Evidence Based Health Care

[vdansk]

There's a really annoying trend in medicine called "Evidence Based". Annoying, because it makes us look at results rather than common sense. Annoying, because it proves that common sense is sometimes wrong.

Take prostate cancer screening. It turns out that men screened for prostate cancer have no decrease in mortality, but a big increase in incidence of impotence or incontinence from more aggressive treatment. It doesn't make sense--shouldn't finding cancer earlier save lives?--but it's true.

I've been thinking lately about this as it applies to the whole HealthCare reform debate. Will HealthCare reform save lives? Common sense says yes; just like with prostate screening, I can say that some people will live because of it who would have died. What I don't know is if, again like prostate screening, some people will die who would have lived. Will infant mortality go down? Hooray! Will standard of care in some disease states slip, as it has in Canada? Boo! But how will it all work out in the long run? We won't know until after it happens.

Certainly, people are now dying who could be saved by available treatments. Some of them have insurance, which just refuses to cover the measure that could save them.

Looking at the mess that Insurance Companies have made of everything, I am, with trepidation, reversing my stand on the Public Option. Let's face it...the government can't do worse than Cigna.

Comments

[warriorbard63.livejournal.com]

If the Insurance Companies don't want a Public Option out there, all they'd have to do is eliminate their insane restrictions, cover everybody equally and with no prior condition exclusions and lower their prices. If they all did that, we wouldn't be talking about any kind of reform. Sadly, there's virtually no such thing as a good corporate citizen in this industry. It's true of most things...it's the irresponsibility and greed of the corporations that have made government intervention necessary. In a perfect world, I'd be an anarchist, but that isn't possible.

And I'm also for Tort Reform to lower the cost of malpractice coverage for you docs. It's kinda sad to note that trial lawyers are the biggest lobby in DC, though, and every attempt at this has been shot down by both sides of the aisle, going back more than 20 years.

[chris-warrior.livejournal.com]

well, you know i was always for a public option. but that's cause my self-employed profession allows me tons of "free" professional massage, but no endoscopy, x-rays, or antibiotics. *wry look*

and i have a feeling i'd actually take an antibiotic right about now.

[mewsrissicat.livejournal.com]

This. Yes.

I agree that the biggest issue is that there is simply no way to tell what's actually "better". This issue is convoluted, with good and bad points to all approaches, and everyone still trying to come out on "top".

But -- I expect that the "public option" will be far less horrific, if people simply remember that (like the folks in Australia), they can pay for an alternative health care plan, or may have a better plan that is employer-provided.

[dcltdw]

The best summary I've been able to come up with is: with something run by the government, I expect there to be inefficiency due to bloat and antipathy. With a corporation, I expect there to be inefficiency due to greed and antipathy. Now, I realize I've just made the cardinal sin of reducing a sitution into a binary solution (I generally believe that that's a *terrible* way to view anything), but given those two choices, I'll take gov't any day.

Much more constructively, I don't think the point is to get it right. The point is to get it better. The old adage of "the enemy of Good Enough is Perfect" applies here.