Consider the tales of two women with breast cancer, described in How We Do Harm, (Brawley, St. Martin’s Press 2012):
- Edna reports to an emergency room after her breast has fallen off entirely. She had health insurance until her employer raised the cost and she couldn’t afford it any more.
- Helen finds a lump in her breast and uses her generous insurance plan to get the very best surgeons and doctors. The Cadillac of care – including treatments that had no evidence of success but had severe side effects – nearly kills her.
Two terrible – and terribly common – examples of how the U.S. health system under-serves and over-serves, Brawley argues. As an oncologist and researcher, he can make a credible case.
The book exposes the medical profession’s self-interest and the many ways that it shows itself. I do not think that most doctors are deliberately profit-mongering. However, I do believe that many are blind to the downside of over-treatment, or of treatment that has weak evidence of success. They believe in what they are doing. The profit is a pleasant side effect.
This book does not specifically argue for central planning, but it does show that having an objective view is difficult (or nearly impossible) when the only input comes from the doctor providing the service and the patient receiving it. Americans hate the idea of some cold bureau deciding that a treatment is not worthwhile. Brawley’s book shows that warm-blooded decisions – clouded by the medical professional’s profit motive and by the patient’s fear — often lead to worse outcomes.
We will never get to any sort of central planning or even central recommendations in the U.S. Somehow, a science-based recommendation from an objective source is regarded with suspicion. After reading Brawley’s book, you may regard your doctor’s recommendation differently: his or her recommendation may not be based upon science. It could be based on how two or three patients have fared, or it could be based upon the results of your “wallet biopsy” – that is, whether your insurance will pay for the care. Yet Americans prefer this to the more dispassionate view, the one that is more likely to lead to more health for less money.
“The [U.S. health care] system is not failing. It’s functioning exactly as designed. It’s designed to run up health-care costs.”
This is my favorite line of the book, disheartening as it is. I hope more and more people will come to value the science and put the politics into perspective. With more scientists like Brawley writing excellent books, I have strengthened my hope.