The Treatment Trap
“In debates over health-care reform, a missing element has been the failure to confront the over-use of medical care. Politicians and the health-care establishment don’t want to talk about it. One person’s overuse is another person’s payment for college tuition or a mortgage on a McMansion.”
Two people who are talking about it are authors Rosemary Gibson and Janardan Prasad Singh. The name of their book is The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It. Gibson and Singh cite medical research and share insights gleaned from doctors, nurses, hospital CEO’s, patients and their families.
“Health care insiders confirm that medical care that doesn’t make people better has become more prevalent in the past decade…A seasoned nurse observes, ‘Health insurance used to be about giving people access to health care. Now it’s about giving providers access to patients.’ The former CEO of Johns Hopkins Health System, Dr. James Block, says about over-use, ‘My God, there’s so much of it, you see it everywhere.’”
“In November 2008, the National Quality Forum, a Washington, D.C.-based nonprofit organization, released a list of prescription drugs, lab tests, diagnostic tests, and surgeries that are overused. The list includes antibiotics, x-rays, cardiac CT scans, heart bypass surgery, back surgery, knee and hip replacement, prostatectomy, angioplasty and hysterectomy.”
“Dr. James Weinstein, director for the Institute for Health Policy and Clinical Practice at the Dartmouth Medical School, calls overuse an epidemic…One doctor calls it ‘the green monster.’ It lurks in every crevice of the system; its appetite is voracious, and it is obese…It wants to keep you in the dark—it doesn’t want you to know that so much of medicine is guesswork. Under the guise of benevolence, it wants to sell just about anything to an unsuspecting public even if it doesn’t help and may possibly harm. Its greatest enemy is truth.”
“In 1976, a House Subcommittee on Oversight and Investigations heard evidence and concluded that 2.4 million unnecessary surgeries were performed annually, resulting 11,900 deaths. The annual cost of these surgeries was estimated at $3.9 billion. Since 1976, no new estimate of overuse has been calculated.”
“The term ‘over-use’ was first coined in 1991 by Dr. Mark Chassin, a physician and researcher; and now president of the Joint Commission, the Chicago-based organization that accredits and certifies sixteen thousand health-care organizations. In an article in the Journal of the American Medical Association, he defined it as providing a treatment when its risk of harm exceeded its potential benefit.”
An anesthesiologist tells the story of “Mr. Goode,” an elderly patient in surgery for a total knee replacement. The surgeon on the case replaced the anesthesiologist with a different one. After the surgery, the patient was back in surgery in dire condition. The anesthesiologist read the patient’s chart and saw that his EKG suggested significant coronary disease. In talking with the patient, the anesthesiologist found that his symptoms were suggestive, not of arthritis but, of poor blood flow to his legs. He realized that the surgeon had replaced him as anesthesiologist, on the case, because the surgeon knew he would have stopped the surgery. “Mr. Goode” died later that day. When the anesthesiologist complained to his superior, the chief of anesthesiology said, “No one important dies.”
A doctor who practices medicine on the east coast has this to say: “It’s a bit graphic, but over-use is like the nature programs on PBS television. When the tigers or lions kill their prey, all kinds of creatures come to share in the feast. This is what happens to patients. I see it every day. When a doctor admits a patient to the hospital, he might call in six, eight, or ten consultants. Each one bills the patient. No one questions whether the procedure or whatever the consulting doctors do benefits the patient. It’s a feeding frenzy.”
“He continues: ‘Not far from here a group of doctors refer patient to each other. They do all sorts of things to them, and give each other kickbacks. The patients think it is good care, but they don’t know enough to know otherwise. It’s not good care. It’s exploitation. It’s assault and battery. It happens every day in doctors’ offices. The government allows the doctors to be crooks. It’s a form of organized crime and no one does anything about it.’”
“Overuse increases the cost of health care for everyone and causes health insurance premiums to skyrocket. Millions of people are denied entry to the health-care pasture because they cannot afford the price to enter. If unnecessary grazing were curtailed, more people could enter the pasture to receive the care they need.”
 Gibson, Rosemary and Janardan Prasad Singh. The Treatment Trap: How the Overuse of Medical Care is Wrecking Your Health and What You Can Do to Prevent It. Chicago: Ivan R. Dee, 2010.