Re: The future of medicine

a_weisman_at_yahoo.com
Date: 03/10/05 

Date: 10 Mar 2005 07:14:06 -0800

pmerv@direcway.com wrote:
> >From USA Today
> The country needs to train 3,000 to 10,000 more physicians a year -
> up from the current 25,000 - to meet the growing medical needs of an
> aging, wealthy nation, the studies say. Because it takes 10 years to
> train a doctor, the nation will have a shortage of 85,000 to 200,000
> doctors in 2020 unless action is taken soon.

Since doctors cause so many deaths (the figure of 100,000 is widely
considered too low), one might be concerned that MORE doctors will mean
MORE preventible deaths and MORE medical mistakes.

I haven't ever seen the evidence based medicine study that really needs
to be done.

That study would weigh the costs and benefits of medical interventions.

For all the medical mistakes, deaths, mortality and morbidity that they
cause through error, medication reactions etc., how much good do they
actually do?

For every health care dollar spent, how much additional benefit is
gained if any.

The only analysis that I ever saw went like this:

Out of 100 patients, 90 are either going to get better on their own OR
there is no benefit from medical intervention, their condition is not
responsive (medical intervention may even make things worse).

Out of the remaining ten patients, doctors harm more than they help.

Conclusion: medical intervention is more likely to do harm than to
help.

Conclusion: we'd all be better off without medical intervention.

Further more nuanced conclusion: doctors should concentrate on doing
ONLY the things where their interventions are more likely to help than
harm, So for example, trauma care actually saves lives which without
the trauma care might well not be saved. So doctors SHOULD provide
trauma care. But most areas of medicine? Well maybe they should
consider doing no harm as their hypocritical oaths require.

I really think that this is the first and most important evidence based
medicine study that needs to be done. On the macro level, is there
evidence that doctors, hospital, medical intervention, actually do more
good than harm? If not, let's rethink things in a very fundamental way
and concentrate on identifying the areas where doctors hospitals and
medical intervention make a positive difference and those where it
doesn't and concentrate on the ones where it helps and severely limit
those where it hurts.

Seems logical?

Also, let's consider what we're getting for our health care dollars. If
for each additional dollar we are facing diminishing marginal returns
(defined here: diminishing marginal returns Definition
http://www.investorwords.com/1440/diminishing_marginal_returns.html

and here:

diminishing returns: Definition and Much More From Answers.com
http://www.answers.com/topic/diminishing-returns )

Then maybe we should stop spending money when the marginal benefit is
truly marginal-or maybe even producing negative returns. More is not
necessarily better. Less might well turn out to be more.

Just a thought.

Relevant Pages

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