The Treatment Trap: How the Overuse of Medical Care Is Wrecking Your Health and What You can Do to Prevent Itby Rosemary Gibson, Janardan Prasad Singh
With health reform enacted by the Congress and signed by the President, the subject matter of The Treatment Trap is a compelling component in the national debate. Taking advantage of Rosemary Gibson's knowledge gleaned from extended experience in the field of medical care and Janardan Singh's similar knowledge but from a financial perspective, the authors explore
With health reform enacted by the Congress and signed by the President, the subject matter of The Treatment Trap is a compelling component in the national debate. Taking advantage of Rosemary Gibson's knowledge gleaned from extended experience in the field of medical care and Janardan Singh's similar knowledge but from a financial perspective, the authors explore the most neglected issue in American medicine today: the overuse of medical care, including needless surgery and other invasive procedures, out-of-control x-ray imaging, profligate testing, and other wasteful practices that have become routine among too many American doctors. Their combined reporting and analysis concentrates on the human aspects of this disturbing trend in health care, with personal experiences that reflect poorly on hospitals as well as physicians. They show how money spent for questionable and even useless care is diverting major funds that could be better used to treat patients who are genuinely sick and sometimes cannot afford the extravagant charges of the American health-care system. Their suggestions for reforming the delivery of health care, and their cautions to individual consumers about how to deal with situations they may encounter, make The Treatment Trap essential reading for medical care consumers, health-care professionals, and policymakers alike.
- Dee, Ivan R. Publisher
- Publication date:
- Product dimensions:
- 5.60(w) x 8.60(h) x 1.10(d)
Read an Excerpt
The Treatment Trap
By Rosemary Gibson
Ivan R. DeeCopyright © 2010 Rosemary Gibson
All right reserved.
Chapter OneVOICES IN THE WILDERNESS
IT WAS 1998, and the truth was coming out. In Washington, D.C., the Institute of Medicine of the National Academy of Sciences convened a prestigious group of physicians, nurses, and consumers who acknowledged a uniquely American characteristic of our healthcare system. They called the phenomenon "overuse" and said it occurs when the potential for harm of a health-care service exceeds the possible benefit.
What exactly is overuse? It happens when people have surgery even though their medical condition does not warrant it. It is the revolving door of seemingly benign yet unnecessary tests and office visits that can stir an avalanche of still more tests and procedures. It is the rendering of treatment when no evidence exists that it will yield a benefit.
The phenomenon began to be noticed in the 1970s when Dr. John Wennberg, a physician and pioneer in research on differences in health-care use among communities around the country, observed an epidemic of tonsillectomies in Vermont. His research showed that in the town of Stowe, 70 percent of the children had their tonsils removed by the time they were fifteen years old, compared with only 20 percent of children in Waterbury. Wennberg wrote, "For half a century, the tonsil has been the target of a large-scale, uncontrolled surgical experiment-tonsillectomy."
Wennberg discovered another epidemic, affecting men in Maine. Sixty percent of men who lived in certain communities had their prostates removed by the time they were age eighty, while only 20 percent of men had the surgery if they lived elsewhere in the state.
In the U.S. Congress in 1974 the House Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. Experts testified that nearly 18 percent of surgeries they studied might not have been necessary. In 1976 a House Subcommittee on Oversight and Investigations heard evidence and concluded that 2.4 million unnecessary surgeries were performed annually, resulting in 11,900 deaths. The annual cost of these surgeries was estimated at $3.9 billion. Since 1976, no new estimate of overuse has been calculated.
In the 1980s and 1990s the Rand Corporation and other researchers studied the overuse of selected medical procedures and found that many people had surgeries and tests they did not need. One of the procedures they examined was endoscopy, a most unpleasant examination in which the patient swallows a thin, flexible, lighted tube, called an endoscope, which then transmits a picture of the esophagus and stomach from the inside. Seventeen percent of endoscopies were performed for clearly inappropriate reasons.
The term "overuse" was first coined in 1991 by Dr. Mark Chassin, a physician and researcher, and now president of the Joint Commission, the Chicago-based organization that accredits and certifies sixteen thousand health-care organizations. In an article in the Journal of the American Medical Association, he defined it as providing a treatment when its risk of harm exceeds its potential benefit. At last a growing phenomenon in American health care had a name.
Although there was ample evidence of too much medicine, it did not arouse concern among the public, the medical establishment, or policymakers. "I feel as if I am a voice in the wilderness," says Dr. James Weinstein of Dartmouth, who has conducted extensive research on unnecessary back surgery. "There's a Latin phrase for it, 'Vox clamantis in deserto,' a voice shouting in the desert or wilderness."
OVERUSE COMES OUT OF THE CLOSET
In recent years, however, overuse has gained media attention. A Wall Street Journal front-page headline reported new studies that "hint at overuse" of stents to open clogged arteries. The New York Times reported on Elyria, Ohio, where the number of angioplasty procedures performed to open clogged arteries was four times the national average.
When Jane Brody, the veteran personal health columnist for the Times, described her painful experience with knee surgery, an orthopedic surgeon responded that his boss at his hospital complained that he didn't perform enough surgeries to bring in sufficient revenue. Brody wrote, "This is outrageous and just reveals the monetary motivation behind much of modern medicine. The patient be damned; just bring in the bucks."
Local newspapers provide a hometown flavor about overuse. In Hilton Head, South Carolina, the Island Packet reported on a whistle-blower lawsuit filed by a physician at Hilton Head Regional Medical Center accusing a physician colleague of performing hundreds of unnecessary heart catheterizations. The accused physician reportedly fled the country, possibly to Canada or Saudi Arabia.
The Miami Herald reported on a whistle-blower case brought by an anesthesiologist in which a neurosurgeon was prosecuted by the U.S. attorney for performing more than 150 unnecessary back surgeries. The Minot (North Dakota) Daily News described a lawsuit filed by a woman who accused a physician of performing an unnecessary lung surgery. That same month the Victoria (Texas) Advocate published an article, "Are Doctors' Morals for Sale?" quoting local doctors who claimed that their peers were performing excessive and needless tests and procedures "simply to make a buck." The newspaper alleged that "insured Victorians are being fleeced."
Consumer advocacy organizations have joined the voices in the wilderness to forge a path toward a more reasonable use of medical care. Debra Ness, president of the National Partnership for Women and Families, a Washington, D.C.-based nonprofit group that advocates for better health care, told a U.S. Senate committee, "Unnecessary care is rampant."
What lies beneath the news reports, congressional testimony, and health statistics? What happens to the people? A closer look reveals the untold human story.
Excerpted from The Treatment Trap by Rosemary Gibson Copyright © 2010 by Rosemary Gibson. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Meet the Author
Rosemary Gibson is senior program officer at the Robert Wood Johnson Foundation, where for thirteen years she has directed hundreds of millions of dollars in grants aimed at improving end-of-life care. Janardan Prasad Singh is an economist at the World Bank and has written extensively on health care, social policy, and economic development. The authors have also collaborated on Wall of Silence, a book of narratives about medical error.
and post it to your social network
Most Helpful Customer Reviews
See all customer reviews >
After reading this book, I am scared to go the doctors. Very interesting story though. I think anyone who has several medical problems should read this book before going to the doctors and getting admitted to the hospital
Rosemary Gibson tells a difficult message with clarity and ease. The overuse of tests, treatments, and surgeries is a whispered phenomenon that is brought to light by professionals and patients in this easy to read book. Interspersing personal stories with just enough research and data allows any reader to get a handle on the pressing issue of the overuse of medical care. The final chapters give a roadmap for activists and consumers to address the challenges we face in medical decision making. Thank you Rosemary for bringing us the stories to underscore the problem.