1. I’ve ranted for years about the part unnecessary tests and procedures play in America’s outsized health spending, but it’s not just the money. I know men who have had prostate surgery, and the money is the least of it. The heartbreaking part is that research indicates that a lot of that misery was unnecessary. As Art Caplan wrote this week:
PSA testing produces far more misery than good. Positive PSA tests often are inaccurate, detecting only an infection not cancer. As many as 70 percent of men with poor test scores do not have cancer. This leads to lots of worry and unnecessary procedures for the majority of men who will get a false result. Frequently, unnecessary surgery leads to incontinence, impotence or other nasty complications.
Even when cancer really is present in older men the tumor is usually growing so slowly that leaving it alone makes more sense then undergoing surgery to have it removed.
Boston Scientific is a valued local company, but I winced when I read recently that their medication-covered heart stents were no more effective at extending life than far less expensive and invasive treatments, like exercise and a healthy diet. These are thorny, difficult issues, and politicizing them — blaming Obama when a team of scientists reveals PSA tests do more harm than good, for instance — doesn’t help.
2. People’s eyes glaze over when the topic of health care cost-containment comes up, so I’m not surprised that the fine distinctions between legislation supported by Deval Patrick, the House and the Senate haven’t drawn much attention. Even less notice is given to areas where the competing proposals agree. So I was glad to hear from state HHS secretary JudyAnn Bigby
the other day that all the proposals call for the same approach to malpractice tort reform. All endorse the “Disclosure, Apology and Offer”
approach endorsed by the medical establishment (though not necessarily the trial lawyers), a system that has had more success in reducing malpractice insurance costs and litigation without compromising victims’ rights than simple caps on malpractice awards.Under the reform bill, apologies by physicians and hospitals would not be admissible in court, removing a huge barrier to simple honesty and compassion.
I’d say there’s a real good chance malpractice reform will be law in Massachusetts by the end of July.