Wednesday, May 6, 2015

On unnecessary medical check-ups

An article by Dr. Atul Gawande on unnecessary testing in medicine and the harm it causes.

Personally, I have all along belonged to the school of thought that preventive medical checks are totally unnecessary; the "annual medical check-up" is guaranteed to do you mostly harm, and very little good. Dr. Gawande explains why in a better fashion than I have seen anywhere. I like his analogy of diseases being like turtles or birds; but we treat them like they are rabbits.

My own two-bits:

Remaining free from disease has very little to do with medicine and a lot to do with lifestyle, which includes diet, sleep, exercise, and state of mind. For each of these areas, on how to improve quality of life, advise can be found in several different sources, but never, repeat never, from your doctor. Doctors, especially of the allopathic kind, know very little of how to stay healthy - they only study disease, are obsessed with disease, and with the narrow specialty which each one of them comes to represent. When my son was eight years old, he had a peculiar problem - pains all over his body -  wherever we touched him, it would pain him. The pain was real, but the cause was unknown. We made the mistake, based on a local doctor's recommendation, of taking him to a specialist on Rheumatoid Arthritis. And guess what? His diagnosis was that he suffers from Rheumatoid Arthritis, and the solution? Steroids!  One dose was all it took (my son had hallucinations after consuming that dose) to convince us that something was seriously wrong. We asked around and took him to a more enlightened pediatrician who basically told us that it was all in the mind; if we waited for a few days the problem would disappear. And it did! For a carpenter with a hammer all the problems in the world will seem like nails!

And this whole "testing" thing - what is it based on? You get tested for a hundred different things, for each of which "normal" ranges have been established based on some statistical cut-offs. The probability of each marker being awry, even if two percent, leads to an almost certain chance of something being diagnosed as wrong once you look at some forty parameters. And based on that one parameter that looks wrong, you undergo several more tests - the chances are, by the time the tests are done, there will be something wrong with you. Not because something is actually wrong with you, but because the tests say so. Until something is really wrong with you, it is better to let the body take care of itself. Chances are, if you get yourself tested three months later, that particular problem would have disappeared but some other problem would be thrown up by the tests.

Add to this the pressure on doctors to make money. They get cuts (40 percent, and in some cases, even 60 percent of the test fees) from the diagnostic labs. They are employed by hospitals which insist on a minimum success rate, not in terms of curing people, but in terms of getting people admitted to hospital. And the hospitals themselves operate on metrics like "revenue per bed" which of course includes allied services like unnecessary tests and further interventions. Investors in these hospitals demand "profit" and the patient is just a cow to be milked for getting that profit. It does not help that in a lot of these hospitals, the investors are doctors themselves. 

And what about the medicines that are prescribed as a result? Based on suspect statistics, or should I say scam statistics, which in turn are based on tests like cholesterol, which are getting increasingly discredited, people are put on things like statins for life. Completely unnecessary drugs, actually harmful, which cure nothing, and create more problems while solving none. The advantage (to the pharma companies) of course, is that, these drugs are life-long; and they are very likely to cause other complications for which you are likely to take more drugs, not that you will ever know the cause and effect relationship.

Mammograms are also being increasingly discredited. As to the so-called cancers that they can detect, and the desirability of operating for the same, Dr. Gawande's article brilliantly brings out the fallacies of such  thinking.

The tribe of doctors qualifying nowadays are not specialized in overall health and wellness. They all know about a small part of the human body, and study it in isolation from the rest. The body, though, is a holistic system operating on natural and biological principles; not a physical machine where if one part goes phut, you replace it, and the machine runs on. Add to this, the proliferation of for-profit diagnostic centers and hospitals, and what do you get? The more hospitals and test centers there are, it goes without saying, the more sick people there will be in order to fill those beds. The cause and effect cycle works both ways! And the fact that they are for-profit, answerable to shareholders who look for return on investment, means of course, that all of us will end up spending more and more money on these treatments, frequently giving up other things in life in the process. And in a lot of cases, eroding our quality of life due to the treatments and their inevitable after-effects.

The fact that most of us are covered by insurance in one form or another does not help. It makes everyone go in for unnecessary treatment and medications since someone else is paying. That kind of logic is fine while buying jewelry - if someone else is paying, more is better. But not when it comes to health - in health and treatment, less is often better. 

One more personal anecdote  - when my son was born I was working for Shell, where the policy was to cover all costs on maternity, whichever hospital, no limits. The mistake would have been to go to Breach Candy (one of the pricier places in Bombay). We went to the local hospital which was exactly 20 meters away from our house, and the total costs, including delivery and pre-and-post expenses? Rs. 8000. Even though it was 1995, I think that was a pretty moderate sum. A bigger hospital would never have let us off so lightly!

A brilliant article which you must read. Dr. Gawande is now part of my pantheon, along with Dr. B M Hegde.


America's Epidemic of Unnecessary Care
Millions of people get tests, drugs, and operations that won't make them better, may cause harm, and cost billions.
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Posted By Dinesh Gopalan to Personal Finance, Investments, and other things at 5/06/2015 03:56:00 PM

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