Critelli: The Insidious Myth That More Healthcare is Always Better Healthcare
The founder of medicine, the Greek philosopher Hippocrates, said over 2,000 years ago: “Natural forces within us are the true healers of disease.”
For many medical conditions, his observation remains correct: our immune system and other natural processes heal most conditions.
Unfortunately, too many Americans demand more intensive and aggressive care because they mistakenly believe it will give them better results.
The Dartmouth Atlas Survey, created by Dr. John Wennberg and based on decades of research on Medicare and Medicaid spending, demonstrates that, despite huge differences in healthcare spending among medically comparable populations, more intensive care often produces no better outcomes and sometimes worse ones. Why?
Cumulative radiation exposure
When any of us get X-rays, CT scans and other diagnostic tests, which expose us to radiation, there are clearly adverse health risks from excessive radiation exposure from excessive testing or badly administered tests. Over a lifetime, the average patient getting radiation-emitting diagnostic tests from competent health care professionals using good diagnostic equipment is not at increased cancer risk, but getting excessive diagnostic testing increases risk because radiation effects are long-term and cumulative.
Excess use of drugs
Many different kinds of risks are associated with the excessive use of prescription drugs. Taking too many antibiotics or taking more expensive and powerful antibiotics unnecessarily increases the risk of creating antibiotic resistant bacteria called “superbugs”, such as the MRSA bacteria. Individual hospitals try to manage this risk through antibiotic stewardship, but patients who have received excessive prescriptions for antibiotics or have failed to adhere to their prescriptions bring those “superbugs” with them into the hospital.
Getting too many prescriptions leads to greater risk of adverse drug interactions. Many Americans individually seek out specialists on their own and end up with multiple and incompatible prescriptions.
Getting too many prescriptions of progressively more powerful pain killer drugs can also lead to addiction to these drugs.
Aggressive cancer treatments
During the health care debate in 2009-2010, President Obama often cited the case of Americans like his late grandmother who deserved affordable access to the most cutting-edge cancer treatments. But are such treatments always better for the patient?
Surprisingly, as Dr. Atul Guwande of Harvard Medical School pointed out in the August 2, 2010, issue of The New Yorker, there are many cases in which receiving aggressive cancer care actually has a statistical probability of shortening life, compared with palliative care. Beyond that, a patient receiving aggressive end-of-life care is in excruciating pain and has severe difficulty with breathing and other bodily functions, compared with patients receiving palliative care.
Mental health and substance abuse treatment
Many people with substance abuse problems assume that the most expensive residential programs insure the best outcomes. As we learned at Pitney Bowes with our mental health and substance abuse programs, the “best” health care choice for many people with substance abuse programs may not be the most aggressive and expensive. Some people benefit more from less intensive outpatient programs or from medications, when removing themselves from the substance abuse problem’s source.
One cause of differential health care spending is the frequency with which populations receive surgical care for certain conditions, such as back-related problems. Miami, Florida, residents are many times as likely to get surgery for back problems as Des Moines, Iowa residents. Over a population, more frequent surgeries do not resolve back problems, but surgical interventions create increased risk from hospital-acquired infections, surgical errors, or post-operative complications.
Prostate cancer treatment options range from low-cost watchful waiting or prevention-based strategies like the Dr. Dean Ornish program to high-cost laser-based or surgical alternatives. There is no definitively ‘best’ treatment, but a set of imperfect choices based on an inherent inability to predict the disease’s probable course. Cost differences between the least and most expensive treatments are over 10 times, but surgery and the other more expensive treatments have greater potential negative side effects.
Expensive, aggressive treatments are often superior to other alternatives, but, too often, we confuse expensive and aggressive treatments with effective ones. No treatment path is risk-free, and every treatment carries the risk of flawed execution by the physician or the patient, which creates new and sometimes greater risks.
Comprehensive, lifelong, patient-controlled personal health records are valuable tools to enable healthcare consumers to receive the most appropriate care. They can track cumulative radiation levels, alert patients to excessive antibiotic usage or to adverse drug interactions, provide valuable patient decision support tools for mental health, cancer, or other disease treatment alternatives.
The ultimate goal is to enable consumers to secure optimal health and health care at the lowest cost, but, to do that, we must demolish the myth that more care is better care. We must do so if we are to “bend the healthcare cost curve.”
Michael J. Critelli, is the chief executive officer and President of Dossia, a personal health records company. He has held that position since January, 2011. Critelli is the retired executive Chairman of Pitney Bowes Inc., a provider of global mailstream solutions. Mr. Critelli served as Pitney Bowes Chairman and Chief Executive Officer from 1997 to 2007 and as Executive Chairman from 2007 to 2008.