Friday, February 7, 2014

Krauthammer Hammers Five Health Care Myths

If you have a nail to hit, hit it on the head.

David Lambeth,  The Golden Book of Writing (1923)

In his inimitable style, Charles Krauthammer, MD, hammers five myths by hitting them on the head, shattering them in the process (“Health Care Myths We Live By, “ Washington Post,  February 6, 2014).

The first myth is that antioxidants, a big part of the $28 billion vitamin/supplement market,  prevent, ease, or treat chronic disease. Nonsense, says Krauthammer, quoting Annals of Internal Medicine editors, “Beta-carotene, vitamin E and possibly high doses of Vitamin A are harmful and vitamins and minerals supplements are ineffective for preventing mortality and morbidity of major chronic diseases.”  (“Enough is Enough: Stop Wasting Money on Vitamin and Mineral Supplements, Annals of Internal Medicine, December 17, 2013).

That’s nails myth number one.

Myth numbers two and three.  Insuring the uninsured will save huge amounts of money because the uninsured would stop using emergency rooms .  This is a prime financial rationale of ObamaCare.   “Well,” observes Krauthammer, “ In a randomized study, Oregon recently found when the uninsured were put on Medicaid, they increased their ER use by 40 percent.” And, “Medicaid coverage generated no significant improvement in measured physical health outcomes.” (Medicaid Increases Emergency Department Use: Evidence for Oregon’s Health Insurance,” Science, January 2014): and “The Oregon Experiment: Effect on Clinical Outcomes,” May 2, 2013,  New England Journal of Medicine).

Those are  nails for myths  two and three.

Myth four.  Routine tonsillectomies are needed.  “We know now no tonsillectomies, except for certain indications, are grossly unnecessary”. “No Need for Tonsillectomies Is Found,” San Jose Mercury News, December 22, 2013.”

That nails myth number four.

Myth Five.  Krauthammer says of the myth “Electronic records will save zillions,”  “That’s why the federal government is forcing doctors to convert to electronic records by the end of 2014. In the name of digital efficiency, of course.” But,"Krauthammer asserts," because EHRs are so absurdly complex, detailed, tiresome, and wasteful that if  the doctor is to fill them out, he can barely talk to and examine the patient, let alone make eye contact – which is why you go to the doctor in the first place.” (“When Treating a Patient with Dementia: Electronic Records Fall Short, Washington Post, February 8, 2010).    

 So what does the doctor do? He hires a “scribe” to follow him around and fill out the forms.  And what has Washington done about the EHR myth?   It has thrown $19 billion in stimulus money “ to create a sprawling mess." ( “Docs Using Scribe to Ease EHR Transition," Modern Healthcare, February 8, 2010).

That’s the nail for myth number 5.

Of these myths, Krauthammer conclude, “After, ‘First,  do no harm,” medicine’s second motto should be ‘Above all humility.’ 
Unfortunately, in policy-making circles and among humankind,   the humility required to abandon a money-losing, inefficient, and unproven practice  is not considered a virtue.   There is a bureaucratic motto that reads, “ If I say it is so, it must be so.” And among the public, the myth persists, that vitamins and supplements have to be good for you because they keep the doctor away.  

 And so it goes, the money, that is.

Tweet:  Certain myths – that vitamin/supplements, tonsillectomies, Medicaid expansion, and  EHRs  - are good for you are fallacious and waste money.

No comments: