It's easy to forget how much of American medicine is a guessing game, how totally your treatments are a composite result of your doctor's experiences, biases, treasured anecdotes, and personal reactions to his own training. Most folks think medicine operates off a rigidly defined set of standards: if you have symptom A, your doc orders tests B, C, and D. Not quite. According to a new study, doctors are ordering useless tests for asymptomatic patients at staggering rates. Of tests that aren't recommended for patients with a particular batch of complaints, we're spending between $12 million and $63 million. Worse, for tests with risks that outweigh the benefits for certain patients, doctors are ordering them against recommendations over 40 percent of the time, for a total cost reaching into the hundreds of millions. And that's not even to get into the ricochet tests and expenses that come from false positives found by unnecessary diagnostics.
The problem, basically, is that medicine often doesn't know it's doing. Technology is moving too fast, and we have too many treatments, for the profession to keep up. Add in that most doctors aren't spending their spare time reading journals, we're defunding medical research, and one-third of journal studies are overturned anyway, and you've got a problem.
A few examples: Remember when everyone used to get their tonsils out? Now we know that does kids little good. Back surgery? Apparently no more effective than drugs and physical therapy. Ulcers? They're bacteria, not stress. Angioplasties? We're hair trigger with these things, as we are with bypass surgeries, to the tune of hundreds of thousands unnecessary procedures a year. Prostate cancer? We don't actually know how to treat it, or at least how to choose between treatments for it. Masectomies? Turns out they're generally no more effective than the far less intrusive lumpectomies. Our culture, both medical and general, has a preference for the most aggressive treatments, but the data often doesn't bear that intuition out. This, by the way, is the world conservatives want patients navigating their own way through -- one that lacks even enough digestible evidence for highly trained professionals to effectively traverse.
