Sunday, November 22, 2009

Healthcare Reform


A few evenings ago I listened to a thoughtful National Public Radio guest who suggested “inappropriate healthcare” as a place to save dollars. I believe such efforts are worthy, certainly not new, and unlikely to significantly change healthcare cost trends.

Yet the words “inappropriate healthcare” struck me. Have I been part of the “inappropriate healthcare” that he referred to? Every day in my medical practice I would see at least one cancer patient whose disease had not been significantly helped by the chemotherapy drugs that I had prescribed. Every day I would also see at least one patient who had been cured by their chemotherapy. We often celebrated with patients who had been helped by chemotherapy despite poor odds.

Even in hindsight, I have difficulty defining when I rendered inappropriate care. A few times in my career a patient or their family sought a new physician because I had stressed (as compassionately as I could) that in my opinion chemotherapy treatment in their situation would likely cause more harm than good. What if this patient was one whose cancer would have responded against great odds? Did this make my advice inappropriate? What if the next physician decided to treat them and the patient was just made sicker by tens of thousands of dollars of drugs that did not work?

By addressing these complex aspects of care I do not mean to say that efforts to evaluate the appropriateness of care should not continue. However, I doubt that these are the most germane questions to ask.

The succinct adage - ‘garbage in, garbage out’ - quickly reminds one that a computer does not fix faulty data. Such a reminder helps focus efforts where they really count, since even the most elegant analysis of bogus data is a waste of time.

Our current medical model could use such a pithy slogan to focus our efforts more effectively.

Billions of dollars of junk food in, trillions of dollars of pills and surgery to chronically maintain the junk out’ is hardly pithy, but it accurately fits our healthcare reality. And like ‘garbage in, garbage out’, it should focus our efforts where they belong - avoiding the ‘garbage in’ in the first place.

Hypertension, heart disease, and diabetes are only a few of the ‘junk in, disease out’ illnesses that plague us. More studies won’t make it any more obvious that our high fat, high salt, high sugar, and non-nutritious diets make us obese and then kill us. Largely ignoring junk food in the healthcare equation has resulted in millions of Americans dying prematurely and trillions of wasted healthcare dollars.

I sometimes quiz audiences about this ‘junk in, illness out’ perspective. I’ll ask them to raise their hands if they think they eat more junk food than they should. Most people giggle a bit and then sheepishly raise their hands.  I then follow this question by asking them if they also put diesel fuel in the tank of their gasoline-powered car.

In an instant the audience gets a glimpse of the depth of the delusion supporting our junk food habit. It becomes clear, if we were as smart with our bodies as we are with our cars, we could be much healthier.

To paraphrase Clinton’s message on the economy - as far as spiraling healthcare costs are concerned, - ‘it’s the food, stupid’.

No comments:

Post a Comment