The sensitive new technologies that enable doctors to find and diagnose more medical problems have also led them to find, explore and treat things that never would have caused problems, according to Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. “We now recognize that we all harbor abnormalities,” Welch said in a Times story last year.
That’s not to say that the nation should instantly start following all of these findings and recommendations all of the time. In some cases, more research is needed. And in any specific patient’s case, physicians should make decisions based on the individual’s needs and situation; the task force, for example, never meant to say that a 45-year-old woman with a strong family history of breast cancer should avoid mammograms. But increasingly, the nation’s medical establishment is coming to recognize that aggressive treatment can sometimes be as much a problem as certain diseases.
This will be an easier pill for patients to swallow if researchers and policymakers do their best to clarify which issues are financial and which are medical. The studies on palliative care and on surgery for early-stage prostate cancer, for example, clearly fall into the latter category. They didn’t even consider the cost factor of surgery or of efforts to extend life in the late stages of terminal lung cancer. Rather, they were designed to determine what brought about the best results for patients.
And yes, healthcare expenses must be curbed as well. Along with studies on what works best medically, there will have to be research-based determinations of which medical treatments offer too little benefit for the cost. Restrictions on such treatments will be hard for people to accept, but access to healthcare already is being rationed to some extent by insurance companies, and not always in ways that make medical sense. It will be easier for the public to trust tradition-defying findings if there is no hidden agenda, and it is made clear which recommendations are based on cost-benefit analysis and which are based on research that is concerned only with what ails us and what’s medically good for us.