The medical myth of more is better
Monday, August 24, 2009
A doctor who's in the thick of the current health-care debate made a crucial point when he told me that the real issue shouldn't be limited to medical insurance reform rather an entire medical-care reform. It's been rightly said that the most expensive technology in American medicine is the doctor's pen, because with a flourish of the hand he can order an unnecessary test or surgery. Some kind of insurer must pay for that, so simply providing more coverage will not bring health care costs to economically sustainable levels, nor will it ensure better health to society.
It's estimated that 2.5 million unnecessary surgeries are performed each year, with hysterectomies, heart bypass grafts, lower back surgery, and angioplasty leading the list. Just two procedures alone, coronary artery bypass grafting (CABG) — known in the trade as cabbage — and balloon angioplasty cost $100 billion annually. With long waiting lists for CABG, you'd think it was vital for prolonging the lifespan of heart patients, but that's a mistake. Current statistics suggest that about 3% of bypass surgeries extend life expectancy, with angioplasty scoring even lower at zero percent.
On all sides the "more is better" cult cripples and bankrupts the American health-care system. If you pay your doctor a visit tomorrow, you have a 43 percent chance of being given an unnecessary test. Stress-related chest pains that are muscular in origin can still wind up leading to a battery of expensive cardiac tests, including risky catheterization. If you have a cold or flu, there's a 73 percent chance that you will be prescribed an antibiotic, which is useless against viruses, including cold and flu viruses, but which carry risks of allergic reactions and other side effects, not to mention weakening of the immune system.
The U.S. ranks 37th in overall health system performance in the world by the WHO while paying far and away the biggest bill. What we need is not more unnecessary tests, which cost an estimated $700 billion dollars a year, but more intelligence. The Obama administration has rightly focused on the three main points of reform:
1. Provide coverage for the 47 million citizens who don't have insurance. Their health care is being paid for through public funds when the final bill comes due — no one gets treated for free — so it's absurd to hide the cost when it can be borne by those who need the care and have a duty to pay for it.
2. Provide a public option so that private insurers don't have the profits game entirely to themselves. Not only will a public option be cheaper, but it starts to remove the cutthroat profit motive in health care insurance to a more sensible and ethical motive of improving people's health and wellbeing.
3. Bring down medical costs, which involves two main fronts of attack. First, stop the "more is better" ethic (or rather, lack of ethics) that is tied to doctors' profit motive. Second, bring malpractice coverage and lawsuits into line with reality, since many medical tests are motivated by physicians protecting themselves rather than protecting the patient's health.
A great deal of fear and misinformation has been stirred up recently about end of life care in regards to health care reform. From my experience as a physician, efforts to extend life indefinitely through resuscitation and respirators usually only extends the patient's suffering and extends the hospital bill thousands of dollars a day. While there are important exceptions, nevertheless it is vital that patients have the opportunity to discuss and make these critical decisions for themselves before they are incapacitated and force their families into a decision fraught with guilt and uncertainty.
Anyone who wants to delve into the truly dismal state of health-care economics has a wealth of sources at hand. Read the excellent articles now online at The Atlantic and The New Yorker magazines for starters. You will quickly realize that this isn't an issue where the already insured are altruistically passing reform to benefit "them," the incapacitated elderly, the chronically ill, and the under-insured, all of whom have the smallest voice in Congress where health-care lobbyists actually outnumber members of Congress six to one. We have arrived at a generational crossroads where wasteful, inefficient medicine meets an aging population. We must make it through to the other side as a whole nation.
Otherwise, consider what looms ahead. The present generation of young children might become the first to live shorter lives than their parents thanks to runaway childhood obesity and lack of exercise. Fast foods continue to zoom in popularity, and sodas and sugary drinks are the main source of calories in the American diet. Health-care costs could cripple American industry by amounting to 50% of overhead by mid-century. Even if those dire possibilities don't faze you, consider one of President Obama's most basic points: Compared to other countries, the richest nation in the world is paying more for less when it comes to health care. That alone is reason enough to quash the myth of "more is better" right now, while we have the best chance of real reform.
Deepak Chopra is the author of over 50 books on health, success, relationships and spirituality, including his most recent novel, "Jesus: A Story of Enlightenment," available now at www.deepakchopra.com. To follow him on Twitter, go to www.twitter.com/Deepak_Chopra.http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2009/08/24/chopra082409.DTL Related Links to cited Articles Above ~
How your neighbor can make you fat (or thin)
Monday, September 21, 2009
A new field of sociology is studying "social contagion," a deeply mysterious phenomenon that could change everything we think about our behavior. We all experience how fads and trends work. Out of the blue, everybody seems to be doing something new, whether it's texting, fleeing My Space for Facebook, or playing a new video game. Fads are contagious behavior. You catch them from other people. Yet no one knows how behavior goes viral. What makes a group of people all decide to act the same way?
This becomes a crucial medical question if you want a group to stop doing something harmful — getting young people not to smoke, for example, or persuading a whole population to stop getting obese. The most advanced work on this question has come from two researchers at Harvard, Nicholas Christakis and James Fowler, whose new book, Connected, was previewed in a recent New York Times Sunday magazine article. Christakis and Fowler analyzed data from the nation's biggest heart study, which has followed three generations of citizens in Framingham, Mass. They looked into the behavior of over 5,000 people who were mapped into 51,000 social connections with family, friends, and co-workers.
Their first discovery was that when someone gains weight, starts smoking, or gets sick, close family members and friends are around 50% more likely to behave the same way. This reinforces a social-science principle that is decades old: behavior runs in groups. We have all experienced it as peer pressure, or by knowing families where everyone seems to be overweight or a smoker. The reverse is also true. If you run with a healthy crowd, you are more likely to adopt healthy behavior yourself. Not just health is involved; almost any behavior can be contagious. In a dorm at college, if you happen to room with someone with good study habits and high grades, your grades are likely to improve by association.
But the second finding from Christakis and Fowler was far more mysterious. They found that social connections can skip a link. If person A is obese and knows person B who isn't, a friend of person B is still 20% more likely to be obese, and a friend of that friend is 10% more likely. This "three degrees of connection" holds good for all kinds of behavior. A friend of a friend can make you prone to smoking, unhappiness, or loneliness. The statistics are there to prove it, even though you have never met this friend of a friend.
The findings of Christakis and Fowler suggest invisible connectors that run through a whole society. If their research holds up, think about the implications. The notion of a collective unconscious was posed almost a century ago by the Swiss psychologist C. G. Jung, who also claimed that we all have a shadow side that hides in the unconscious. Did Jung hit on invisible connectors long before data came along to support him?
That's really a side question to the main one: What kind of connection can exist invisibly, without people talking to each other, watching how each other behaves, or even knowing about each other's existence?
While pondering this issue, I'd like to point out that the same questions apply to the brain. When your brain is engaged in a behavior, millions of neurons "catch" the same intention and behave in synch without visible connections. Different areas of the brain light up simultaneously. We don't see one neuron teaching another the new behavior, nor do we find a hidden telephone system that transmits the new intention — such as deciding to get out of your chair and grab a glass of orange juice — from a starting point in one part of the brain to other locations. Instead, every neuron gets on board at the same time to carry out your intention.
These are complex issues, and I'm giving only a hint of how mysterious they are. But the new research on social contagion is exciting, because it supports the notion that there is actually one mind that coordinates not just how people catch on to fads or decide to imitate each other, not just how distant brain cells know what other brain cells are doing, but far-flung phenomena like how a baby learns to speak and how twins separated by thousands of miles suddenly know what's happening to each other. These invisible connectors are showing up in many, many areas of life. Social contagion is making news because we all like to rely on data, but the possibility that we all participate in one mind challenges religion, philosophy, and the meaning of life itself.
Deepak Chopra is the author of over 50 books on health, success, relationships and spirituality, including his most recent novel, "Jesus: A Story of Enlightenment," available now at www.deepakchopra.com. To follow him on Twitter, go to www.twitter.com/Deepak_Chopra.