March 15, 2010

MEDICINE ISN'T ABOUT HEALTH...:

The medicalization of life: At both birth and death, the phrase "Do everything possible" is increasingly incompatible with a good life. (H. Gilbert Welch, March 15, 2010, LA Times)

Consider this. Two of the most common tests preformed on pregnant American women are obstetrical ultrasound and electronic fetal monitoring. After reviewing experimental studies involving more than 27,000 women, the Cochrane Review -- an independent, international collaboration that summarizes evidence for medical procedures -- found that routine late-pregnancy ultrasound "does not confer benefit on mother or baby."

But it does do a good job of scaring expectant parents. Among other things, it finds minor anatomical abnormalities (like "bright spots" in the heart or intestine) that have been associated with feared genetic disorders such as Down syndrome. Less than half of maternal-fetal medicine specialists reported using the test to screen for these disorders in 2001; now almost all do. The problem is that the minor anatomical abnormalities are about 30 times more common than the genetic disorders they have been associated with.

That means most parents who are told after an ultrasound that their child might have serious problems are told so needlessly. Not surprisingly, this leads to a lot of unnecessary heartache and extra testing. This has led one of the founders of the technology to write that its routine use has crossed the line and now causes "more harm than good." [...]

There is even more medical care at the end of life. Although most Americans say they would like to die at home, the most common place of death is still the hospital.

A hospital is not a peaceful place. The prevailing paradigm is intervention, not comfort. Nowhere is this more true than in intensive care units. They tend to be busy, noisy, frenetic and frightening places. There are lots of monitoring devices, which lead to lots of uncomfortable procedures. The ICU is not a good place to die.

Yet they are being used more and more for this purpose. Between 1995 and 2005, Dartmouth Atlas data show a 25% increase in the proportion of Medicare patients spending time in the ICU during their last six months of life. The average number of days spent in the ICU went up even more -- by 43%.

Furthermore, a startling number of doctors can be involved with care at the end of life. A third of Medicare patients cared for by "America's Best Hospitals" (as designated by U.S. News & World Report) were seen by 10 or more physicians during their last six months of life. That's right, 10 or more. It's hard to imagine how that can ever be good. These may be our best hospitals, but they are certainly not our best deaths.


...it's just another consumer good, but one where we aren't forced to shop, like consumers should.

Posted by Orrin Judd at March 15, 2010 6:20 AM
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