Quiz of the Day: Define Overtreatment
Now that government is paying the health care bills we are hearing a lot about overtreatment. As always, where one stands on it depends upon how one defines it.
Here is what the National Cancer Institute says about mammograms and overtreatment:
Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCIS, a noninvasive tumor in which abnormal cells that may become cancerous build up in the lining of breast ducts) that need to be treated. However, they can also find cancers and cases of DCIS that will never cause symptoms or threaten a woman’s life, leading to “overdiagnosis” of breast cancer. Treatment of these latter cancers and cases of DCIS is not needed and leads to “overtreatment.” Overtreatment exposes women unnecessarily to the adverse effects associated with cancer therapy
Why not leave the harmless DCIS tumors alone?
It turns out that that medicine cannot predict whether any given DCIS tumor will threaten a woman’s life. If saving lives is the objective, the prudent thing is to take them all out.
Or, as the National Cancer Institute says when it is trying to have its cake and eat it too, “Because doctors often cannot distinguish cancers and cases of DCIS that need to be treated from those that do not, they are all treated.”
In other contexts, removing a growth that might threaten someone’s live is called preventive care. When it is breast cancer, the National Cancer Institute apparently considers it overtreatment.
If the objective is to control expenditures, perhaps the DCIS tumors should be ignored until they begin to spread. The best way to ignore them, and to stop spending even more money, would be to stop looking for them in the first place.
Here’s the quiz: Wisdom teeth that are not causing problems are often removed because x-rays indicate that they are in a position to cause possible tooth loss, infection, or gum disease at a later date. Is this overtreatment? Should the practice be banned by government’s intent on enforcing so-called “global budgets” for health care expenditure?
“Why not leave the harmless DCIS tumors alone?”
I am not sure if I understand why these tumors are either treated with cancer therapy or to ignore them. Why wouldn’t the course of action be to monitor them and figure out if they are harmful.
I agree that removing something, whether it is harmful or not, can be overtreatment. But it seems that the patient and doc have a choice between two extremes. The slope gets slippery when the tumor seems to not be harmful, then a year later becomes cancerous.
Oh man, the plaintiff’s attorneys have to love this…
Well I am curious to find out the correct answer for the quiz, but I think the answer is that it depends. Some people have mouths that can handle the extra wisdom teeth that grow in and have no problems. For others, it is wildly painful once they grow in. Health care should not be uniform for all patients.
“Health care should not be uniform for all patients.”
Once the government takes over, they try to squeeze everyone into one-size-fits-all plans. This should be the correct answer. I wonder what the prize is..
It makes you wonder how many women have been unnecessarily terrified by a diagnosis that would never have amounted to anything.
We don’t terrify easily.
European countries have a much more laid back approach to the mammography issue. Why? Liablity is much less there. A Swedish mammography expert years ago started recommending more watchful waiting for these non-invasive tumors. If a woman eventually has one of those tumors that becomes aggressive, the US mammographer would not have a leg to stand on in court.
Age-adjusted (using WHO standard population) 5 year breast cancer survival rates, percent:
United States (2005-2007), 89.2;
Canada (2004-2006), 88;
Sweden (2000-2002), 86.8.
I’d opt for the better survival rate.
I would rather be safe than sorry. I would want someone to overtreat me than wait too long until something did happen and then my life is even more threatened. Overtreatment definitely occurs in other health professions as well. Cancer is unique in that you HAVE to catch it early!
To answer the question posed in the title, unnecessary health care (overutilization or overtreatment) is when medical services are provided with a higher volume or cost than is appropriate. In the United States, where health care costs are the highest as a percentage of GDP, overutilization is the predominant factor in its expense. Factors that drive overutilization include paying health care providers more to do more (fee-for-service) and covering patients’ costs by a third-party (public or private insurance) payer. These factors leave both doctors and patients with no incentive to restrain health care prices or use.
Similarly, overtreatments are unnecessary medical interventions (therapies). They could be medical services for a condition that causes no symptoms and will go away on its own, or intensive treatments for a condition that could be remedied with very limited treatment. Overdiagnosis, when patients are given a diagnosis that will cause no symptoms or harm, can lead to overtreatment.
Then you have to be very careful with screening, because the whole object is to catch something potentially harmful. The problem will always be that screening for something may lead to finding something else, which may lead to more testing, etc. There was a recent article in JAMA about a physician’s father, who at age 80 went for a routine physical. The examining physician felt what he thought was an abdominal aneurysm (which left untreated will cause certain death if ruptured). This led to further testing which led to a hospitalization and ultimately a clean bill of health but a $50,000 hospital bill. Now, if the gentleman had in fact had a bulging aneurysm that was repaired in a timely fashion, the bill would likely have been even more, but he would be alive. It’s a Pandora’s Box.
This seems to work OK for me:
Overtreatment is when I’m paying for it. Undertreatment is when you’re paying for it.
That’s a great definition John! Although, I am also interested in the definition of “medically necessary”…especially as it applies to Obamacare’s “death panels.”
Welcome to Obamacare! Where “oops” become a diagnosis!