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How Much Does Technology Improve Health?

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Last week’s CDC report, “Health, United States, 2009” confirms that Americans are increasingly turning to medications, scans, and procedures to improve their health. Exercising, eating right, and weight loss: not so much.

Don’t get me wrong. I love technology as much as the next guy. Maybe more. I’m writing this on a laptop while jetting from California to New York. My iPhone, Blackberry, and Kindle are all within ten feet of me. But my inner Luddite is starting to stir.

Here are the good news and bad news about three major findings of the CDC report:

1) The use of imaging studies like CT and MRI scans has tripled in the past ten years.

The good news
These tests can be truly lifesaving. They can diagnose conditions like appendicitis and cancer much earlier than in the past.

The bad news
They’re expensive and carry risks. The annual price tag for all these scans is about 100 billion dollars and about 35 to 40 percent are estimated to be unnecessary. Experts are concerned that radiation exposure from tests like CT scans might increase the risk of cancer. And false positives often lead to further testing.

2) The percentage of Americans taking at least one prescription drug increased from 38 percent in 1988-1994 to 47 percent in 2003-2006. Those taking three or more drugs increased from 11 percent to 21 percent.

The good news
Medications clearly help control many medical problems – for example, hypertension, high cholesterol, and diabetes.

The bad news
The more pills you take – including vitamins, minerals, and herbs – the greater the risk of an adverse interaction. Just three months ago, the FDA warned that commonly-used medications such as Prilosec and Nexium can make the anti-clotting drug Plavix less effective.

And medications can give patients a false sense of security. No matter how much Lipitor you take, you’re not safe from heart disease if you eat a lousy diet, never exercise, and are obese.

3) Procedures such as angioplasty (opening up a blocked artery supplying the heart) and joint replacements are skyrocketing.

The good news
Used wisely, procedures are a tremendous boon. Emergency angioplasty performed during a heart attack saves lives. Knee and hip replacements can keep people active who otherwise would become immobile.

The bad news
About 30 percent of elective procedures are unnecessary according to experts like Dr. Elliott Fisher, director of population health and policy at the Dartmouth Institute for Health Policy and Clinical Practice. Dr. Fisher advises, “If I were a patient, I’d ask two questions: help me understand the risks and benefits of these procedures, and by the way doctor, do you have a financial interest in ordering this test?”

To try to put the CDC report in perspective, I spoke to Dr. Linda Fried, Dean of the Mailman School of Public Health at Columbia University. She explained that despite advances in many areas over the past decade, we are falling way short in providing adequate healthcare to Americans. A big reason: we lack a public health system that emphasizes prevention.

She told me, “In our fast paced society, which goes for silver bullets, quick fixes, high return on investment on quarterly reports, prevention is not part of that scenario because prevention’s for all of our lives, for our whole lives. And if we’re successful in prevention, we don’t see anything different and that is a mindset change which we need to learn to live with.” She added, “Eighty percent of health is created through prevention and public health. Three percent of our (healthcare) dollars go into that. We need to find a better balance.”

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One Response to “How Much Does Technology Improve Health?”

  1. Oliver says:

    I find a couple of the arguments problematic. Let’s start with the first set:
    On the good side: “They can diagnose conditions like appendicitis and cancer much earlier than in the past.” on the bad side “And false positives often lead to further testing.”

    Here’s the deal: If you want high sensitivity testing, false positives are something you’re likely going to live with. The higher the sensitivity, the higher the probability that you’re going to get more false positives. The real issue here is not the number of false positives. The real issue is the question whether CT and MRI are appropriate techniques for screening. That is not an issue of technology – they have plenty of applications in far more specific uses – it’s an issue of the medical establishment is a given field issuing appropriate guidelines for the differential diagnosis at hand.

    “Dr. Fisher advises, “If I were a patient, I’d ask two questions: help me understand the risks and benefits of these procedures, and by the way doctor, do you have a financial interest in ordering this test?””

    Dr. Fisher overlooks that a large part of the population doesn’t want to do a conscious risk-benefit analysis. All too often, people want simple answers for complex questions. It’s a cop-out to advise the patient to ask the doctor to help the patient understand the risks and benefits. Where’s Dr. Fisher advising doctors to learn how to communicate with people significantly less educated or for other reasons unlikely to understand what a given procedure implies? And what use is it if the patient asks if the doctor neither has the time nor the training to do it? This is pushing the responsibility onto the shoulders of the weakest link to cover for one’s own profession.

    Lastly, you close by talking about prevention. Aside from the fact that here, again, it’s an issue of failure of communication of the importance, prevention is more than just ensuring that nothing at all happens. When we’re talking about diseases with genetic factors, all good behaviour might not help preventing something bad happening. But you can in many cases still prevent a full outbreak: Catch a colon polyp before it turns into carcinoma etc. What you need for that is diagnostic testing. Diagnostic testing to catch the disease before it becomes life-threatening. The solution to the dilemma that some screening tests might do more harm then good (such as in tests involving radiation) or maybe detect disease that wouldn’t need treatment as well (as seems to be the case in many cases in prostate cancer) isn’t no testing whatsoever. In my opinion, it’s trying to find new tests that give a more differentiated answer.

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