Appearing with little fanfare in the media, Dr. Deborah Grady's editorial in the May 10 Annals of Internal Medicine proclaimed a shocking "medical heresy",that less health care is better than more health care.(1) US Health care is generally assumed and expected to be beneficial, yet when outcomes are measured, studies show that more health care equates with worse outcomes, not better.(2,3) This revelation isn't new, and is actually old news, like a worn and familiar piece of old clothing. The real news is that this "medical heresy" in now appearing in mainstream medical journals. Are mainstream doctors getting fed up? Is Mainstream going Alternative?
Above left image: President Obama Signs the Health Care Reform Bill, courtesy of Wikimedia Commons.
Dr Grady cites specific examples of treatments that result in harm, with adverse effects outweighing the benefits. The first example is synthetic "monster" hormone therapy used by the mainstream medical system, found to cause cancer and heart disease in the famous 2002 Women's Health Initiative study. (4) It seems incredible, but true. The mainstream medical system used Synthetic "monster" hormones for years until the WHI (Women's Health Initiative) study finally convinced millions of women to switch to safer and more effective bioidentical human hormones. My previous articles on the safety and importance of bioidentical hormones discusses this at length.(5)(6)
Dr Grady's second example is the discredited practice of arthroscopic surgery for osteoarthritis. Millions of these useless procedures were performed in the late 90's until it was abandoned after randomized trials showed no benefit.(7) My previous article on the placebo effect discussed this.(8)
A Fourth example is screening mammography. "The adverse effects of mammography--false-positive findings, biopsies, anxiety, and over-diagnosis and treatment of latent cancers may overwhelm the benefit." (11) My previous articles on screening mammography discuss this.(12)
Dr Grady's final example is the over-use and misuse of antacid drugs called proton pump inhibitors (PPI's), which have serious adverse effects of increased rates of fractures, Clostridium difficile infection, and increased risk of pneumonia. (13-18) I discussed the harms and benefits of acid blocker drugs in a previous article.(19)
Reducing Medical Care Opposed as "Rationing"
Dr Grady reminds us that the term "rationing" is frequently misused and abused in health care debates. In politics, those who want more health care oppose those who propose less health care. Less health care is called "rationing", a term originating in the wartime practice of rationing food, fuel and other scarce goods, and services, and may not apply to over use of health services which causes harm rather than benefit.
A False Hope - Bone Marrow Transplantation for Breast Cancer
A perfect example of misuse of the term "rationing' is the discredited bone marrow transplantation for breast cancer. Starting in the 1980's, thousands of procedures were done costing up to 400,000 dollars each. While many women stricken with advanced illness clamored for the "lifesaving" procedure, their health insurance companies balked at paying for an experimental and unproven treatment. A media and legal campaign ensued claiming the insurance companies were cruel tyrants withholding or "rationing" a "lifesaving" treatment. After a couple of decades of harming thousands of severely ill women, medical studies were eventually done, and these showed the procedure had no merit, causing it to be discredited and abandoned. This incredible story can be found in an article by Nicholas Gonzalez MD, and the book, False Hope. (20-22)
The Solution: Less Health Care
When the health care system is dominated and corrupted by huge corporations that place profit over people, the end result is a health care system that produces more harm than good. Hence, the sage old doctor's advice, Doing Nothing, is frequently the best treatment plan, and the title for the first novel written by my medical school advisor, Dr Neil Kurtzman.(23)
Links and References
Less Is More, How Less Health Care Can Result in Better Health
Deborah Grady, MD, MPH; Rita F. Redberg, MD, MSc, Editor
Arch Intern Med. 2010;170(9):749-750.
Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending, part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288-298.