What is effective medical care?

The ongoing national discussion of medical care issues is missing the essential element of assuring medical care effectiveness.

We spend more annually per person than any other country, yet our average lifespan is decreasing.

While partially due to lifestyle issues, this mismatch surely indicates that we are not getting sufficient value for our medical dollars.  We are spending a great deal for treatments of little benefit.

Congress is not going to correct this situation.  Its bread is heavily buttered by the pharmaceutical, insurance, and medical care industries, who all profit tremendously by selling us extremely expensive treatments whose effectiveness is of no material interest to them.  It is relevant only to us, the patients who consume their products.  So forget about Congress looking out for our best interest in a grand medical plan.  It won't happen.

Remediation is up to us, and we fortunately have the information we need readily available.  Now, understand that I am not suggesting that we should be our own doctors.  I am arguing that we must do sufficient study so as to be capable of questioning our doctors and making our own treatment decisions based on their answers and attitudes.  Doctors stay very busy, and they usually don't have the time to stay current regarding the results of recent studies.  So you need to prompt them with pertinent questions to assure that you obtain evidence-based medical treatment.

We should all understand the difference between relative and absolute risk.  When we are told that a treatment will reduce our chances of a heart attack by 50%, does that actually mean our chances are reduced from 1 in 1,000 to 1 in 2,000?  Relative risk reduction often sounds quite promising, while absolute risk reduction may be insignificant.  They are not interchangeable.  Know and ask so that you understand what you are being told.

Number Needed to Treat, or NNT, is a metric developed in every clinical trial for pharmaceuticals.  Ask your doctor or find it yourself for every medication you are offered.  Thennt.com website provides basic information and references the pertinent studies supporting it.  Become familiar with either this or a similar site.  As an example, the NNT for statins preventing heart attacks is 60.  Sixty people without prior heart disease must take a statin for five years to prevent one nonfatal heart attack.  The NNT for statins preventing stroke is 268.  And the NNH, or Number Needed to Harm, is only 10 for causing muscle damage and 50 for developing diabetes.  Hmm...

If you have cancer, research, then ask your oncologist about the Australian chemotherapy study.  A massive study with detailed results determined that overall, chemotherapy makes about a 2% contribution to five-year survival.  But everyone experiences the poisonous side effects.  And chemo can be quite effective for a few types of cancer.

Popular procedures for which the expected harm exceeds the benefit include mammograms, stents, and PSA tests.  Again, do the research on every test or treatment suggested to you, then discuss with your doctor and make your decision.  Most doctors are not upset when you decline a proffered treatment; they merely document with a CYA note in their file for possible future legal protection.

It is your life, thus your responsibility to understand the possible benefit or harm of prescriptions and procedures.  And not insignificantly, it is your money.  Don't spend it on ineffectual treatments.

The ongoing national discussion of medical care issues is missing the essential element of assuring medical care effectiveness.

We spend more annually per person than any other country, yet our average lifespan is decreasing.

While partially due to lifestyle issues, this mismatch surely indicates that we are not getting sufficient value for our medical dollars.  We are spending a great deal for treatments of little benefit.

Congress is not going to correct this situation.  Its bread is heavily buttered by the pharmaceutical, insurance, and medical care industries, who all profit tremendously by selling us extremely expensive treatments whose effectiveness is of no material interest to them.  It is relevant only to us, the patients who consume their products.  So forget about Congress looking out for our best interest in a grand medical plan.  It won't happen.

Remediation is up to us, and we fortunately have the information we need readily available.  Now, understand that I am not suggesting that we should be our own doctors.  I am arguing that we must do sufficient study so as to be capable of questioning our doctors and making our own treatment decisions based on their answers and attitudes.  Doctors stay very busy, and they usually don't have the time to stay current regarding the results of recent studies.  So you need to prompt them with pertinent questions to assure that you obtain evidence-based medical treatment.

We should all understand the difference between relative and absolute risk.  When we are told that a treatment will reduce our chances of a heart attack by 50%, does that actually mean our chances are reduced from 1 in 1,000 to 1 in 2,000?  Relative risk reduction often sounds quite promising, while absolute risk reduction may be insignificant.  They are not interchangeable.  Know and ask so that you understand what you are being told.

Number Needed to Treat, or NNT, is a metric developed in every clinical trial for pharmaceuticals.  Ask your doctor or find it yourself for every medication you are offered.  Thennt.com website provides basic information and references the pertinent studies supporting it.  Become familiar with either this or a similar site.  As an example, the NNT for statins preventing heart attacks is 60.  Sixty people without prior heart disease must take a statin for five years to prevent one nonfatal heart attack.  The NNT for statins preventing stroke is 268.  And the NNH, or Number Needed to Harm, is only 10 for causing muscle damage and 50 for developing diabetes.  Hmm...

If you have cancer, research, then ask your oncologist about the Australian chemotherapy study.  A massive study with detailed results determined that overall, chemotherapy makes about a 2% contribution to five-year survival.  But everyone experiences the poisonous side effects.  And chemo can be quite effective for a few types of cancer.

Popular procedures for which the expected harm exceeds the benefit include mammograms, stents, and PSA tests.  Again, do the research on every test or treatment suggested to you, then discuss with your doctor and make your decision.  Most doctors are not upset when you decline a proffered treatment; they merely document with a CYA note in their file for possible future legal protection.

It is your life, thus your responsibility to understand the possible benefit or harm of prescriptions and procedures.  And not insignificantly, it is your money.  Don't spend it on ineffectual treatments.