Here’s a transcript of the Presidential Address given to the 9th Congress of the International Federation for the Surgery of Obesity by Henry Buchwald, M.D., Ph.D., in which he touts bariatric surgery as a way to control skyrocketing medical costs. Now, the good doctor’s concern is admirable, but turning to the likes of him for advice on controlling medical costs is kind of like asking the foxes for advice on how to secure the henhouse.
In a previous post, I pointed out that this type of surgery is far less effective and far more dangerous than most people probably realize. I’m not going to re-hash those arguments here. I’m going to confine my argument to just one point – the idea that weight loss surgery is the solution to soaring medical costs.
The reason medical costs are soaring is simple – it’s because doctors have an obvious vested interest in foisting upon people as many expensive and invasive treatments as they will stand for. And the way to control medical costs for obese people is the same as for non-obese people – stop performing interventions that are of marginal or no value.
Do obese people get more prescriptions for antidepressants than non-obese people? Then let’s tell them the truth – that overall, these pills are NO BETTER THAN A PLACEBO for treating major depression.
(As an aside, why did anyone ever think it would be otherwise? Life is depressing. We’re here, without any explanation, in a universe operating in remorseless obedience to inexorable physical laws, in a world populated by beings ruled by their own selfish desires. We don’t know what we face after death, although I would say the smart money is on annihilation. The central challenge of being human is taking responsibility for one’s life, and finding meaning in a meaningless universe. Why did anyone think there were any chemical shortcuts?)
Do obese people undergo more angioplasties and coronary bypass surgeries than non-obese people? Again, let’s tell them the truth – that overall, these interventions offer NO SURVIVAL ADVANTAGE compared to noninvasive medical treatment.
Do obese people get more prescriptions for blood pressure medication than non-obese people? Once more, let’s tell them the truth – that these drugs are a really lousy substitute for taking care of the bodies we are born with, and if you feel you must take pills to regulate your blood pressure, remember that a gentle generic diuretic will do as well as the calcium channel blockers – for about one-twentieth of the cost.
Do obese people get more prescriptions for cholesterol-lowering drugs than non-obese people? Once more, let’s tell them the truth – that again, these drugs are a really lousy substitute for taking care of the bodies we are born with, and that if you really feel you must take a drug to control your cholesterol levels, the generic stuff is just a good as an expensive name-brand drug.
And so forth.
A study by the Pennsylvania Health Care Cost Containment Council looked at all bariatric surgeries performed in Pennsylvania in the year 2003 and found the average cost for surgery and six months’ follow-up care was $35,643. That’s over $40,000 in today’s dollars. According to this article in JAMA, sixteen million people in this country are considered eligible for weight-loss surgery. At a cost of approximately $40,000 apiece, the bill would come to well over six hundred billion dollars. We ain’t got it.
Why do people think that expanding the power and privilege of the medical profession is the solution to a problem created by medical hubris in the first place? It makes no sense, no sense at all, to spend hundreds of billions of dollars we don’t have, in order to control skyrocketing medical costs. That’s like try to drink your way into sobriety.
Photo via Wikimedia Commons