accurate.

  13. Doctors have to cover their asses by reboot246 · · Score: 3, Informative

    Doctors perform a LOT of tests and procedures simply as a guard against getting sued. Their malpractice insurance providers insist that the doctors cover their asses.

    I know several doctors personally, and one told me that slightly over half his cost of doing business (and medicine IS a business) was malpractice insurance. Next time you walk into a doctor's office, understand that whatever you pay to the doctor goes to rent, salaries, utilities, insurance, supplies, and some $$ to the doctor himself.

    It's been suggested many, many times that the solution to the rising cost of healthcare is tort reform or loser pays. Why won't anybody listen?

    1. Re:Doctors have to cover their asses by Huge_UID · · Score: 3, Informative

      "2.4% of the nation's total health care expenditure"
      Source: Forbes
      https://www.forbes.com/sites/rickungar/2010/09/07/the-true-cost-of-medical-malpractice-it-may-surprise-you/#a095cf72ff5b

  14. Re:Well it's better than death panels by Insanity+Defense · · Score: 2

    Well it's better than death panels which I know for a fact exist in communist countries like the UK and Scotlirland.

    Did I mention that I'm self employed so I can deduct my medical insurance premiums (and everything else, actually)?

    --
    cayenne8

    What about the American death panels that have existed for decades? You know the ones at the insurance companies who decide whether or not to pay for the medical coverage to save your life or to keep the money for bonuses?

  15. Re:Subsidize something and you get more of it by HiThere · · Score: 2

    I *HAD* the goddamn coverage I needed. I just needed to stand there bleeding while I tried to convince some damn office worker several states away that I had an injury that needed the coverage, and he appeared to be under pressure to decide that I didn't need it without knowing anything about the case. The insurance did, eventually, pay, but by god I'm not going to do anything to support that kind of system when I have a reasonable choice otherwise.

    --

    I think we've pushed this "anyone can grow up to be president" thing too far.
  16. Double negative by petes_PoV · · Score: 4, Interesting
    The point of those operations was not to heal people. It was to avoid a lawsuit. It is much better for a hospital or a doctor to put a patient forward for some treatment than to do nothing. That leaves them open to malpractice or negligence claims. And since they aren't the people paying, it makes no difference to them if the procedure works or does nothing.

    Avoiding a cost is just as good as making a profit, if someone else is paying.

    --
    politicians are like babies' nappies: they should both be changed regularly and for the same reasons
  17. Re:Kind of like when Russia rigged the US election by Tulsa_Time · · Score: 2

    Yes.. they bought some facebook ads.. impressive strategy.

    Good thing we are spending billions on counter intelligence.

    --
    5 out of 6 people enjoy Russian Roulette & 6 out of 7 Dwarfs are not Happy
  18. Rolling the dice by PeeAitchPee · · Score: 2

    Sure, but by the time you're in your teens, X-rays can give you a very good idea of whether or not you're going to have problems with your wisdom teeth down the road. In my case, I (with my parents' guidance) chose "wait and see" even though the doc said that I'd likely have wisdom teeth problems later on -- and I did, but not until age 40 (and then, only with two instead of all four they originally wanted to take out). The question is, essentially -- do you want to pull them before they're fully grown and really impacted and causing problems / pain, or preventative yank them when they're smaller and marginally less problematic?

  19. Re:Prevent and revert heart disease with nutrition by rock_climbing_guy · · Score: 2
    I read the book "The Pleasure Trap" after seeing it recommended in a comment right here on Slashdot.

    The dietary advice inside is based on the works of Doctor Dean Ornish, so for those of you not familiar, here is the dietary advice:

    - No alcohol or tobacco

    - No meat or seafood

    - No added sugar

    - No added salt

    - No heated oils

    - No white rice or white bread

    - No exceptions, ever, under any circumstances.

    In addition to the above, the author recommends at least 10 hours of sleep every night.

    Just letting you know :-)

    --
    Wh47 d1d j00 541, 31337 15n't t3h r0xor5 ne m0r3???