|Mayo Clinic (Photo credit: Wikipedia)|
By Dr. Mercola
From time to time, medical experts reverse course on certain practices and procedures when science dictates a change in the standard of care. One classic example of a "reversal" is when hormone therapy for menopausal women came to a screeching halt when so many women developed blood clots, stroke, and breast and uterine cancers.In an attempt to determine the overall effectiveness of our medical care, the Mayo Clinic tracked the frequency of these medical reversals over the past decade and published a report in Mayo Clinic Proceedings, August 2013.1The results are discussed by lead researcher Dr. Vinay Prasad in the featured video. Prasad and his team found that reversals are common across all classes of medical practice, and a significant proportion of medical treatments offer no benefit at all.In fact, they found 146 reversals of previously established practices, treatments and procedures over the past 10 years. Many new medical treatments gain popularity over older standards of care due to clever marketing more than solid science.Conflicts of interest are rampant in medical research. Shiny new medical treatments nearly always come with hefty price tags, which helps drive up the already astronomical cost of health care in this country. In addition to the end of routine hormone therapy for menopausal women, you will probably recall the following policy reversals over the past decade:2
- Changing the schedule for women's Pap tests and men's rectal exams, both of which used to be yearly
- Moving the starting age for women's yearly mammograms from age 40 to 50
- Use of COX-2 inhibitors such as Vioxx (a non-steroidal antiinflammatory drug, or NSAID, that directly targets the COX-2 enzyme; Vioxx killed more than 60,000 people before being pulled from the market in 2004)
More Than Half of All Medical Procedures Are of No Benefit and Many Actually Cause Harm
The most telling data in the report show just how many common medical treatments are not helping patients at all—or are actually harming them. Of the studies that tested an existing standard of care, 40 percent reversed the practice, compared to only 38 percent reaffirming it. The remaining 22 percent were inconclusive.This means that between 40 and 78 percent of the medical testing, treatments, and procedures you receive are of NO benefit to you—or are actually harmful—as determined by clinical studies. Prasad writes:3"Reversal harms patients who undergo the contradicted therapy during the years it was in favor and those patients who undergo the therapy in the lag time before a change in medical practice.Most importantly, it creates a loss of faith in the medical system by physicians and patients. The solution to reversal is upfront, randomized clinical trials for new clinical practices and a systematic method to evaluate practices already in existence."In an editorial, John P. A. Ioannidis, MD stresses the importance of not only promoting effective medical practices, but also disseminating knowledge about ineffective practices that should be abandoned.Many therapies continue long after they are deemed useless or harmful, due to inertia in the system. He suggests using incentives to urge physicians to begin testing the effectiveness of common practices and calls for a renewed commitment to rigorous clinical research.4
Top 10 Failures of the American Health Care System
In 2007, the Commonwealth Fund conducted a large survey comparing the health care attitudes and experiences of people across seven countries: Australia, New Zealand, the United Kingdom, Germany, the Netherlands, Canada and the United States.5 The results are quite telling about how broken the American health care system really is.6 Of the seven countries, Americans were the least likely to report being "relatively satisfied" with their healthcare. Let's take a look at 10 of the most significant findings of that survey.
1. We Spend the Most Money on Health Care, But Get the Least in Return
The US spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia, yet the US ranks last in health and mortality when compared with 17 other developed nations.Sadly, 30 cents of every dollar spent on medical care in America is wasted, which amounts to $750 billion annually. That is the same amount the Department of Defense estimates we spent on the ENTIRE Iraq War! This $750 billion of waste is made up of inefficient delivery of care and excessive administrative costs, unnecessary services, inflated prices, prevention failures, and outright fraud. The largest defrauder of the federal government is the pharmaceutical industry.7Thirty-five percent of Americans have difficulty paying their medical bills,8 and nearly two-thirds of all bankruptcies are linked to inability to pay medical bills due to being uninsured or underinsured. Medical impoverishment is nearly unheard of in wealthy nations, other than the US, because all have some form of national health insurance.9By dissecting medical bills, Time Magazine writer Steven Brill says we can see exactly how and why you are overspending and where your money is going. Americans are being grossly overcharged; even nonprofit hospitals are making greater profits than some prosperous for-profit businesses. The entire system unfairly affects the poor and uninsured as they are charged the FULL inflated price, while those with coverage have their costs radically reduced through pre-negotiated lowered rates.How much will you spend for a hospital stay? Certainly more than you would pay for even the most extravagant vacation! The average cost of a hospital say is $18,000, compared to $6,200 among OECD nations, according to this George Washington University infographic.10 Things add up quickly when you're in an American hospital.For example, a liter of normal saline rings up at $546.11 This one-liter bag of saline contains about nine grams of salt (less than two teaspoons), which costs 44 cents to a dollar to produce. But then the bag makes its way from the manufacturer through a series of giant group-purchasing middlemen and distributors before arriving at your hospital's pharmacy. Upon arrival, that IV bag has a mystery formula applied to it, and a price is magically determined, which is then recorded on your hospital's "chargemaster." No one really understands how these prices are calculated.Only recently did the federal government release the prices that hospitals charge for the 100 most common medical procedures, revealing tremendous and seemingly random variation in the costs of services.12 For example, if you need a hip replacement, you can spend $5,300 in Ada, Oklahoma, or you can fork over $223,000 for exactly the same procedure in Monterrey Park, California. You can find out how your state compares in average fees for service using an interactive online chart created by theWashington Post.13
2. Our Chronic Disease Rates Are Extraordinarily High
Americans have the second highest rate of chronic disease of the seven countries examined, with Australia being number one. With all of the money we're spending, what are we missing? This statistic reflects poor preventative care and lack of attention to lifestyle habits, such as diet, exercise, stress, sleep, and "electron deficiency" (insufficient contact with the Earth).The majority of Americans (adults and children) are becoming insulin-resistant due to their junk food based diets, loaded withsugar, processed grains, and chemical additives. Insulin dysfunction is putting many in a state of perpetual inflammation and driving up the rates of chronic disease. Americans consume nearly 4,000 calories per day on average—more than anyone else in the world.14 Yet, they are malnourished because most of these calories are from processed food, therefore devoid of nutrition.
3. Poor Coordination of Care
This issue is tied to the problem of waste. We drop the ball when it comes to managing patient care, especially if you have a complicated illness requiring multiple providers. As a result, we have poor access to medical records, duplicate testing, gaps in communication, confidentiality violations, and rushed and fragmented health care. According to an infographic based on data from multiple sources, created by Jonathan Govette:15
- 3 out of 10 lab tests are reordered because the results can't be found
- 68 percent of specialists receive no information from the primary care provider prior to the referral visit; 60 to 70 percent of referrals go unscheduled; and 25 percent of appointments are missed
- 7,000 people die every year from sloppy physician handwriting
4. Most Americans Do Not Have a Primary Care Provider
One of the reasons Americans' health care is so poorly managed is that they are least likely to have primary care providers. There are 0.5 general physicians per 1,000 people in the US, but the average among OECD nations is 1.23.16 Americans are also the most likely to say that their physician doesn't know important information about their medical history, which has dire implications for quality of care and increases the likelihood of medical errors. And, speaking of errors...
5. Americans Are the Most Frequent Victims of Medical Errors
It can be argued that medical errors are leading cause of death in the US—higher than heart disease, higher than cancer. The latest review17 shows that about 1,000 people die EVERY DAY from hospital mistakes alone. This equates to four jumbo jets' worth of passengers every week, but the death toll is largely ignored. Types of errors include inappropriate medical treatments, hospital-acquired infections, unnecessary surgeries, adverse drug reactions, operating on the wrong body part—or even on the wrong patient! One in four hospital patients are harmed by preventable medical mistakes in this country, and 800,000 people die every year as a result. Of those 800,000, 250,000 die as a result of medication errors.
6. Fewer Americans Are Receiving Health Care
Americans do have shorter waits for non-elective surgeries, compared with other developed nations. Only four percent of us wait more than six months, which is considerably less than the Canadians (14 percent) or Britons (15 percent). However, when you consider how many Americans lack access to any health care at all, the wait-time advantage disappears.Nearly one-third of Americans are uninsured or underinsured.18 Twenty-five percent do not visit a doctor when they're sick, due to the cost. Twenty-three percent can't fill their prescriptions. This is far worse in America than in any of the other countries surveyed. In Canada, only five percent skipped care, and in the UK only three percent. As you know, I'm not a fan of using the standard health care approach in every situation. However, if you become acutely ill or injured, lack of access to care can be devastating.
7. We Don't Pay Physicians in Proportion to Their Quality of Care
Most other countries reward physicians for good care with financial incentives. For example, in the UK, 95 percent of physicians are paid, at least in part, according to the quality of care they deliver. In Australia, it's 72 percent. The US scores lower than anyone else, at 30 percent.
8. Our Health Care Is Inconvenient
Americans' access to after-hours services (early in the morning, later in the evening, and on weekends and holidays) is just mediocre. For access to evening hours, we lag behind Australia, Canada, Germany, and New Zealand. A full 67 percent of Americans—more than in any other country—say it's difficult to get care on nights, weekends, or holidays without resorting to the emergency room, where care is costlier and, if your injury is not life threatening, inefficient and time consuming. Only 30 percent of Americans report that they can access a doctor on the very day they need one, as opposed to 41 percent of Britons and 55 percent of Germans.
9. American Physicians Don't Listen to Their Patients
About 70 percent of Americans are satisfied with their physician's "bedside manner," which is lower than the Canadians, Australians, and New Zealanders. But we are five percent more satisfied than the Britons, and well above the Germans or Dutch. However, when you look at specifics, we compare less favorably. Americans are less happy about how well their physicians explain things to them, how long they spend with them, or how smoothly their appointments go, with respect to things like coordinating records and scheduling.
10. Most Americans Are Dissatisfied with the Current System
You've probably heard reports claiming that Britons and Canadians are highly dissatisfied with their health care system, but this survey proved that Americans have them beat by a substantial margin. Americans were the least likely of all seven countries to report relative satisfaction with their health care system.Only 16 percent of Americans report being happy, compared with 26 percent in the UK and 42 percent in the Netherlands. Thirty-four percent of Americans want a complete overhaul in the health care system, whereas only 12 percent of Canadians and 15 percent of Britons say the same. So we pay the most for our health care, but we have the lowest satisfaction ratings—even lower than those who spend more time "waiting in line." Ezra Klein of the Washington Post makes an excellent point:19"There is no other area of American life where we collectively accept such a bad deal. We spend more than any other nation on our military, but our military is unquestionably the mightiest in the world. We spend the most on our universities, but our universities are the best on the planet. But we spend the most on our health care—twice as much as anyone else—and our health system is mediocre-to-poor, with 47 million of us lacking the insurance necessary to easily access it."
Affordable Health Care Act: Getting MORE of What Isn't Working
The US does not have a health care system; we have a disease-management system dependent on expensive drugs and invasive surgeries. It's a system with a mission to maximize profits, as opposed to helping people maintain or regain their health. The Affordable Health Care Act is likely to make matters worse rather than better, as the Act does not include any illness prevention strategies. Nor does it contain any measures to rein in out-of-control health care costs related to overcharges. Instead it expands an already flawed model of "care" that is one of the leading causes of both death and bankruptcy for Americans.Ronald Reagan hit it right on the nose when he said, "Government doesn't solve problems—it subsidizes them." Integrative medicine (IM) is a better alternative to the current system, as it offers a combination of conventional medical therapies and complementary or alternative therapies for which there is some high-quality scientific evidence for safety and effectiveness. The more you take responsibility for your own health by nurturing your body, the less you will need to rely on the "disease care" system that passes for health care in this country.