There are at least two conversations going on in the health care marketplace today, each focused on one of two key questions. One is: How can we achieve the Triple Aim? The other is: Why do they get to do that? (It’s not fair! I want more!)
Until we stop asking the second question, we can’t answer the first question. Why? Because all too often the answer to the second question is the equivalent of: It’s OK, Timmy, I’ll buy you TWO lollipops; pick whichever ones you want.
It’s the tragedy of the commons, transposed to the health care marketplace.
Recent cases in point:
- Tufts Medical Center – Blue Cross Blue Shield of Massachusetts grudge match
- Mammography and PSA guidelines
1. Avastin. Late last year, Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
Last week, the Cleveland Clinic sent out the following “News Tips”:
“Top 5 Medical Tests for 2012
As we head into 2012, healthy New Year’s resolutions will abound. People will pledge to work out more, eat healthy foods and finally go to see their doctor for a physical.
Cleveland Clinic experts note that there are a few tests that everyone should have during their yearly physical. For men, the following tests are recommended by many physicians:”
Included in the list were: Read more »
*This blog post was originally published at Health News Review*
The word “cancer” strikes fear in everyone who is told they have it. It conjures up images of a fast-moving, life-threatening disease.
That isn’t necessarily the case for men with newly diagnosed prostate cancer. More than half of them have a type of cancer that is confined to the prostate gland and that grows so slowly it will never affect their health or their lives. Yet almost 90% of men told they have prostate cancer opt for immediate treatment with surgery or radiation therapy—which often cause trouble getting or keeping an erection and an assortment of urinary problems.
Two weeks ago, a panel of experts convened by the National Institutes of Health recommended that many men with localized, low-risk prostate cancer be closely monitored, and that treatment be delayed until there was evidence that the disease was progressing.
“It’s clear that many men would benefit from delaying treatment,” Dr. Patricia A. Ganz, conference panel chairperson and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center at the University of California in Los Angeles, said in a statement, adding that Read more »
*This blog post was originally published at Harvard Health Blog*
In the face of accumulating evidence and a U.S. Preventive Services Task Force finding that PSA screening for prostate cancer does more harm than good, the most frequent response I hear from physicians who continue to defend the test is that PSA is all we have, and that until a better test is developed, it would be “unethical” to not offer men some way to detect prostate cancer at an asymptomatic stage. (However, these physicians for the most part don’t question the ethics of not offering women screening for ovarian cancer, which a recent randomized trial concluded provides no mortality benefit but causes considerable harms from diagnosis and treatment.)
I’m currently reading historian Stephen Ambrose’s dual biography of Oglala Sioux leader Crazy Horse and Civil War cavalry general George Armstrong Custer, whose troops were routed by the Sioux at the famous Battle of Little Bighorn in 1876. One premise of the book is that the same aggressive instincts that served Custer so well during the Civil War Read more »
*This blog post was originally published at Common Sense Family Doctor*
Cancer. Just the word is scary. Actually, that’s the problem. Once you say that word, the average American will do anything — ANYTHING! — to just get it out of my body!!! Whether or not they have it, whatever the actual numerical chances of their ever developing it, no chance for detecting or treating it should ever be neglected. EVER! Ask any Med-mal lawyer. Better, ask any twelve average people off the street (i.e., the ones who are going to wind up on a jury). “The doctor didn’t do every possible test/procedure, and now the patient has CANCER? String him up!”
Hence we have the new guidelines for PSA testing. (Given that many patients with prostate cancer have normal PSAs and lots of patients with high PSAs don’t have prostate cancer, it doesn’t seem semantically correct to call it “prostate cancer screening”.) Surprise! Turns out that not only does PSA testing not save lives, but that urologists don’t really care. Certainly not enough to stop recommending PSAs to just about everyone they can get their hands on.
Nor do breast surgeons have any intention of modifying their recommendations, not only in light of new understandings of the limitations of mammography, but even as Read more »
*This blog post was originally published at Musings of a Dinosaur*