When Less Care Is Better

David Leonhardt has a smart column in today's NYT that takes on the "more care is better" idea with some cold, hard facts. Leonhardt frames his story on the idea that we need to say "no" a lot more, starting with CT scans, and more.

It’s not just CT scans. Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people believe they reduce heart attacks. For many patients, the evidence suggests, that’s not true.


Advocates for less intensive medicine have been too timid about all this. They often come across as bean counters, while the try-anything crowd occupies the moral high ground. The reality, though, is that unnecessary care causes a lot of pain and even death.

Being the economics writer, Leonhardt's focus is on keeping costs down, but there are benefits for individual patients here, too. It's worth remembering that a lot of this care comes in late-stage disease, when the margin for improving lives is slim - in fact, when late-stage interventions can often be detreminental to life.

We tend to think that throwing more resources at a problem can solve it, but just as that doesn't work in technology - see the myth of the man-month - so it can be ineffective in healthcare. But actually convincing people that they're wrong on this point - which we feel in our bones, despite the evidence - will take some work.

UPDATE: A nifty comment on the same article from Health Beat: "...An increased focus on learning to communicate risk and benefit effectively and by ramping up the patient’s role in decision-making will be far more important in reducing health care costs than learning to “say no.”"

Thomas Goetz1 Comment