North Carolina’s General Assembly went home last week without coming up with a way to deal with the projected shortfall in the state’s employee health care program.
    When the legislators come back next year they might want to take a look at some radical ideas for saving health care dollars proposed by UNC medical school professor Nortin Hadler in his new book, Worried Sick:     A Prescription for Health in an Overtreated America.
Hadler would restrict funding for medical procedures that have not been scientifically proven to provide positive benefits.{mosimage}
    What kinds of procedures is he talking about? Surely not the ones that many think have given us better health and extended our lives like:
    •Coronary artery bypass grafts, angioplasties or stents to save lives or improve symptoms;
    •Arthroscopy for knee pain;
    •Any surgery for backache;
    •Statin therapy to reduce cholesterol and thereby save lives;
    •Newer antidepressants for situational depression;
    •Drugs for decreased bone density;
    •PSA screening and radical prostatectomy to save lives;
    •Screening mammography to save lives;
    •Many a cancer treatment to save lives;
    Hold on to your hats. These are exactly the kinds of treatments that Dr. Hadler would limit. According to Hadler, when these procedures have been subjected to rigorous scientific measurements of their impact on large groups of patients, their demonstrated favorable results are minimal or negligible.
    Hadler’s conclusions run counter to the individual experiences of many of us. We know people who have regained strength and good health after heart, back or knee surgery. We have heard testimony from people with family histories of heart disease testify to their improved cholesterol counts thanks to the statin drugs their doctors prescribed. We have seen friends suffering from depression improve after taking one of the new drugs. In response, Hadler tells us to look at the numbers — the ones that show the results, over time, of these treatments as they are compared with the results where these treatments were not given.
    In Worried Sick, Hadler sets out his version of “the numbers.” Chapter by chapter he lays out the results of “double blind” surveys that have evaluated these and other popular treatments. According to Hadler, the purported benefits of these treatments, often costly and sometimes risky, do not stand up to the scrutiny of these tests.
    In many, if not most, cases a doctor’s recommendation or performance of these treatments is what Hadler calls Type II medical malpractice. There are two kinds of medical malpractice, he explains. Type I is “doctors doing the necessary unacceptably poorly.” Type II is “doctors doing the unnecessary, albeit very well.”  
    It would probably take a well-trained statistician to evaluate properly Dr. Hadler’s summaries of the results of the multiple surveys he uses to show that these treatments are “unnecessary.”
But assume for a moment that he is correct. If these treatments (and other similar ones) are really unnecessary, Americans are wasting a lot of money to pay for them. So is the North Carolina state health plan.
    Hadler presents a detailed proposal for health care reform. Its key feature would severely limit reimbursements for any treatment that does have significant positive benefits as measured by rigorous scientific evaluation.
    Worried Sick is a long book. Sometimes there is “TMI” (too much information) to make for easy reading and understanding of Hadler’s important main points. But anyone who wants help in evaluating any one of the treatments will welcome the details that Hadler provides.
    More important perhaps, Hadler’s challenge to the value of these treatments demands a response from the physicians, pharmaceutical companies, and others who sell these treatments’ benefits and urge us to “take advantage” of them.
    I would like to hear their rebuttal — point by point.
    And, maybe our legislators would also like to hear what they say.

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