April 22, 2011

∴ Health Care Follies

I visited my doctor this week. Just a routine physical exam this time, and apparently I'll make it another year. During the visit we had an interesting conversation about the cost of health care in America, and something he said struck me.

We were talking about heart disease and how the health care industry attacks it. For patients presenting symptoms of approaching heart illness such as angina, he's a fan of a diet published by Dr. Dean Ornish in 1990. The diet is a departure from the contemporary American one, which is high in saturated fats and simple carbohydrates.

My doctor quoted a medical study that uncovered a significant benefit from adopting the Ornish diet.

In this study, 28 patients followed the Ornish program (as described in the Principles section above), while a control group of 20 patients followed conventional dietary guidelines for heart disease (including restriction of fat intake to 30% of calories and cholesterol intake to 200-300 mg per day). After one year, the patients in the Ornish program showed a significant overall regression of coronary atherosclerosis (as measured by quantitative coronary arteriography), while, in the control group, atherosclerosis progressed. Patients in the Ornish group reported near complete relief from angina (chest pain), a likely result of increased blood flow to the heart. (Ornish, 1990)

In other words, adopting this diet can save a patient's life. And yet, as my doctor told me, the number one medical response to symptoms of approaching heart disease is not to send the patient home with diet counseling, or referral to a dietician, but rather a cardiac catheterization, often followed by implantation of a stent.

While the stent is valuable as a temporary fix for a blocked artery, it does nothing to move the patient into a healthier lifestyle. The artery can re-close as the patient continues his unhealthy diet. For patients who don't yet have near-completely blocked cardiac arteries, a lifestyle change is the better treatment plan.

My doctor would like to go the diet route, but as he says, if the patient fails to adopt the diet (likely) or is too close to a completely blocked artery and suffers a heart attack, a lawsuit for failure to follow the established procedure will result. Wanting (needing) to avoid a costly lawsuit, the doctor's hands are tied. The very expensive procedure is prescribed even though a far less costly, and proven, treatment exists.

We do a lot of unnecessary process in public life. Much of it is aimed at Covering (Y)our Ass, because Americans as a group don't forgive, they get even. Lawsuits are the usual result.

The question is, how do we limit litigation to what's reasonable while retaining the right to redress under the law, and how do we define "reasonable?" Or, more directly, how do we tell people that sometimes they will suffer the pains of their own ignorance, and it's their own damn fault?