What’s different about healthcare

That’s a deceptive title because when talking about a “free market” for products, there are many things “different” about the health care product.

I touched on a few in yesterday’s entry.

Today I’d like to explore the notion of effectiveness. In my specialty medical oncology, the only way we gauge effectiveness is through large studies of patients with the problem and comparing the outcomes (length of survival, rate of recurrence, etc). In any given patient it’s often difficult, if not impossible, to ascertain whether the treatment has actually worked or not.

For example, consider the patient with breast cancer who has had surgery with the tumor completely removed. If nothing else is done we will know in time whether the surgery cured the patient or not.

But, we often treat these patients with some type hormonal blocker (tamoxifen or another) with or without chemotherapy (called adjuvant therapy in doc talk). This can get quite expensive and is associated with frequent severe side effects.

If treated in this way and the tumor doesn’t recur, in any individual case we cannot know whether the surgery removed it all or the ensuing hormone blocking and/or chemo had some effect. Furthermore, if the tumor does recur later we are unable to determine whether the treatments delayed the recurrence.

The same is true for all other cancer types. In an individual case we simply cannot know whether the therapy given was worth the pain, cost and side-effects, unless large comparison studies of treatments and their outcomes are done.

You can of course say well, if it doesn’t return who cares. But given that tumors often recur and that there are extreme side-effects and greatly decreased quality of life from treatment and yes extreme costs, it’s important to understand whether a therapy works and just how effective it is.

Now to the difference between health care and other products. We spend literally thousands of dollars on treatments for cancer. Single drugs can cost as much as $100,000/year–that’s more than the great majority of people earn in year. In most instances, in cases of advanced disease, the improvement in survival from these agents (take Senator Kennedy’s case for example) is limited, measured in days to a few months. We, our health care non-system spend literally hundreds of billions of dollars for treatment of just these cases.

Can you name another product in this cost range, bought in the free market, that may not work? or may work for only a few days or months? or if it does work costs hundreds of thousands of dollars?

Well, that’s the situation in health care. Our costs are untenable; Our outcomes difficult to measure; and the purveyors of these products don’t want to do comparison studies to figure out what works and how it actually does work.

We do need reform!