May 23, 2018
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Medical experts can help curb costs

By Dr. Erik Steele

If it really ticks you off that a panel of medical experts recently suggested many women may need fewer mammograms than has been recommended in the past, then put your head in the mammogram machine and gently tighten the screws until you smarten up, because those experts did just what we want them to. Without cool, objective, analytical reviews of the health care we get, we can’t figure out what care is really helpful, and what care does more clinical and economic harm than good.

There’s a lot at stake in that distinction. For one thing, almost every treatment has some downside to it, such as a complication. In addition, if we stopped wasting so much of the $4 trillion-plus we spend on health care here every year, we could provide affordable health insurance to every American without spending an additional nickel.

But where’s the waste? Which tests and treatments may not help as much as we hope? That’s where expert panels such as the United States Preventive Services Task Force (the “mammogram” panel) come in. They sift through the reams of data about whether different treatments and tests do more than seem like a good idea, more than just find diseases, but also actually save lives in significant numbers.

They look past the experience of individual physicians and patients to large studies involving lots of patients, because what works for some patients is sometimes unreliable for telling us what will help most patients. These experts operate in a relative vacuum of emotion and bias around difficult issues such as breast cancer, because emotion and bias warp our judgment.

The list of what expert panels and the studies they review have helped us figure out is huge and grows weekly. Without them to help guide us, we might fail to give many of the vaccines that save thousands of lives a year in America and keep doing many unnecessary surgeries. We might not know which studies are solid and credible and which are fronts for pharmaceutical and medical device companies. We might not know the up and down sides of testing for disease, e.g., that for every case of invasive breast cancer found in low-risk women age 40 to 49, about 556 women must have mammograms, 47 must have additional imaging studies done, and five must have biopsies.

The complications of medical tests or treatments may be minor, and may also include death or disability. But treatments and tests of limited or no value to our health also cause economic complications. Health care costs now are largely a closed system; every dollar we spend on one bit of health care is a dollar lost to some other priority. Health care waste comes at a cost of less affordable health care, which means some patients will not get care they need because of prohibitive cost. The highest health costs in the world also mean the loss of effective wage increases, loss of American jobs and much more.

Most of us with insurance from our employers will now spend thousands of dollars each year out of our own pockets on our care; an expert panel recommendation might help us avoid spending the equivalent of a couple of house payments on an unnecessary test.

You can ignore expert panels and ask your own doc about this stuff, but often individual docs are not sure about some of it until the experts sort the tons of data for us. Our experience is too small and it may bias us. So may our medical specialty. We cannot keep up with the 4,000-plus medical articles that come out every week telling us something new. What we can do is weave together what we know from experts, learn from experience and know about you and what’s important to you, into advice for you.

So the next time some panel of experts trolls through the data and tells us that some kind of care we have been getting for a while might not be the best care, don’t shoot the messengers even if the message makes you uncomfortable. We all need every bit of objective help we can get figuring out what health care is really worth having, because a lot of it is not.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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