“Money and Medicine” Medical Waste and Overtreatment
May 02, 2015
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By Dr. Mercola
America spends more per capita on health care than any other developed nation, yet health outcomes are among the worst.
Despite sizeable health care expenditures, Americans are among the sickest citizens of the developed world, ranking only 50th worldwide for life expectancy. Americans also rank near the bottom for everything from infant mortality to obesity, heart disease, and disability.1
US health care costs are driven through the roof by inefficient delivery of care, excessive administrative costs, fraud, and a mountain of medical waste, as well as a fragmented insurance system that lacks any standardized price setting mechanism.
If something isn’t done about our out-of-control health care costs, there’s a real danger they may bankrupt this country.
Filmmaker Roger Weisberg takes on these issues in the PBS program “Money and Medicine.” In his feature, he interviews several physicians and health care administrators who seek to reform a very broken health care system.
When It Comes to Medical Care, More Is Definitely NOT Better
Americans are receiving—and paying for—an enormous amount of unnecessary medical treatment.
According to a report by the Institute of Medicine, approximately 30 percent of all medical procedures, tests, and medications may in fact be unnecessary, at a cost of more than $750 billion a year.2 The worst part is that gross overtreatment is making Americans sicker, rather than healthier.
When you consider drug reactions and unnecessary interventions that typically come with multiple side effects, as well as the financial and emotional stress involved with medical treatment, there is more likely an inverse relationship between money spent on health care and wellness.
An approach that tends to be underutilized today is “watchful waiting.”
In many situations, your body is capable of healing itself when treated with lifestyle modifications like diet, exercise, sleep and movement. Many patients will opt for a more moderate approach if their physician presents the option.
Intermountain Health Care in Utah is an excellent example of how the game can be changed. The hospital has reduced its surgical rates by 40 to 60 percent by simply giving patients a choice between having surgery and taking a more “watchful waiting” approach—with no worsening of outcomes.
Interestingly, this rate is about the same as that shown by physicians themselves when they make similar medical decisions for their own families.
Medical Care Is the Third Leading Cause of Death in the US
When you add up medical errors, drug interactions, and hospital-acquired infections, medical care is the third leading cause of death in the US, right after heart disease and cancer. Preventable medical mistakes account for one-sixth of all American deaths.
According to the latest estimates, 210,000 to 440,000 Americans die from egregious hospital errors each year, with hospitals that cater primarily to Medicare patients tending to rank the worst. Types of errors include the following:
Treating the wrong patient: Can lead to wrong medications or even wrong surgeries—such as amputation of the wrong limb Surgical souvenirs: Surgical tools or objects left inside the patient’s body are more common than you might think Operating on the wrong body part Fake doctors: One estimate from 25 years ago is that there were more than 5,000 fake doctors in the US—and the numbers are much higher today, thanks to phony degree mills3 Hospital-acquired infections: In 2011, an estimated 722,000 patients contracted an infection during a stay in an acute care hospital in the US, and about 75,000 of them died as a result of it Wrong medical tubing: Many types of medical tubing look alike—yet they can be deadly when the wrong ones are used. Lost patients: Those with dementia or mental disorders can wander off and fall victim to many hazards Waking up during surgery Waiting too long in the ER: Excessive waiting for medical care costs many their lives each year4 Air bubbles in the blood: After removal of a chest tube, if the hole isn’t sealed correctly, air can enter and cut off blood to your lungs, heart, or brain—a life-threatening event
CT Scans Expose You to Massive Radiation
The performance of more diagnostic tests and screening procedures leads to increased false positives, medical errors, and complications. One type of diagnostic test that’s grossly overused today is the CT scan. Physicians are ordering CTs for even the mildest of head injuries that could be evaluated effectively with a simple hands-on exam. Of course, no one wants to miss a brain bleed, but the vast majority of scans add no meaningful information to the physical exam.
Then why are so many being done? Many physicians are practicing defense medicine. Today’s legal climate has them so concerned about being sued over missing that “one in a thousand brain bleed” that they’re ordering scans for nearly everyone who bumps their head.
But CT scans introduce their own measure of risk—just one CT exposes you to the radiation equivalent of 200 to 500 chest x-rays. This is very concerning in light of the estimate that tens of thousands of cancer deaths each year result from excessive exposure to ionizing medical radiation. The radiation from just two or three scans triples your child’s risk for developing brain cancer later in life. I’m not saying that CT scans should never be done, but they should be used judiciously, when truly medically indicated.
Mammogram Screenings Are Riddled with False Positives
Thirty-nine million American women get mammograms each year. Over their lifetimes, one in eight women will receive a breast cancer diagnosis, but FOUR of the eight will have at least one false positive within a decade.
Unfortunately, working up false positives sometimes kills people. Studies show that the incidence of mammography actually saving women’s lives is extremely low—and routine screenings may actually be harmful. When you get a false positive, your physician will feel compelled to steer you toward a series of unnecessary medical interventions that may result in physical and psychological suffering, financial strain, and even cancer. False positives can result in the loss of a breast or even death, in rare cases. A cancer diagnosis may also interfere with your eligibility for medical insurance.
Prostate Cancer Screenings Are Essentially Meaningless
The US spends $10 billion per year treating prostate cancer. Last year, 218,000 men were diagnosed and 32,000 died of the disease. However, the 30 million men who get screened annually for prostate cancer are put at risk due to the ridiculously high numbers of false positives. More than half of older men have pathologic evidence of prostate cancer. Therefore, PSA screening makes little sense, which explains why it’s shown to have barely any impact on mortality rates.
According to Stanford University researchers, the PSA test indicates nothing more than the size of your prostate gland. According to Dr. Gilbert Welch, professor at Dartmouth Medical School: “Prostate cancer screening is the poster child for overdiagnosis.”
A great deal of harm results from unnecessary prostate treatments after false positive PSA tests. Estimates are that 15 prostates must be removed in order to prevent just one prostate cancer death, and these surgical procedures carry serious side effects including impotence and incontinence. There are presently no good comparative studies to indicate which treatments produce the best outcomes, so a physician’s own personal preference and habits are what typically dictate his recommendations, rather than science.
Cesarean Sections: Low Risk for Docs, High Risk for Moms
Cesarean sections have become the most common surgery in the US today, accounting for nearly one-third of all births. In 1965, C-sections represented a mere 4.5 percent of all births. Sadly, Cesareans have become almost “fashionable” to some women, especially those of higher socioeconomic status who are scheduling them for no reason other than convenience—referred to by the media as the “too posh to push” crowd.5 Surgical births are very physician-friendly, as they are more easily scheduled during normal business hours. They are more predictable and much faster than vaginal deliveries, plus less likely to end in a lawsuit, minimizing the risk—the risk to your doctor, that is.
A study in the British Medical Journal6 found that a woman's risk of death during delivery is three to five times higher during Cesarean section than vaginal delivery due to complications from blood clots, infection, and anesthesia. There are wide variations in Cesarean rates across the country, but the national rate is about 34 percent. The World Health Organization (WHO) states that no country should have a Cesarean rate greater than 10 to 15 percent.
Some hospitals are taking active measures to reduce their Cesarean rates, such as Intermountain Healthcare in Utah, which has reduced their rate to 20 percent by implementing a team-based approach to patient care. Intermountain Chief Quality Officer Dr. Brent James said that a massive decrease in elective inductions has saved the residents of Utah $50 million per year in medical costs. He estimates that if hospitals across the country would do the same, it could save the US $3.5 billion annually.
The Cost of Chasing Miracles
Another area of health care that deserves a good, long look is end of life care. Medical breakthroughs have led to a near doubling of the human lifespan over the last century, from 47 years in 1900 to nearly 80 years today.7 According to one study, 30 percent of all Medicare expenditures are attributed to the five percent who die that year, with one-third of that cost occurring in the final month of life.8 But just because we can extend life, where is the line between promoting life and prolonging death? Unfortunately, this is a difficult question to answer.
Intensive care units (ICUs) were originally designed to help critically ill people recover. However, increasing numbers of beds are now occupied by patients on life support, with a growing percentage for whom medical science offers no hope of recovery. If a physician were to offer your loved one an operation that had only a one in a million chance of success, if you’re like most Americans, you’d probably consent to the procedure... we’re all about hope.
However, the harsh reality is that chasing end of life miracles can lead to dying patients being hooked up to feeding tubes and ventilators indefinitely and put through agonizing therapies long after all reasonable hope is gone. Most would probably agree that this is no way to die. Yet, many family members understandably cling to the tiniest measure of hope and when faced with end of life decisions, feel like terminating life support is the equivalent of performing a “medical execution” or euthanasia.
In the featured program, one ER physician says, “Our current system propagates the idea that we can stave off death indefinitely.” Perhaps for many of these patients, we should begin shifting our focus away from high-tech medical interventions and more toward palliative care. Studies are showing that palliative care, especially when begun early, is of greater benefit to terminal patients—for longevity AND quality of life. Besides, miracles are just as likely to happen without as many drugs and pumps and tubes—and probably even more so.
A study in the New England Journal of Medicine9,10 found that cancer patients who received early palliative care and fewer oncology treatments lived longer and showed significant improvements in both quality of life and mood. Another study11 found that the less money spent in the final month of life, the better the patient’s death experience. Not only does palliative care improve patients’ final days, but limiting medical interventions to when they are actually appropriate promises to lessen the financial burden on our already-stretched health care system.
Avoiding Unnecessary Medical Care Can Save Your Life
One of the reasons I’m so passionate about sharing the information on this site about healthy eating, exercise, and stress management is because it can help you stay OUT of the hospital. But if you do require a hospitalization, you can minimize your risk by knowing how to play the game. My primary recommendation is to avoid hospitals unless it's an absolute emergency and you need life-saving medical attention. In such cases, it's advisable to bring a personal advocate—a relative or friend who can speak up for you and ensure you're given proper care if you can't do so yourself. Dr Saul reviews this in far greater detail in my interview with him.
If you're undergoing an elective procedure, remember that this gives you greater leverage and personal choice—be sure to use it! Many believe training hospitals will provide them with the latest and greatest care, but they may actually be more dangerous. You may wish to avoid elective surgeries and procedures during the month of July because this is when brand new residents begin their training. According to a 2010 report in the Journal of General Internal Medicine,12 lethal medication errors consistently spike by about 10 percent each July, particularly in teaching hospitals, due to the inexperience of new residents. Also be cautious of weekends.
Keeping yourself healthy by making wise lifestyle choices is the best way to reduce your need for medical care in the first place, and one of the best strategies is to optimize your diet. You can get up to speed on this by reviewing my comprehensive Nutrition Plan. Additionally, knowing what to do to make your hospital stay as safe as possible is equally important, in the event that you are hospitalized. Understand that you, the patient, are the most powerful entity within the entire hospital system. However, the system works on the assumption that the patient will not claim that power. Knowing your rights and responsibilities can help ensure your hospital stay is a safe and healing one.
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