Two Recent Health Care Experiences

A friend and his pregnant wife, who live in Los Angeles and are not poor, recently had an ultrasound.  (Probability of the ultrasound machine not operating properly and producing more than the stated amounts of energy: unknown, but a recent Stockholm survey found one-third of the machines malfunctioned.) Part of the office visit was a post-ultrasound visit with a genetic counselor.  The genetic counselor walked them through illnesses in their family tree and assessed their coming baby with very low risk for Trisomy 21 (Down syndrome), Trisomy 13 and Trisomy 18.

At the end of their session, they were offered other services they might opt to buy to better know their chances of knowing about any fetal problems: Chorionic villus sampling and amniocentesis as well as a maternal blood test.  None were really necessary.

My friend was irked that the CVS and the amniocentesis were called “low risk”. Maybe you know that a large fraction of doctors claim to practice “evidence-based medicine”. You might think this means they pay attention to all evidence. In fact, evidence-based medicine practitioners subscribe to a method of ranking evidence and ignore evidence that is not highly ranked. Most evidence of harm is not highly ranked, so evidence-based medicine practitioners ignore it. This makes every treatment appear less dangerous — misleadingly so. When a doctor says “low risk,” the truth, because the practice of ignoring evidence of harm is widespread (and drug companies routinely underestimate risk), is closer to “unknown risk”. The combination of (a) understating risk, (b) selling unnecessary stuff of which you have understated the risk, and (c) doing this with pregnant women, whose fetuses are especially vulnerable, is highly unattractive.

Also recently, the friend’s toddler had some sort of infection. The toddler had a bit of a fever, but was generally in good spirits, and played with his toys (i.e., was not bed-ridden or in severe distress). After a few days, his wife took the child to their pediatrician to make sure everything was fine.

“Don’t just accept the antibiotics,” my friend told his wife. “Push back a little. See what happens.”

The pediatrician did prescribe antibiotics. When my friend’s wife said she preferred not to give the child antibiotics if it were not really necessary, the doctor (female) said, “You’re right. I actually don’t know if the infection is bacterial or viral.”

Both stories — which obviously reflect common practice — illustrate how the healthcare system is biased toward treatment, including treatments that are unnecessary and dangerous. The good news is that this bias is clearer than ever before.

5 Replies to “Two Recent Health Care Experiences”

  1. My friend taught me a brilliant system for what to do when the kids were sick.

    First of all, don’t run to the doctor after the first sniffle or cough. When it’s more serious, go for a checkup. The doctor usually prescribes antibiotics. Ask if they are warrented.

    If they are, go home with the prescription but don’t fill it. If by next morning the kid is on the mend, you never need to fill the prescription. 90% of the time, this is what happened.

    I rarely ended up filling the prescription. I felt good that at least a health professional had seen my kid to rule out something serious – wouldn’t want to just never go to the doctor to avoid meds.

  2. “Push back a little. See what happens.” This is generally good practice when dealing with experts.

    About twelve years ago, I had undertaken some complicated financial transactions, so I hired an accountant to prepare my tax return. When he showed me a draft of the return, I was stunned at my unexpectedly high tax liability. I found an area of the return that looked suspicious to me. The account insisted that there was no mistake. But he called me a couple of hours later and admitted that he had inadvertently double-counted some income.

    Experts are to be treated with deep suspicion.

  3. Agreed… all experts should be treated with deep suspicion. Anybody can have an opinion, but experts dangerously base theirs on inductive reasoning, i.e., “what I saw over the past must remain true today.”

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