First, a bit of old business. A friend asked me if the Medicare benefits and taxes figures I quoted last weak were adjusted for net present value. The dollar amounts quoted were in 2010 dollars adjusting for inflation, so yes, they were adjusted for net present value. The link to the original study is http://www.urban.org/publications/412281.html. Now for the new stuff:
A study in Health Affairs reported the results of a national survey where people were asked about their attitudes to treatment guidelines. Respondents rated highest these statements against using guidelines:
- No outside group should come between doctors and patients in making treatment decisions
- Doctors will be unable to tailor care to the needs of individual patients
- Treatment guidelines are vulnerable to abuse and corruption
- The government and insurance companies will use treatment guidelines as a way to control costs and ration care
There are many fallacies mixed in these beliefs. One is that doctors can somehow magically determine which test or treatment will work in which patient. If research shows a blood pressure medicine works in 70% of patients and 10 patients were started on the medicine, no doctor could tell in which 3 it won’t be effective. Another misunderstanding is how much work goes into reviewing the literature and writing guidelines. Unless their written by a narrow-minded ology society with some ingrained belief system it wants to perpetuate, I find standard guidelines to be balanced most of the time. Another fallacy is that American healthcare is not already rationed. We ration by insurance status.
I think the biggest influence of these opinions is the individualistic culture of the U.S. We have warped the notion that one person can start a computer company in his dorm room — or work hard, study, and someday become president — to a belief that an individual can be cured by a treatment shown to be ineffective by rigorous medical research. TV dramas and news stories love stories where a person claims to have been told by doctors that nothing can be done, only to find the doctor who doesn’t give up hope and tries a treatment others said would fail. Of course the claim is that the heretical treatment saves the day and saves the patient — a true medical miracle.
Humility is a harder story to tell and harder to accept. If a person has a serious illness, guidelines are the best tools to find the tests and treatments most likely to work. If all treatments proven to be effective are given, but they don’t result in a cure, now what? There are very few news stories or TV dramas that show a person bravely accepting this new reality. When a reporter interviews a person with an incurable disease, you can bet the ranch that the concept of fighting the disease will be covered. Fighting the disease involves conflict, which is a natural part of story telling. Peacefully spending time with loved ones does not involve conflict, therefore the media finds it boring.
American’s individualistic culture makes it hard for us to accept that the results of medical research developed across populations, and resulting in average responses, applies to them as individuals.
Miracles are interesting; quiet acceptance is not. If Americans gained some wisdom and perspective on when to apply these approaches, this would be the biggest miracle of all.