The cost and value of that annual preventative health check up
Healthcare News LINK
Published: Monday, 24-Sep-2007

Even though as many as an estimated 63.5 million American adults visit their doctor for a preventive health or gynecological examination each year, the value of such visits is a controversial issue.

According to a new study such visits cost the nation dearly, somewhere in the region of $7.8 billion annually; but preventive health examinations (PHEs) also called periodic health evaluations, for health promotion and screening of disease risk factors and subclinical illness are not recommended by major North American clinical organizations.

However it seems that two-thirds of patients and their doctors do believe it is important for patients to have a yearly check-up.

The researchers from the University of Pittsburgh School of Medicine and RAND Health Pittsburgh, analyzed data from a nationally representative survey of office-based doctors conducted between 2002 and 2004.

Doctors were randomly selected and then completed a one-page form detailing their encounters with each of 30 randomly selected patients during a designated reporting week.

Researcher Dr. Ateev Mehrotra and his colleagues found that over a three year period there were 181,173 visits, of which 5,387 were preventive health examinations and 3,026 were preventive gynecological examinations.

Extrapolated to a nationwide figure this equates to 44.4 million adults (20.9 percent of the population) receiving preventive health examinations and 19.4 million women (17.7 percent of adult women) receiving preventive gynecological examinations each year.

The researchers found the rates of preventive health examinations varied, with individuals in the northeast 60 percent more likely to receive one than those in the west, and also by insurance type; those who were uninsured were half as likely to receive one as those with private insurance or Medicare.

The researchers say preventive health examinations and preventive gynecological examinations are among the most common reasons adults see a doctor and while such visits frequently include preventive services, most of those are provided at other visits.

Many of the preventive health exams in the study included laboratory tests, such as complete blood cell counts or urinalyses, that do not clearly improve patient outcomes.

Dr. Mehrotra says more than a third of annual physicals include potentially unnecessary testing at a cost of more than $350 million a year, which is almost the same as is spent by the state of Massachusetts annually to provide insurance to the uninsured.

Dr. Mehrotra and his team hope that their findings will inform future recommendations about the frequency of preventive exams and the feasibility of providing one to all adults in the United States on an annual basis.

They say if every adult were to receive a preventive physical exam annually, the U.S. health care system would need to provide up to 145 million more visits every year; that in turn would account for an impractical 41 percent of all time spent on direct patient care by primary care physicians.

Dr. Mehrotra says the research underlines the need to find other means of delivering preventive care beyond annual physicals or to advise some patients they can come in much less frequently.

The researchers say their findings provide a foundation for the continuing national debate about the use and content of preventive health examinations and preventive gynecological examinations.

The research is published in the current issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Damn, turns out I've been wasting everyone's time and money for no reason for the past 25 years... Does "sorry" cut it?

mm

There's no mention of age. It's hard to believe that the value of exams as a function of age was not considered. Poor reporting?

After seeing the lines for a free prostrate screening all I could think of was:
Just wait until we get "free" health care.
The lines will be long, very long.
Maybe it will work out to 1 year long.

Is a CT scan always necessary after your child suffers a bump on the head? Should you think twice before undergoing surgery for lower back pain? Are your elderly parents going to be allowed to die at home, or will they spend their last few weeks in a hospital, hooked up to machines and tubes, subjected to painful, unnecessary procedures?

These are the kinds of questions you may find yourself asking once you’ve read Overtreated. Each year, our medical system delivers an enormous amount of care that does nothing to improve our health or lengthen our lives. Between 20 and 30 cents on every health care dollar we spend goes towards useless treatments and hospitalizations, towards CT scans we don’t need, towards ineffective surgeries—towards care that not only does nothing to improve our health, but that we wouldn’t want if we understood how dangerous it can be. This is the surprising and deeply counterintuitive message of Overtreated.

Of course, almost everything in our personal experience says just the opposite, that far from delivering too much care, our medical system isn’t giving us enough. Forty-seven million of us don’t have coverage, and even those of us who do have health insurance feel as if our insurers and doctors are continually trying to deny us treatments and tests and drugs that could help us.

Yet as award –winning journalist Shannon Brownlee shows in this remarkable book, much of what we think we know about health care is simply wrong. With probing insight and facinating examples, Brownlee unveils its topsy-turvy economics, where the supply of medical resources—beds, specialists, intensive care units—determines what care we receive, rather than how sick we are and what we actually need.

Overtreated offers a fresh way to think about health care reform. Americans worry about rationing—that any effort to rein in costs will lead to restrictions on treatments that could improve our health. But as Brownlee argues in this compassionate and compelling book, we can improve the quality of American medicine, control costs, and cover the uninsured—all without the limitations and expense that Americans fear. Her humane, intelligent, and penetrating analysis empowers readers to avoid the perils of overtreatment in their own care, while simultaneously pointing the way to a better system.

http://www.overtreated.com/the_book.html


*Starred Review* Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is. In a step-by-step deconstruction of America's improvident health-care system, Brownlee sheds light on events, attitudes, and legislation in the twentieth century's latter half that led to this economic nightmare. With the skill of a crack prosecuting attorney, she cites specific cases of physician and hospital fiscal abuse. Her aim is broad but not scattershot as she hits not just docs and hospitals but private insurers, Medicare, patients, medical device manufacturers, and pharmaceutical companies by, for instance, quoting a pharmaceutical salesperson who confesses financing a physician's swimming pool to get the doc to write more prescriptions. She is not all bad news, though, for she posits models that could be adapted to create a nationwide health-care system that conceivably could staunch the current fiscal hemorrhaging. If only.

http://www.amazon.com/Overtreated-Medicine...6781&sr=1-1

An Intuitive (and Short) Explanation of Bayes’ Theorem

Breast cancer affects 0.8% of women over 40. Mammography correctly interprets 90% of the positive tests (when women do have breast cancer) and 93% of the negative ones (when they don't have breast cancer). If you ask a doctor how accurate this test is if you get a positive test, the majority will tell you the test is 90% accurate or more. That is wrong.

the accuracy of the test is 7/(7+70) = 10%. Wow, that is pretty different than the 90% that most doctors believe!

it is only after the third consecutive positive test that you can be over 90% certain that you have breast cancer.


Interesting — a positive mammogram only means you have a 7.8% chance of cancer, rather than 80% (the supposed accuracy of the test). It might seem strange at first but it makes sense: the test gives a false positive 10% of the time, so there will be a ton of false positives in any given population. There will be so many false positives, in fact, that most of the positive test results will be wrong.

Link

Link

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer

In 1967, Jack Wennberg, a young medical researcher at Johns Hopkins, moved his family to a farmhouse in northern Vermont.
Dr. Wennberg had been chosen to run a new center based at the University of Vermont that would examine medical care in the state. With a colleague, he traveled around Vermont, visiting its 16 hospitals and collecting data on how often they did various procedures.

The results turned out to be quite odd. Vermont has one of the most homogenous populations in the country — overwhelmingly white (especially in 1967), with relatively similar levels of poverty and education statewide. Yet medical practice across the state varied enormously, for all kinds of care. In Middlebury, for instance, only 7 percent of children had their tonsils removed. In Morrisville, 70 percent did.

Dr. Wennberg and some colleagues then did a survey, interviewing 4,000 people around the state, to see whether different patterns of illness could explain the variations in medical care. They couldn’t. The children of Morrisville weren’t suffering from an epidemic of tonsillitis. Instead, they happened to live in a place where a small group of doctors — just five of them — had decided to be aggressive about removing tonsils.

But here was the stunner: Vermonters who lived in towns with more aggressive care weren’t healthier. They were just getting more health care.

Why is this happening, then?

Above all, it’s the natural outgrowth of our fee-for-service health care system. It turns doctors into pieceworkers, as Ms. Brownlee puts it, “paid for how much they do, not how well they care for their patients.” Doctors and hospitals typically depend on the volume of work for their income, and they are the gatekeepers who decide when work needs to be done. They also worry about being sued if they do too little. So they err on the side of overtreatment.


Link

Doctor Faces Suits Over Cardiac Stents

Dr. Mark Midei inserted 30 of the company’s cardiac stents in a single day in August 2008, “which is the biggest day I remember hearing about,” an executive wrote in a celebratory e-mail.

Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home, according to a report being released Monday by the Senate. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.

“What was going on in Baltimore is going on right now in every city in America,” said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who said he routinely treats patients who have been given multiple unneeded stents. “We’re spending a fortune as a country on procedures that people don’t need.”

Over the past year, St. Joseph has told hundreds of Dr. Midei’s patients that they did not need the expensive and potentially dangerous stents that the doctor inserted because their arteries were not as obstructed as he had claimed. Now, state health officials are investigating other local cardiologists who inserted a suspiciously high number of stents, which are tiny wire mesh devices inserted to prop open clogged arteries in the heart.

After reports about the Midei case and the wider state investigation, the number of stent procedures performed at St. Joseph and other area hospitals plunged, raising doubts about the appropriateness of much of the region’s cardiac care.


Link

Medicare incentivizes unnecessary surgeries

Bradley was checked into the hospital right away, and told he could be called into the operating room at any minute. But then, something even more alarming happened.
He says a nurse came in and under her breath said, "Get out!" As Bradley remembers, the nurse continued and said, "I can get fired for saying this, but I don't think you need the surgery."

Director of cardiology, Dr. Chae Hyun Moon, had performed more than 30,000 angiograms and ultrasounds - procedures in which a tube is threaded through a patient's heart to look for clogged arteries.
Based on those tests, he had sent thousands of patients for coronary bypass operations. One patient was Jay Bradley, a 35-year-old father of three. Two years ago, Bradley started having chest pains and went to see Moon. The diagnosis was grim.
"He put the monitor in front of my face, showed me a little artery on there and said, 'Well, this is clogged, and this one's the top front of your heart and there's zero chance of survival.'"

Link


For much of a ten-year period between 1992 and 2002, the cardiac program at this 240-
bed, Tenet-owned hospital in Redding, a small city at the northern tip of California’s
Sacramento Valley, was performing an extraordinarily high number of cardiac
procedures. These eye-catching statistics on catheterizations and coronary bypass
operations were reported annually in the Dartmouth Atlas of Health Care and were well
known to federal and state officials. Yet no agency sought as much as an explanation. It
was not until 2002, when a skeptical heart patient called the FBI that an investigation
began.


Link

Eat right and exercise -- die anyway

Nortin Hadler says he would sue any doctor who tried to test his cholesterol. Likewise, his bone density, prostate levels, colon cells, etc. The Harvard-trained doc, now in his sixties and a rheumatologist and professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, says you, too, should avoid these routine tests, as well as most angioplasties, bypass surgeries and routine mammograms. That's because -- contrary to what the medical establishment tells you -- the tests and procedures don't extend most lives, he says; they just convince healthy people they're sick

So if these screenings and procedures don't prolong our lives, what does?

About 85 percent of your mortal hazard lives in two questions: Are you comfortable in your socioeconomic status? And do you like your job? If you say no to either or both of those, that represents some of the most powerful mortal hazards that we are able to document.


So how do you personally deal with all this?

I will die, hopefully on my 85th birthday, and I don't really care which of the diseases that I'm bearing on my 85th birthday does me in. I only care that I made it to my 85th birthday -- plus or minus something -- and on that birthday I can look back and smile.


Link

How to Stay Well Despite the Health-care System

Answer true or false to these ten statements:

(1) Cardiovascular surgery clearly and unequivocally benefits the patient.
(2) Even though obesity (which is unhealthy) is on the rise in America, American life expectancy is increasing.
(3) There are very reliable methods for screening that spares us the risk of dying from colorectal cancer before our time.
(4) Mammography is of much value to the women screened.
(5) Prostate gland screening for males doesn't work.
(6) It is abnormal to live two years without a backache.
(7) One of the potentially dangerous acts physicians perform is to take a "history" from a patient.
(8) Bone thinning is an insidious illness.
(9) Psychological and social stress is not all bad.
(10) There is compelling evidence that acupuncture, physical therapy, massage, therapeutic touch, and distant healing work for physical complaints.

If you answered true to any one of statements (1,3,4,8,10) or false to any one of statements (2,5,6,7,9), then you may benefit from this enlightening book authored by medical professor Dr. Nortin Hadler.


Link

Doctor Loses License

He’s accused of performing unnecessary surgical procedures on hundreds of his patients. And now many of those patients are celebrating news that state yanked Dr. Marc Midei’s medical license.

Marrs is one of 585 people who received a letter from St. Joseph Medical Center saying Midei may have unnecessarily given her a stent–a tiny device designed to open up blocked arteries. A charge Midei has vehemently denied.

Stents

So if these screenings and procedures don't prolong our lives, what does?

About 85 percent of your mortal hazard lives in two questions: Are you comfortable in your socioeconomic status? And do you like your job? If you say no to either or both of those, that represents some of the most powerful mortal hazards that we are able to document.
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Where is the documentation for this? Most surveys show that way over 50% do not like their jobs------so you think they will die from this.

Longevity keeps going up--------

Statins -Cholestrol medicine has way cut way down deaths from heart disease in the last 20 years

Why Almost Everything You Hear About Medicine Is Wrong

“People are being hurt and even dying” because of false medical claims, he says: not quackery, but errors in medical research.

It’s a disturbing view, with huge implications for doctors, policymakers, and health-conscious consumers. And one of its foremost advocates, Dr. John P.A. Ioannidis, has just ascended to a new, prominent platform after years of crusading against the baseless health and medical claims.

A major study concluded there’s no good evidence that statins (drugs like Lipitor and Crestor) help people with no history of heart disease. The study, by the Cochrane Collaboration, a global consortium of biomedical experts, was based on an evaluation of 14 individual trials with 34,272 patients. Cost of statins: more than $20 billion per year, of which half may be unnecessary.

Even a cursory glance at medical journals shows that once heralded studies keep falling by the wayside. Two 1993 studies concluded that vitamin E prevents cardiovascular disease; that claim was overturned by more rigorous experiments, in 1996 and 2000. A 1996 study concluding that estrogen therapy reduces older women’s risk of Alzheimer’s was overturned in 2004. Numerous studies concluding that popular antidepressants work by altering brain chemistry have now been contradicted (the drugs help with mild and moderate depression, when they work at all, through a placebo effect), as has research claiming that early cancer detection (through, say, PSA tests) invariably saves lives. The list goes on.

Surgical practices, for instance, have not been tested to nearly the extent that medications have. “I wouldn’t be surprised if a large proportion of surgical practice is based on thin air, and [claims for effectiveness] would evaporate if we studied them closely,” Ioannidis says.


Medicine Newsweek

Lies, Damned Lies, and Medical Science

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

It didn’t turn out that way. In poring over medical journals, he was struck by how many findings of all types were refuted by later findings. Of course, medical-science “never minds” are hardly secret. And they sometimes make headlines, as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn’t really help fend off Alzheimer’s disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries.

His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views

Indeed, nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest.

Medical research is not especially plagued with wrongness. Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right).

http://www.theatlantic.com/magazine/archiv...l-science/8269/

Publication Bias

... the tendency of scientists and scientific journals to prefer positive data over null results, which is what happens when no effect is found. The bias was first identified by the statistician Theodore Sterling, in 1959, after he noticed that ninety-seven per cent of all published psychological studies with statistically significant data found the effect they were looking for.

Sterling saw that if ninety-seven per cent of psychology studies were proving their hypotheses, either psychologists were extraordinarily lucky or they published only the outcomes of successful experiments. In recent years, publication bias has mostly been seen as a problem for clinical trials, since pharmaceutical companies are less interested in publishing results that aren’t favorable. But it’s becoming increasingly clear that publication bias also produces major distortions in fields without large corporate incentives, such as psychology and ecology.

Selective Reporting

... an equally significant issue is the selective reporting of results—the data that scientists choose to document in the first place. Palmer’s most convincing evidence relies on a statistical tool known as a funnel graph. When a large number of studies have been done on a single subject, the data should follow a pattern: studies with a large sample size should all cluster around a common value—the true result—whereas those with a smaller sample size should exhibit a random scattering, since they’re subject to greater sampling error. This pattern gives the graph its name, since the distribution resembles a funnel.

The funnel graph visually captures the distortions of selective reporting. For instance, after Palmer plotted every study of fluctuating asymmetry, he noticed that the distribution of results with smaller sample sizes wasn’t random at all but instead skewed heavily toward positive results. Palmer has since documented a similar problem in several other contested subject areas. “Once I realized that selective reporting is everywhere in science, I got quite depressed,” Palmer told me.

Acupuncture

One of the classic examples of selective reporting concerns the testing of acupuncture in different countries. While acupuncture is widely accepted as a medical treatment in various Asian countries, its use is much more contested in the West. These cultural differences have profoundly influenced the results of clinical trials. Between 1966 and 1995, there were forty-seven studies of acupuncture in China, Taiwan, and Japan, and every single trial concluded that acupuncture was an effective treatment. During the same period, there were ninety-four clinical trials of acupuncture in the United States, Sweden, and the U.K., and only fifty-six per cent of these studies found any therapeutic benefits. As Palmer notes, this wide discrepancy suggests that scientists find ways to confirm their preferred hypothesis, disregarding what they don’t want to see

The problem of selective reporting is rooted in a fundamental cognitive flaw, which is that we like proving ourselves right and hate being wrong. “It feels good to validate a hypothesis,” Ioannidis said. “It feels even better when you’ve got a financial interest in the idea or your career depends upon it. And that’s why, even after a claim has been systematically disproven”—he cites, for instance, the early work on hormone replacement therapy, or claims involving various vitamins—“you still see some stubborn researchers citing the first few studies that show a strong effect.


Bias science

A major study concluded there’s no good evidence that statins (drugs like Lipitor and Crestor) help people with no history of heart disease. The study, by the Cochrane Collaboration, a global consortium of biomedical experts, was based on an evaluation of 14 individual trials with 34,272 patients. Cost of statins: more than $20 billion per year, of which half may be unnecessary


of which half may be unnecessary

at least we agree half are necessary and saving lives
less dying of heart disease

do not look at all or nothing------look for common agreements


look at the good statins have done saving lives

http://heartdisease.about.com/od/othertrea...hdosestatin.htm

Doctor Panels Recommend Fewer Tests for Patients

In a move likely to alter treatment standards in hospitals and doctors’ offices nationwide, a group of nine medical specialty boards plans to recommend on Wednesday that doctors perform 45 common tests and procedures less often, and to urge patients to question these services if they are offered.

The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States.

“Overuse is one of the most serious crises in American medicine,” said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the initiative.

The list of tests and procedures they advise against includes EKGs done routinely during a physical, even when there is no sign of heart trouble, M.R.I.’s ordered whenever a patient complains of back pain, and antibiotics prescribed for mild sinusitis — all quite common.

The American College of Cardiology is urging heart specialists not to perform routine stress cardiac imaging in asymptomatic patients, and the American College of Radiology is telling radiologists not to run imaging scans on patients suffering from simple headaches. The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease.

Even oncologists are being urged to cut back on scans for patients with early stage breast and prostate cancers that are not likely to spread, and kidney disease doctors are urged not to start chronic dialysis before having a serious discussion with the patient and family.


http://www.nytimes.com/2012/04/04/health/d...WAY&ei=5065

Appendix Removal: Huge Sticker Shock in Study

It's a common, straightforward operation, so you might expect charges to be similar no matter where the surgery takes place. Yet a California study found huge disparities in patients' bills — $1,500 to $180,000, with an average of $33,000.

http://www.nytimes.com/aponline/2012/04/23...rick.net&hp


America’s false autism epidemic

Many people with the diagnosis don’t really meet the criteria for it, and the diagnosis has become so heterogeneous that it loses meaning and predictive value. This is why so many kids now outgrow their autism. They were never really autistic in the first place.

http://www.nypost.com/p/news/opinion/opedc...H94IcUB795b6f7L

Unelected Bureaucrats Confiscate Your Private Medical Records Without Your Consent

Kathleen Sebelius decreed that all private health insurance companies must turn over to the federal government their medical records on all patients insured by them to be included in the federal health information database without patients’ consent.

The traditional American view is that you, the patient, are the owner of the information in your medical records that reside with your personal physician. You control to whom your information is released. Under the new Sebelius ruling, the government will control your medical information on federal computers in a federal database. Thus, your personal medical information is open to anyone with access to the system.


http://www.aapsonline.org/index.php/site/a...te_medical_rec/

The Patient Paradox: A world where patients have been turned into customers, and clinics and waiting rooms are jammed with healthy people

A world where pharmaceutical companies gloss over research they don’t like and charities often use dubious science and dodgy PR to ’raise awareness’ of their disease, leaving a legacy of misinformation in their wake.

Explaining the truth behind the screening statistics and investigating the evidence behind the hype, Margaret McCartney, an award-winning writer and doctor, argues that this patient paradox – too much testing of well people and not enough care for the sick – worsens health inequalities and drains professionalism, harming both those who need treatment and those who don’t.

Screening can do more harm than good – but how many people know that when they sign up for breast screening or a cholesterol check? The Patient Paradox argues that screening tests – both in the NHS and private sector – are overhyped and oversold.
This book calls for patients, doctors and policy makers to look at the damage being caused as doctors have become deprofessionalised and patients have been turned into customers.


http://evenstarsexplode.wordpress.com/2012...health/#respond

I thought the whole Roe v Wade abortion law was based on a woman's "right to privacy."

What is the "regression fallacy"

The regression fallacy ascribes cause where none exists. The flaw is failing to account for natural fluctuations.

Things like golf scores, the earth's temperature, and chronic back pain fluctuate naturally and usually regress towards the mean. The logical flaw is to make predictions that expect exceptional results to continue as if they were average.

Example:

When his pain got worse, he went to a doctor, after which the pain subsided a little. Therefore, he benefited from the doctor's treatment.

The pain subsiding a little after it has gotten worse is more easily explained by regression towards the mean. Assuming the pain relief was caused by the doctor is fallacious.


http://en.wikipedia.org/wiki/Regression_fallacy

The characteristics of health systems are complexity, uncertainty, opacity, poor measurement, variability in decision making, asymmetry of information, conflict of interest, and corruption.

Only 11% of 3000 health interventions have good evidence to support them, said Domenighetti. A third of the activity in the US health system produces no benefit, said a recent study in the New England Journal of Medicine. Half of all angioplasties are unnecessary. Some €153m a day is lost through corruption in health systems in the European Union.

Four fifths of new drugs are copies of old drugs. Screening is creating diseases like ductal carcinoma in situ. Most doctors (80-90%) have taken “bribes” from pharmaceutical companies, although many may not see their free pens and lunches and subsidised travel as bribes (but if they are not bribes what are they?).

Between 15% and 40% of articles in medical journals are ghostwritten. Half of clinical trials are not published, and there is systematic bias towards positive results, hence suggesting that treatments, usually drugs, are more effective and safer than they actually are.

Yet against this backcloth more than four fifths of people in most countries think medicine is an “exact or almost exact science



http://blogs.bmj.com/bmj/2012/12/17/richar...-slow-medicine/

I was checking out some of my ancestors and they lived into their 90's back in the early 1800's and had kids in the double digits.

I wonder what kind of annual physical exams they had.