More not always better

More Care Is Not Always Better

What’s the Issue?

It is easy to assume that the real problem with the healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money in the system. But what does the evidence show? What is the right amount of healthcare? And what kind of care are Canadians getting?

A growing number of studies show that more healthcare is not always better and the more expensive drug is not necessarily the right choice. In fact, the evidence suggests that sometimes more care, care that you don’t need, can be harmful and expose patients to unnecessary risks.

So what is the “right amount” of care? Getting the “right amount” of healthcare means that you are getting as much care as you need, but no unnecessary care. Here are some examples: Getting antibiotics for an infection that is helped by antibiotics is the “right amount” of care. Getting antibiotics for a condition that is not helped by antibiotics – such as the common cold – would be unnecessary care. Staying on schedule with the preventive care and screening tests that are recommended for your age and health condition is the “right amount” of care. Having preventive care and screening tests more often than recommended would be unnecessary care.

Evidence

Ben Goldacre: Battling bad science. A good, accessible summary of how to pick out good versus bad science, and the issues in pharma research, how patients and doctors are “sold” drugs using bad science - told in most entertaining way.

See the Canadian Health Services Research Foundation Mythbuster focused on the Myth: C-sections are on the rise because more mothers are asking for them.

Synopsis: The rate of Cesarean sections performed in Canadian hospitals has increased by nearly 10% from 1995–1996 to 2008–2009, and it’s not because women are clamoring for them. The preferences of physicians, not maternal preferences, are driving the numbers up. Many obstetricians believe that C-sections are as safe as natural childbirth. A belief not supported by scientific evidence. Surgery always has risks. Canada’s healthcare system could save close to $25 million if the rate of first-time, let alone, repeat C-sections, could be reduced by 15%

Steven Birnbaum, a radiologist notes: A spiral scan of the abdomen or pelvis exposes a patient to about 10 mSv of radiation. The risk of one or two studies is negligible. But in young patients, five of these studies exposes a patient to the amount of radiation that produced carcinogenic effects in the atom bomb survivors of Hiroshima and Nagasaki. In the United States, an estimated 60 million CT studies were done in 2006. Many doctors-including radiologists-have limited knowledge of the doses and of the potential consequences of the massive increase in diagnostic medical radiation exposure

Charles J. Wright, a Canadian surgeon argues in the article Too Much Healthcare We: We Can’t Afford Life’s Creeping Medicalization that “the dangers of over-treatment intensify with advancing age. The pharmaceutical potpourri currently being swallowed by many seniors is an alarming indictment both of the power of pharmaceutical advertising and of the prescribing habits of the medical profession. It is not unusual for seniors to be taking a dozen drugs or more (most of them prescription); in 5 percent of hospital admissions, drug reactions or interactions are the main cause of the patient’s problem.”

Two medical ethicists have recently shown that drugs which pharmaceutical companies market most aggressively to physicians and patients tend to offer less benefit and more harm to most patients.

Healthcare in Canada 2010: Evidence of progress, but care not always appropriate: Regional variations highlight potentially unnecessary surgical procedures.

Atul Gawande, an American surgeon has described the characteristics of McAllen, Texas, one of the most expensive health-care markets in the United States. Here Medicare spends $15,000 per year on every enrollee. Gawande found patients in McAllen got more of pretty much everything (more testing, more surgery, more home care, etc) and he found no evidence that residents were healthier, or the quality of care they received, was better.

Researchers Thérèse Stukel (Institute for Clinical Evaluative Sciences, Toronto) and Graham Woodward (Cancer Care Ontario) addressed the question “In Healthcare, Is More Always Better?” in the Canadian Health Services Research Foundation Researcher on Call Series:

See the Canadian Health Services Research Foundation Mythbuster focused on the Myth: In Healthcare, More is Always Better. Note: the Mythbusters are a series of essays giving the research evidence behind Canadian healthcare debates . Synopsis: when it comes to invasive procedures, and even diagnostic testing, “less is more…and better.”

A recent report from the Health Council of Canada highlights the need for more monitoring of drug safety and effectiveness in Canada noting that while pharmaceuticals can offer significant health benefits, “there are also many risks associated with their use.”

See the Canadian Health Services Research Foundation Mythbuster focused on the Myth: Generic drugs are lower-quality and less safe than brand-name drugs.

Synopsis: medicinal or active ingredients must meet the same Health Canada standards whether the drug is a generic or brand-name.

Health Council of Canada points to over-use of diagnostic imaging in Canada, which raises concerns about patient safety:

The Canadian Agency for Drug and Health Technologies showed an over-use in blood glucose test strips, which greatly increases costs without providing any benefit:

See also from the Canadian Health Services Research Foundation: Reference-based drug insurance policies can cut costs without harming patients.

Synopsis: Reference pricing of drugs is one successful way for insurers to cut costs without negatively affecting patients, allowing public funds to be better spent on effective treatments.

The BC Therapeutics Initiative analyzed available evidence to determine if the benefits of statins outweigh the harms in people without proven vascular disease. They concluded that statins do not have a net health benefit for disease prevention and this use does not represent a good use of scarce healthcare resources.

The BC Therapeutics Initiative conducted a similar review of the evidence on the risks and benefits of new antipsychotics when used by children, use which has been rising rapidly. After reviewing the evidence the report concluded: “ Physicians and parents should be especially cautious and concerned when considering using these drugs in children.”

Recommended Reading On More Care Not Always Better Care From The Health Council

Our Commentaries (Read All)

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Why heart health is not just a numbers game

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