10 January 2008

Unnecessary surgery

An article in Men's Health about unnecessary surgery in the US shows how far we are from outcome-based health policy:
[In November 2006] at the American Heart Association's annual scientific sessions in Chicago, a tremor rumbled through through the McCormick Place convention center. Turns out the cause of the quake (which only cardiologists could feel) was a major new study on angioplasty, that near-miracle procedure in which a balloon-tipped catheter is used to unblock an artery. The seismic finding? Only that angioplasty is no more effective than medication for a large segment of heart-attack victims. Or, to put it in stark statistical terms, heart doctors have been performing as many as 50,000 unnecessary operations every year. Frightening, yes, but nowhere near as scary as the broader implications. When the air was suddenly let out of the angioplasty balloon, there was at least one cardiologist present in the convention center who recognized the researchers' conclusion as just another symptom of a condition he'd seen before: doctors cutting first and asking questions later. Is Your Surgeon Scamming You?, John Brant
It's disappointing that cash incentives trump ethics in such circumstances, but we could at least have policies that bias the incentives in favour of long-term positive health outcomes, rather than a profusion of invasive, often-dangerous, procedures that do nothing to benefit the average patient. Unfortunately governments tend to focus on meaningless targets whose only virtue is that they are easy to measure, such as throughput in emergency wards, ambulance response times etc. Targets like these are easily gamed, and while they are quantities that can be measured and compared, they are costly to gather and have nothing to do with the welfare of patents. Of course there would be difficulties in subordinating health policy to meaningful measures of wellbeing (such as Quality Adjusted Life Years) but if carefully designed it would I think lead to a far more successful healthcare system.

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