Wednesday, September 2, 2009

Modern Medical Myths

Medicine can be magical, filled with articles of faith and hope rather than science and rationality.  There are those who believe that this aspect of medicine left when the day of the witch doctor and the shaman was overtaken by the wisdom of science and the white coats that represent the modern health professional.  I submit that we still hold on to myths, even within the erudite discussions taking place in the press and in the public square as we debate health care reform.  Our myths have changed but they are no less powerful than the ideas that led to the bleeding of evil humors in order to cure disease. Let’s review some:

Most Illnesses are Preventable and Focus on Prevention will Save Money

It is true that many diseases are affected by our life style choices.  We eat too much, exercise too little and drink too much alcohol.  That all leads to disease which could be avoided if we all practiced moderation.  The myth is created by the idea that focus can greatly impact risk reduction to the extent that billions of dollars will be saved and the suggestion that people can modify their lifestyles successfully and prevent disease on a national scale.   The facts differ somewhat from this dogma.  Dee Edington and his team at the University of Michigan have been doing research in this area for more than thirty years.  In a recent, 2009 article in the Journal of Occupational and Environmental Medicine they looked at a large population that they had followed for eight years, assessing them yearly through questionnaires (health risk assessments) and providing multi-dimensional health risk reduction programs.  Their findings were that any positive change in reducing risks was minimal.  In that April 2009 article they stated: “No argument exists against the relationship between higher risk and higher health care cost, but optimal strategies for facilitating and sustaining changes are still elusive.”  Dr. Edington has told me personally many times that the real goal of health risk reduction should be to try and keep people from increasing their risks rather than try and get the true reversal of risks as that true reversal has thus far not been possible for large groups of people. 

All Diseases That Are Discovered Early Can Be Treated To Cure

If this were only true!  We know that early detection of hypertension allows for treatment and can help prevent certain types of heart disease and that early detection of some cancers allows a better likelihood of cure but the needed research has to be done on a disease by disease basis and may not hold true.  Prostate cancer, and the use of a Prostate Specific Antigen (PSA) blood test to try and screen for that cancer are an example of screening that may not help people survive.  In the words of the  American Urological Association Best Practice Committee on PSA, “at this point it is not possible to state that screening is associated with more benefit than harm”.  Every positive screening test for any cancer will cause more tests and procedures to be performed.  All of these diagnostics carry their own risk and we often do not know if that one case found may be causing more than one person to end up with a life threatening complication of an unnecessary procedure.  Even when we do find a cancer early, there is no guarantee that we can effectively treat it at that point.

The Ultimate Myth: Death is Optional

There is an old saying that life is a fatal disease.  In our society we often don’t act that way. We tend to want to find answers that tell us that death and illness are always avoidable.  That is not the case.  We fight disease and we prolong life and we try to do it in a way that celebrates the triumph of life and that never loses hope. We can do that without fooling ourselves with myths.

Myths and Health Reform

All of this comes to mind as we discuss massive reform in our health insurance systems.  My advice is to be skeptical of claims that we will save money by decreasing health risks in the population.  Question the dogma that earlier detection of disease will inevitably lead to more cures at lower costs.  Medicine is much more complicated than that and health reform is still just a piece of legislation and will not change human physiology and human behavior.