The more we know the less we do

This has got to be a trend. Last week it was prostate cancer screening, now coronary artery bypass grafts and pills for autism. Stuff we spend a lot of money on that doesn't work, that is.

Getting a "triple bypass" is almost seen as a rite of passage for older men, and of course parents want to do something for their autistic kids so they let doctors feed them pills, although there was never really any evidence for benefit. I've spent however many years on this blog primarily arguing that the biggest problem in medicine is that we do too much, and that we could go a long way toward solving a lot of problems -- including providing universal access, having more to spend on public health, and just plain being healthier -- if we could fix that. So is it harvest time for all like-minded people?

More of the necessary research and meta-analysis is being done, to be sure. But this isn't just an issue of knowledge. The affirmative evidence was never really there to support population-based prostate cancer screening, or CABG surgery, or feeding pills to kids with autism, or COX-2 inhibitors, or rosiglitazone, or ...

Instead, we did all that stuff because of the financial incentives, with a little bit of cultural proclivity thrown in. Getting more and better evidence is important, but we still need to reorganize our health care system to properly take advantage of the evidence we do have, and to avoid wasting money and doing harm.

But it's a conversation we aren't even having. Instead we're talking about repealing Medicare and replacing it with vouchers to buy private insurance. Which is insane. Our entire political discourse these days is insane, in fact. The most basic truths are no-where to be found, and nobody -- most egregiously, not the president -- is articulating them. This is a well educated society, by the way. I'll retire to Bedlam, as they say.