January 6, 2020
Fixing Healthcare With More Regulation?
By Michael D. Shaw
Last month, The BMJ ran a press release entitled “Time to stop commercial distortion of healthcare evidence and practice, experts urge.” As the beginning of the release puts it, “It’s time to stop the endemic financial entanglement with industry that is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems.”
An accompanying article entitled “Pathways to independence: towards producing and using trustworthy evidence” laments the substantial financial conflicts of interest that affect research results. Related to this is the problem of too much medicine, whereby “Overtesting, overdiagnosis, and overtreatment divert resources from tackling genuine need, cause harm to health, and threaten health system sustainability.”
According to the Preventing Overdiagnosis website…
One common way overdiagnosis can happen is when healthy people who attend screening programs or receive tests during check-ups are diagnosed and subsequently treated for the early form of a disease which would never in fact have harmed them. With breast cancer screening for example, a systematic review of studies published in the British Medical Journal suggests that up to one in three of the cancers detected via screening may be overdiagnosed. There are similar concerns with overdiagnosis of prostate, thyroid and kidney cancers.
The lead author of the “Pathways to independence” article, Ray Moynihan, also wrote Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All into Patients. No doubt, the widening definitions of various diseases, along with the lower thresholds to treatment have created millions of new patients, and pharmaceutical drug consumers.
However, determining what constitutes proper and ethical treatment is not always so simple. It is one thing to assert (correctly) that antibiotics are overprescribed, but it is a far different matter to construct useful dietary guidelines, or treatment threshold points. Moreover, the foolish emphasis on population health over treating the individual and individual outcomes will only increase the difficulty. Certainly, there are individuals and possibly certain ethnic groups in which hypertension is strongly affected by dietary sodium, who should restrict their intake. But, should these restrictions be applied to everyone?
The BMJ press release identified four precepts:
- Trustworthy evidence is needed for properly informed health decisions
- Financial entanglement with industry is endemic in healthcare research, education, guidance, and practice
- Greater financial independence from industry is desirable and possible
- Moves towards independence will strengthen trust and improve outcomes in healthcare
The “industry” vilified in this connection is, of course, Big Pharma—a convenient and somewhat deserving target. The long list of lifesaving drugs can easily be overshadowed by episodes of rapacious greed and heavy lobbying. Naturally, the pharmaceutical industry, and all commercial businesses, have every right to maximize their profits. Some enterprises, however, hit us very close to home and invite much tighter scrutiny.
Healthcare and its accompanying insurance products are a huge enterprise and offer many opportunities for fraud and sundry unconscionable practices. But then, so do education, defense, and real estate.
Not surprisingly, most of the solutions proposed in the “Pathways to independence” article involve some type of governmental regulation. Lest we forget, government itself is a massive establishment involving a mostly unaccountable bureaucracy, and is surely subject to the same human frailties of greed, bias, and envy that pervade its commercial counterparts.
Ever since the advent of Medicare in 1965, the intrusion of government into healthcare has—without question—dramatically changed things, and seldom for the better. After all, there are few things more individual and personal than one’s healthcare. Yet, regulation is necessarily limited to broad trends. To make it more granular is to increase its cost, and ultimately limit the consumer’s freedom. In fact, that is playing out currently.
Isn’t it interesting how the very same folks who touted the Affordable Care Act (Obamacare) as the ultimate solution to healthcare in America are now advocating some form of the far more restrictive Medicare for All?
It is no coincidence that the authors of the “Pathways” piece are largely academics. Wouldn’t it be nice to hear what real practicing physicians have to say regarding healthcare, in forums other than insider blogs and the odd television program?