Cary G Dean.
A Question of Ethics
Medical bias towards illness.
There is evidence that the medical profession is biased in favour of diagnosing illness rather than health.
A classic example was a test run in New York on 1,000 11-year-old children and their tonsils.
On first examination 61% were found to have had their tonsils already removed.
The other 39% were re-examined by a group of doctors who recommended tonsillectomy operations for 46% of them.
The rest were again examined by yet another team and, again, nearly half were recommended for operations to remove their tonsils.
After three examinations, only 65 of the original 1,000 had not been recommended for the operation.
The test ended there as they ran out of physicians to perform the examinations.
However, if the physicians had had their way, it is obvious that a great many unnecessary operations would have been performed.
High error rate in diagnoses.
The bias towards illness may also combine with a high diagnostic error rate.
Post- mortem examinations in a British university hospital showed that of the patients who had died of a diagnosed specific heart disease, over half had actually died of something else.
And when the same sample was tested in different laboratories, different results were given in 25% of cases.
Diagnostic machines, it seems, are no better.
In a competition between doctors and computers in 83 cases recommended for pelvic surgery, pathology showed that both the doctors and computers were right in only 22 cases.
In 37 the computers proved the doctors' diagnoses wrong, in 11 the doctors showed the machines to be in error and in 10 cases they were both wrong.
Post- mortem examinations in a British university hospital showed that of the patients who had died of a diagnosed specific heart disease, over half had actually died of something else.
And when the same sample was tested in different laboratories, different results were given in 25% of cases.
Diagnostic machines, it seems, are no better.
In a competition between doctors and computers in 83 cases recommended for pelvic surgery, pathology showed that both the doctors and computers were right in only 22 cases.
In 37 the computers proved the doctors' diagnoses wrong, in 11 the doctors showed the machines to be in error and in 10 cases they were both wrong.
Variations between countries.
There also exists a large variation between diagnostic and prescribing practices between countries which makes comparisons between them of little use.
For example, in Britain, a patient is 7 times more likely to be prescribed a course of vitamins than in Sweden, and in Sweden, 8 times more likely to get gamma globulin medication than in Britain.
United States surgeons perform operations twice as readily as in Britain and the French will amputate almost anything.
Appendicitis and deaths attributed to it is diagnosed in Germany 3 times more frequently than in any other country.
For example, in Britain, a patient is 7 times more likely to be prescribed a course of vitamins than in Sweden, and in Sweden, 8 times more likely to get gamma globulin medication than in Britain.
United States surgeons perform operations twice as readily as in Britain and the French will amputate almost anything.
Appendicitis and deaths attributed to it is diagnosed in Germany 3 times more frequently than in any other country.
And so to the cost.
In the late 1980s, intervention alone in the United States was estimated at $14 billion a year.
The cost of cholestyramine for an estimated five million people at 1990's prices was $10 billion to which up to another $10 billion must be added for laboratory tests and doctors' services.
In Britain, if we also undertook a mass screening and cholesterol reducing programme, it has been suggested that drug treatment would be recommended for 10% of men aged 40-69 and, as a result, the NHS drug bill in England and Wales, 2.3 billion in 1992, would be increased by 20%.
To put it in terms more familiar to the average person, the cost of the drugs alone would be between 80 and 120 per person per month.
The evidence suggests that for that money we might be able to delay a fatal heart attack in the average person by between 3 days and 3 months - but shorten that person's life by a larger amount as he or she died of cancer, osteoporosis or stroke.
The effect on the NHS.
The cost of cholestyramine for an estimated five million people at 1990's prices was $10 billion to which up to another $10 billion must be added for laboratory tests and doctors' services.
In Britain, if we also undertook a mass screening and cholesterol reducing programme, it has been suggested that drug treatment would be recommended for 10% of men aged 40-69 and, as a result, the NHS drug bill in England and Wales, 2.3 billion in 1992, would be increased by 20%.
To put it in terms more familiar to the average person, the cost of the drugs alone would be between 80 and 120 per person per month.
The evidence suggests that for that money we might be able to delay a fatal heart attack in the average person by between 3 days and 3 months - but shorten that person's life by a larger amount as he or she died of cancer, osteoporosis or stroke.
The effect on the NHS.
Sir William Beveridge set up the National Health Service on the assumption that "there exists in any population a strictly limited amount of illness which, if treated under conditions of equity, will eventually decline."
It was calculated that the cost of the service would fall as the rates of illness went down.
No-one considered that the NHS would redefine and broaden its service to such an extent that only budgetary restrictions would keep it from expanding indefinitely.
The increasing sophistication of treatments available and demanded of the National Health Service are putting it under a tremendous strain.
To spend scarce money and resources on any unnecessary treatment is a waste, but to waste billions of pounds on such unproven and dubious hypotheses as the present, so-called
'Healthy Eating'
Recommendations is quite irresponsible and, in the long term, can only be harmful.
It was calculated that the cost of the service would fall as the rates of illness went down.
No-one considered that the NHS would redefine and broaden its service to such an extent that only budgetary restrictions would keep it from expanding indefinitely.
The increasing sophistication of treatments available and demanded of the National Health Service are putting it under a tremendous strain.
To spend scarce money and resources on any unnecessary treatment is a waste, but to waste billions of pounds on such unproven and dubious hypotheses as the present, so-called
'Healthy Eating'
Recommendations is quite irresponsible and, in the long term, can only be harmful.
Dr Halfdan Mahler, Director General, the World Health Organisation recognised such waste when he said in 1984:
"The major - and most expensive - part of medical technology as applied today appears to be far more for the satisfaction of the health professions than for the benefit of the consumers of health care."
About the Author:
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www.Cholesterol-and-Health.org.uk
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www.Cholesterol-and-Health.org.uk
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