Justinian Lane

Offensive Medicine Costs Us ALL

Have you ever heard of defensive medicine? That's the term used by the "reform" lobby to describe a physician ordering tests or procedures purely to prevent litigation. Examples include MRI's and CT scans, cancer screenings, etc. I've written about why I don't think defensive medicine is bad for patients, and so has Greedy Trial Lawyer. The gist of both of our arguments is that an ounce of prevention is worth a pound of cure; wouldn't you rather your doctor err on the side of caution when treating you? "Family Guy" also extols the virtue of excessive medical caution in the episode The Tan Aquatic With Steve Zissou. From Wikipedia:

"When Brian advises Stewie to "wait and see" whether or not he has cancer, Stewie says "Jim Henson had a wait and see attitude, and look what happened to him. Now we've got wrong-sounding Muppets," a reference to Henson's failure to properly address a cold he had, which led to pneumonia, and ultimately his death in 1990."

But this post isn't about defensive medicine. It's about offensive medicine. Cyrus Dugger cited an example of offensive medicine in which his dentist tried to push unnecessary procedures that were conveniently covered by Cyrus' insurer. Cyrus declined the procedures, but undoubtedly some patients do choose to have unnecessary services performed. While Cyrus' dentist and other unethical doctors may practice offensive medicine, they're amateurs at best. The real masters of offensive medicine are pharmaceutical companies, which have lined their pockets with billions of dollars – including taxpayer dollars – by pushing unneeded medications on healthy patients.

From June 26-30 of 2005, The Seattle Times published "Suddenly Sick," a chronicle of the pharmaceutical industry's campaign to convince healthy Americans that they need to take prescription medication every day for the rest of their lives. By exaggerating the likelihood of illnesses and influencing the definition of diseases, pharmaceutical companies have been successful in persuading healthy individuals to seek treatment for trivial or nonexistent maladies. There's even a term for these healthy people: The Worried Well.

"Suddenly Sick" explains that in the case of some illnesses, new guidelines promulgated by doctors with financial ties to pharmaceutical companies have classified millions of people as diseased. In fact, according to those guidelines, three out of four Americans has a disease that should be treated by prescription medication. One disease which had its definition broadened is obesity. Under the new guidelines, Shaquille O'Neal is considered obese. Now, if ever an individual could honestly say, "I'm not fat, I'm big-boned." It's Shaq. Thankfully, Shaq never took phen-fen to treat his obesity.

Obesity isn't the only disease to have its definition expanded dramatically. "Suddenly Sick" explains how lowering the thresholds for high blood pressure has created a windfall for pharmaceuticals.

"In recent years, expert panels from prestigious medical-research organizations such as the World Health Organization (WHO) and the federal National Institutes of Health (NIH) have called for lower thresholds for blood pressure.

Behind each of those panels were the giant pharmaceutical companies that manufacture the new and expensive hypertension drugs.

In May 2003, for example, an NIH panel recommended broader use of hypertension drugs at lower blood pressures. Nine of the 11 authors of the guidelines had ties to the drug companies (see chart).

The drug industry welcomed the new treatment guidelines and marketed them vigorously. Not surprisingly, as doctors followed the new guidelines and treated hypertension at lower readings, sales of the newer drugs increased.

Last year, patients and their insurance companies spent $16.3 billion for blood-pressure pills, up $3 billion from five years earlier."

That's a sales increase of over 500% in five years. I don't know how much the pharmaceuticals paid the doctors at the WHO and the NIH, but even if it were in the millions, the pharmaceutical companies had an excellent return on their investment.

So we have major pharmaceutical companies paying doctors who study disease guidelines; those doctors recommend expanding the disease guidelines in such a way that millions of patients would instantly be considered diseased. Coincidentally, the pharmaceutical companies that paid the doctors just happen to have products to treat the diseases. For some reason, few people question the neutrality of the doctors and the validity of their recommendations. Imagine if a group doctors on the payroll of various law firms recommended expanding the definition of medical malpractice in such a way that millions of patients would instantly be considered victims of medical malpractice. Coincidentally, the law firms that paid the doctors just happen to specialize in medical malpractice lawsuits. I bet few people wouldn't question the neutrality of the doctors and the validity of their recommendations.

I'm neither a doctor nor disputing whether the new guidelines promulgated by pharmaceutical-paid physicians are beneficial. What I am questioning is whether it makes sense to allow pharmaceutical companies to play such an important role in determining the guidelines for the diseases their products treat. How can pharmaceuticals with billions of dollars on the line be expected to remain objective as to the benefits of their products? Should doctors on the payroll of pharmaceuticals be prohibited from influencing the definition of diseases? Or should those doctors have to disclose their financial ties to pharmaceutical companies? These are all questions that we as a society need to consider. "Suddenly Sick" presents evidence that pharmaceuticals work to expand the definitions of disease to include truly healthy patients. Even a small expansion in disease guidelines can lead to thousands of people taking prescription medication they otherwise wouldn't. That can lead to millions or even billions of dollars in sales for the pharmaceutical industry. Who pays for these unnecessary prescriptions? Taxpayers, in the form of Medicare funding, and insured individuals and their employers in the form of insurance premiums. Unquestionably, there is a substantial profit motive for pharmaceuticals to encourage the expansion of disease guidelines. This profit motive can only have grown larger in light of the aging population and the Medicare prescription drug coverage.

"Suddenly Sick" isn't the only resource chronicling the efforts of the pharmaceutical industry to sell to the well. Journalist Ray Moynihan and University of Victoria, British Columbia research Alan Cassels authored the book "Selling Sickness: How Drug Companies Are Turning Us All into Patients." Here is an article from those authors, entitled "Selling to The Worried Well":

"The epicentre of this selling [to The Worried Well] is the United States, home to many of the world's largest pharmaceutical companies. The US has less than 5% of the world's population but represents almost 50% of the global market in prescription drugs. Pharmaceuticals spending in the US continues to rise more rapidly than anywhere else, increasing by almost 100% in just six years, not only because of steep increases in the price of drugs, but because doctors prescribe more and more of them."

If the five percent of the world population in the U.S. consumes fifty percent of the prescription medicine in the world, one wonders why so many tort "reformers" argue that the U.S. tort system and the FDA are preventing medications from coming to market in the U.S. If anything, it sounds like the legal and regulatory systems in other countries are blocking medications from their populations.

I highly recommend reading "Suddenly Sick" with but one caveat: You may become suddenly sick of the offensive medicine practiced by pharmaceuticals and its effect on your pocketbook.

Justinian Lane: Author Bio | Other Posts
Posted at 2:47 PM, Apr 06, 2007 in Medical Malpractice
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Blood pressure and lifespan free of stroke and heart attacks exist in the physical world, and are easy to measure objectively. Majority member Americans do better than their European relatives managed by Euro government health care. The left wants to dictate private patient and doctor decisions, and to bring heartless denial of care to our shores. The left believes the patient is stupid, and must obey the tyrany of the left. If you loved Walter Reed methodology, you will love single payer system when the Democrats take power, and impose their rat infested standards on the entire health system. The return on health care expenses in some cases is 10,000% a year guaranteed, year after year until death. Nothing comes close.

The lawyer, meanwhile, is in total failure in every goal of every law subject. He imposes sicko supernatural doctrines at the point of a gun. The gun is the sole eternal validation of lawyer methods. Compare methods: ever increasing lifespans and health, gun to the head to impose sicko suprenatural doctrines.

Posted by: Supremacy Claus | April 6, 2007 8:44 PM

Justinian: I am not being sarcastic here. You defend defensive medicine of excessive testing procedures. You bash a dentist proposing excessive services. Please, explain how that is not a contradiction. It seems contradictory to me.

Justify the cost for needless procedures, with testing carrying risk, such as invasive diagnostics. Blood test for $10 may not be enough. Let's do cardiac catheterizations on everyone over 50, at $10,000, and a 1% mortality risk. Let's visualize the degree of artery blockage in everyone. Is that defensive medicine OK?

What do you think of allowing the decision to someone who does catheterizations for a living? This person has some idea when the benefits exceed the risk from experience of having done 1000's of them, versus the top down, coercive, philosophizing of a lawyer. This person is so busy, tired, and rich, that time off is worth more than money. Trust he will not be looking to do unnecessary ones.

Medical malpractice expert testimony is said by the self-dealing lawyer to not be the practice of medicine, and is not subject to medical disciplinary investigation. I agree. It is the super-practice of medicine. A lawyer, for purposes of enrichment, pays a notorious whore top dollar to lie about the standard of care. Now, all the legitimate docs have to obey this false standard or face a tsunami of ruinous litigation. I agree the whore should not be investigated by a licensing board. He should be investigated by the DA, and join the lawyer in a prison cell, for perjury and the suborning of perjury for greedy enrichment. Any pro-lawyer biased judge allowing false testimony? Jail too. The criminal cult hierarchy at the Supreme Court has granted this lying whore absolute immunity. The remedy is a federal statute reversing this self-dealing lawyer immunity for its lawyer lying whore, and the exclusion of lawyers from any bench, again by statute.

Posted by: Supremacy Claus | April 7, 2007 7:32 AM

Supremacy, as I've said before, I personally want the most defensive doctor in the world to treat me. I don't care if he's running needless tests out of fear of litigation or concern for my safety if those tests help catch something early. But "reformers" argue that defensive medicine is bad because it wastes insurer's money.

I'm simply pointing out that if the "reform" lobby wants to help insurers, they should start with the pharmaceutical industry, not the tort system.

Posted by: Justinian Lane | April 7, 2007 3:47 PM

Justinian: What is the difference between defensive and offensive medicine? So you support enriching the pathology department running pointless tests, and attack the dentist proposing a marginally necessary treatment? Let's do a total body MRI, lets do yearly brain biopsies looking for tumors for which no evidence exists. If incidental findings result from a total testing program, should these be treated even if you do not complain about them? How often should total testing take place if not on a schedule set by your experienced doctor, yearly, every 6 months, every 6 weeks?

Defensive medicine is designed to prevent a lawsuit, by definition. It benefits the doctor by providing defenses in litigation, and by enriching the doctor from testing without benefit to the patient. Is that what you want from your doctor?

Posted by: Supremacy Claus | April 8, 2007 8:51 PM

Justinian, your opinion on defensive medicine is even less grounded in reality than your opinions usually are.

1) Insurance companies are not money trees. When you run up their costs, you run up everyone's premiums. They don't give away free tests out of the goodness of their hearts.

2) Unnecessary tests are bad because (a) few tests are 100% safe, (b) many tests are inconvenient or uncomfortable or both -- have a colonoscopy sometime, if you don't believe me, (c) having your doctor tell you that the risk of X is high enough that he needs to run a test is one of the least pleasant experiences to undergo, and (d) no test is 100% reliable. Therefore, while some people will get a false sense of security, other people will falsely be told they have a disease. The more tests you do, the more people will falsely be told they have a disease.

Posted by: David Nieporent | April 8, 2007 11:49 PM

David, you completely ignored the main argument I advanced: That unnecessary tests cost insurers far less than unnecessary prescriptions. There's nothing more than anecodotal evidence regarding how much defensive medicine costs us. The articles I presented have hard facts that guidelines promulgated for and by the pharmaceutical lobbying machine have cost insurers and taxpayers billions of dollars in potentially unnecessary prescriptions. You're worried about whether a single person is falsely told they have a disease; the pharmaceutical lobby may have falsely told millions of people they have a disease. And while the individual can have a second colonoscopy done, the millions will just take prescription drugs for the rest of their lives.

Posted by: Justinian Lane | April 9, 2007 11:00 AM