Levitt and Dubner highlighted a
really interesting aspect of medical treatment, the fact that prescribing
anything, whether it has been proven to be effective or not, acts as a powerful
incentive. In their discussion of ontology treatment, L & D made it clear
that the successes of chemotherapy are marginal at best – in one large study,
only 63% of cancer patients survived, but chemotherapy contributed less than 2%
of this success (I’m curious as to what factors were found to account for the
much more impressive 61%). Despite this weak evidence in the efficacy of cancer
treatment, such practices consumer a huge portion of the health-bill. Why? L
& D respond that incentives such as high salaries of oncologists, and the
average gain in two-months to live motivate doctors to prescribe these
expensive treatments. However, they also point out a third reason, which I find
to be the most compelling. They write that doctors find it difficult to tell
patients that there’s nothing they can do – that modern medicine has no answer
for them and they must face death without any tools with which to fight. I
highlight this reason not only to defend the morality of doctors, but because I
believe it reveals an important factor coming from the demand side of the
health market. If cancer treatment is as ineffective as L & D suggest, even
if doctor’s prescribe it, why would anyone do it? Consumers, (in this case
patients), are not stupid; when they are diagnosed with a disease, they have
the capability of looking up survival rates, treatment success, etc. Thus, it
seems like cancer victims should opt-out of chemotherapy treatments much more
frequently. While 30 % already do this, 70% do not. Their reason for suffering
through the painful side-effects associated with such treatments must be hope –
while chemo will probably fail in lengthening their life span, they
understandably cling to the small hope that they will be the anomaly, and
doctors are willing to oblige.
This
trend to delaying the reality of death is also illustrated in ER visits in last
weeks of life. A study conducted by UCSF and Harvard colleagues found that over
50% of older adults who had died had visited the ER during their last month of
life (this number rises to 75 % when extending the time constraint to 6 months).
Furthermore, more than 75% of these people were admitted, and 68 % died there.
These statistics highlight that people frequently use hospitals for comfort,
which is a wildly ineffective allocation of resources. ER’s exist to diagnose
and treat, whereas hospices are much more suitable to the type of care these
elderly patients seek. These ill-advises visits may help explain why a quarter
or more of Medicaid spending occurs in the last six months of life. In sum,
similar to the chemotherapy battle, we as a society are guilty at throwing
money at unfixable conditions in an effort to avoid accepting death – this fear
acts a monkey wrench in the machine, preventing it from making optimal
allocation decisions. This trend is extremely difficult (for those of you who
disagree, I would say you probably haven’t faced this type of decision), but
still clearly merits change from both the demand (the patient-side), and the
hospital side, who are all too willing to appease fears and admit incurable
patients.
Source:
http://newoldage.blogs.nytimes.com/2012/06/05/at-the-end-a-rush-to-the-e-r/
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