Miracle Malpractice

By Kelly Hearn, AlterNet. Posted March 28, 2005.

Medical technologies are a main driver for escalating drug costs, helping put health coverage out of reach for millions of Americans. In a new book, Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises, two medical professionals explore disturbing practices and trends that lure consumers into thinking that "new" drugs and technologies are equivalent to or better than old ones.

The authors are professors at the University of Washington. Dr. Donald Patrick is a Ph.D. researcher in Health Services who has held appointments at Yale and St. Thomas' Medical School in London and has taught at the University of North Carolina. He is a member of the Institute of Medicine. Dr. Richard Deyo received the 2004 John M. Eisenberg Award for Career Achievement in Research from the Society of General Internal Medicine and is a fellow of the American College of Physicians. Dr. Deyo recently spoke to AlterNet about regulatory failures, marketing hype and the need for patient empowerment.

Kelly Hearn: You write that some people believe medical ethics, as currently structured, makes bad public policy. The argument is that huge financial outlays go to paying for medical technologies that, say, extend a single life by a week. Instead, those funds could be better spent improving needed social services or extending health insurance coverage. If Americans are to engage in this debate, what are the major considerations that need to be addressed?

Richard Deyo: I think the most fundamental thing is perhaps the hardest psychologically for people to make. We have to acknowledge that resources available for medical care are limited. They are not infinite. The problem is that individuals, physicians and patients all behave as if resources are infinite and cost is no obstacle. You hear doctors say cost shouldn't be an object. They say, "We have to do everything that might possibly benefit the patient."

The patients feel like there is no limit because insurance picks up the tab up to a million dollars, sometimes two. Now health insurance is becoming unaffordable to many people and Medicare is in trouble financially. I argue we should be trying to get the most health care for the most people as opposed to getting every last minute of life for an individual who may have a terminal illness. But words like "rationing" are taboo. We can't talk about it. It is almost as bad as being liberal in today's political debate. The truth is, if we reflect, we acknowledge that we'll have spent hundreds of thousands for one patient to prolong a week of life in an intensive care unit as opposed to spending that on other things like prenatal care and preventive services, on things that might save more lives.

Technology, you both point out, is only good to a point, that eventually it becomes a cost without a benefit. Given the American obsession with technological advances, what can be done?

More of us in the medical world need to be more honest about the limitations of technologies we are providing and realistic about what it provides. I think in many cases medical professionals, corporations and the media portray every new medical device as a breakthrough while failing to note that if a technology has benefits it is often tiny and often at the expense of side effects, complications and cost. We simply need to be more realistic about what technology offers. In many cases, if patients understood what the device does or doesn't do, they would make the kind of decisions doctors are not willing to make. They might say, "You want to prolong my life for a day for half a million dollars, that's not worth it."

You note in the book that information technology is helping in that respect by making doctors' charts and other patient information accessible and understandable to patients.

I think we need provide patients better information about what their choices are. In many cases, doctors are guilty of presenting a treatment as the only choice. In fact, there are a range of choices with benefits and costs associated with every one. If we could convey this in a concise and easy fashion, and engage patients, it would probably improve the quality of medical decisions. One way to do that is with information technology and computers. It's not the only way, but it is a good way.

Kelly Hearn is a former UPI staff writer who lives in Washington, D.C. and Latin America. His work has appeared in several U.S. publications and web sites including The Christian Science Monitor, The American Prospect and High Country News.

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