Map of life expectancy at birth from Global Education Project.

Monday, July 07, 2014

Les Izmore, continued

Friday's BMJ features a discussion of the Choosing Wisely campaign, which I have referenced here a couple of times. The essential question is whether we can substantially reduce wasteful medical interventions simply by moral persuasion and cultural activism, even without changing economic incentives. Author Richard Hurley says that a survey finds a majority of doctors will order unnecessary tests if a patient insists, and goes on to write "Doctors order unnecessary interventions for a multitude of other reasons, including fear of malpractice suits, to appear to be doing something rather than nothing, to try to demonstrate thoroughness, and because of how they were taught."

Oddly, he doesn't mention what would seem to be another important reason, which is they get paid to do it.

Anyway, what's more interesting about this essay is the discussion of the political background. Physicians don't generally think they have responsibility to reduce health care costs, and in the U.S., at least, the general public thinks that these efforts constitute "rationing," which is evil from the pit of hell, and that any effort not to give some form of medical test or treatment to somebody is all about death panels and murdering people to save money.

What we have so far not gotten across to enough folks is that medical tests and treatments can do harm as well as good, or just be useless. Money wasted on a useless test, drugs or surgery is money that can't be spent on something beneficial, and meanwhile people are directly harmed. But the cultural authority of medicine in the U.S., and the God-like status of physicians, prevents people from understanding or believing this. So the Choosing Wisely campaign has to go beyond targeting health care providers and effectively target the general public. Is anyone prepared to do that?

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