A ‘Beloved Beast’

Posted Sept. 20, 2009, at 6:19 p.m.

Medical technology is both a marvelous benefit and a terrible curse. It can cure disease and postpone death. But at the same time it greatly increases the skyrocketing cost of our health care system.

The constant introduction of new medical devices and procedures and wonder drugs accounts for half of the 7 percent annual increase in our total health care cost.

Curtailment of waste, fraud and abuse sounds sensible but has little promise of success. The main — and correctable — source of the cost increase is the seemingly endless flow of expensive new drugs, devices and procedures: cancer and Alzheimer drugs, all sorts of imaging devices, cardiology procedures, and the replacement of knees, hips, shoulders and other body parts.

Yet almost nobody — not patients, not physicians, not hospitals, not academic analysts, not government officials, not industry and certainly not members of Congress — dare tread such treacherous ground and question the nearly universal belief that “no matter what the cost,” “there is never enough” and “better safe than sorry.”

One who does seriously consider this cost-benefit crisis is Daniel Callahan, a research scholar, whose book, “Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System,” was published this month by Princeton University Press. He is a specialist on ethics and health policy and the author of 41 books. He lives in Hastings-on-Hudson, N.Y., and spends his summers on Little Cranberry Island.

Dr. Callahan concentrates on what he calls “the use and over-use of technology,” especially when devices have only a minimum or speculative prospect of success and when they can extend an elderly person’s life by only a few weeks or months. He compares the agony of seeing loved ones suffer with the death of multitudes through an underfunded national system.

He explains the almost uniquely American preoccupation with always new and better medical technology in terms of pressure by what could be called the medical-industrial complex with its high-pressure advertising and promotion of new and scary ailments and expensive therapies to deal with them. Patients demand what they are taught to believe are the best and the latest. Direct-to-consumer medical advertising is rejected by every other country in the world except New Zealand.

Callahan’s solution is not rationing of medical technology. Instead, he proposes a cost-control campaign, required economic impact statements by industry, a federal cost control office that would assess medical technology and “commend rather than command” cost control strategies. He would provide incentives and higher pay for primary care and family medicine physicians with emphasis on low-cost treatments and technologies and disease prevention.

As Congress tries to shape a new health care system, it will do well to consider Dr. Callahan’s analysis and proposals.

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