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
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I gave him, as I gave my new physician (DrB), my Living will. I will Have NO invasive testing, nothing up my bum, or down my throat of into my manhood. I will take no drug created after 1980. No anti-biotics unless Dr. have tested to see if I have a bacterial or viral illness. I am not interested in what the Fascist medical "profession" calls prophylactic medicine. No more "screening for Cancer" and no more tests without my approval. My dentist twice took slabs of gum for "cancer screening." When I found out what he was doing I told him next time he did a cancer screening on me, I would reciprocate on him, using a dull plastic spoon. He got my point and I got a new dentist who is a bit less of a fascist... I think.
You cannot trust your banks, or your doctors any more, so it is time to pull out the cash and dump the doctors. My outlook is simple, unless I am ill I will not call a Dr. and when I do no guesswork, before I prescribed "drugs" I want to read the MSGS sheets and no more of the doctor calling the pharmacy to order I drug I know nothing about.
Thus far I take no regular medication, and do not plan to. My plans are and have been since age 17, when I am given the death sentence, I will accept it, that means NO Chemo. People are just clinging to life as though dying was the end, my family experiences are just the opposite.
RATED PS: I don't know what -1 means, nor do I care.
I don't think it's a bad idea to turn to healthcare providers for advice regarding controlling healthcare costs. I don't think that the ideas of ONE doc should be latched onto and spouted like the Gospel, particularly since the Obama administration doesn't seem to vet anyone especially well.
By the way, there are new bariatric surgeries available that are less risky and less expensive (though I don't think that this is the answer to controlling costs).
There are healthcare providers who push the expensive treatments, certainly. Many of them do so because the Medicare reimbursement rates continue to be cut. In 2007, the Medicare payments received by doctors just barely covered the overhead of running their offices--not including the salaries of the docs themselves. So, in 2007 docs who have practices exclusive to Medicare patients essentially worked for free.
Antidepressants DO work for many people, but they are hideously overprescribed. If you've been depressed for longer than two weeks, you too, can get a prescription. But for these meds to work, the patient needs to be clinically depressed (genuine chemical imbalance), not situationally depressed (I'm ugly, I'm fat, I'm poor, my job sucks, my dog died, etc.).
We've discussed angioplasties and bypasses before, so I won't get into all that again. I will say that these treatments offer immediate relief to those about to perish from seriously blocked major arteries. Non-invasive treatments are ideal, but a big part of the problem is patient non-compliance. And if docs were to deny someone a quad bypass and the patient died, you can bet there'd be a big, fat lawsuit. Juries don't care that the patient wouldn't folow his doc's orders. They care that the patient was denied the bypass and died.
Some people MUST take blood pressure medication, as non-pharmeceutical treatments just don't work for them. And one med is not necessarily interchangeable for another for a particular patient. There are many, many factors involved in prescribing meds. Docs don't get drug kickbacks. They prescribe the new, expensive one because the patient asks for it and because the drug rep told him it was wonderful and because he doesn't have time to explain, thanks to the insurance companies forcing 10-minute appointments just to cover costs.
Cholesterol drugs: of course a healthy lifestyle is better. And I believe in natural supplements (like fish oil) before beginning a cholesterol med. But generic is not always equal to the brand name, especially with certain types of medications.
As for the medical profession creating the situation of increasing healthcare costs: no, they really didn't. We, the patients contribute to it by watching drug ads on TV and insisting that we be prescribed the newest medications. The insurance companies and the government contribute by reducing the amounts they pay docs and hospitals so much that prices have to be raised just to cover the overhead for the services they provide us. Every single year.
Some docs are unscrupulous, true. They're the ones billing Medicare for services they didn't provide, or ordering unnecessary tests. But most docs are just trying to practice good medicine in this new environment that we have created.
Again, Patrick, I think we are in agreement on the fundamentals, but I would repeat my request to you to be careful regarding the type of medical information you disseminate into the internet.
Patients do have the right to understand the treatment being prescribed for them, and they have the right to refuse it, for any reason.
If more patients took it upon themselves to learn about their conditions and their treatments, we'd be a healthier nation with lower healthcare costs.
Whoa, old buddy. Simmer down. I didn't say anything about lung disease at all. And I certainly never said I am against life-saving medical interventions. For the record, I am in favor of saving lives. I am against performing interventions that are of marginal or no value, especially if I have to pay for them. A point I keep returning to again and again is this: 58% of medical expenses in this country are borne directly by the taxpayers. On a per capita basis, that's more than TOTAL expenditures on medical care in all but three other countries.
Regarding the antidepressants: You say you took the pills and you felt better. I have no reason to doubt your word. That's not at all inconsistent with the idea that the benefits, such as they are, provided by these pills are due to the placebo effect. I have found that people who take antidepressants feel terribly insulted when someone says that. It's not an insult to suggest that you may have gotten better under your own power. When you think about it, that's actually a compliment.
Anyway, I said that OVERALL these pills are no better than a placebo. I will stand behind that. The meta-analysis by Kirsch et al. did find that they provided a benefit (albeit often a small one) for a small minority of the most severely depressed patients. Whether or not you fall into that group, I cannot say. I doubt your doctor knows either. Lewis Thomas, Dean of the Yale School of Medicine, remarked that the doctors who prescribe these antidepressants know less about these patients, their hopes and fears and aspirations, than you could learn sitting next to them on a long airplane flight.
Clinical depression, if it exists, must be preposterously overdiagnosed. Currently 5% of men and 11% of women in the United States are taking SSRI's. Clinical depression couldn't possibly be as common as that. Our paleolithic ancestors trekked for miles in search of game, ran down wooly mammoths, and battled giant cave bears -- not to mention each other. They didn't lie down and say "I'm too depressed to go on" -- and if any did, those got weeded out of the gene pool. We were meant to thrive.
As a person living with a chronic illness, I suggest you have as much at stake here as anyone -- maybe more. Every dollar spent on useless interventions is a dollar that cannot be spent on life-saving treatment.
There's more than money at stake here. The medical profession kills 200,000+ people every year. I say 200,000 PLUS because nobody knows the true figure, and as Melody Peterson pointed out in the book Our Daily Meds, nobody seems very interested in finding out. It stands to reason that if the medical profession performed fewer interventions, they would kill fewer people.
Thanks for reading and commenting.
The dirty little secret of the pharmaceutical industry, one that most people probably never dream of, is that many of these new "medicines" do NOTHING for MOST of the people who take them. For example, the West of Scotland study showed that, over a five-year period, men taking Pravachol had a one percent less chance of dying from any cause, and a two percent less chance of a non-fatal heart attack, then men taking a placebo. That means that of every one hundred men taking the drug, ninety-seven received no benefit whatsoever. (Lowering cholesterol is not, in and of itself, a benefit -- it's only a benefit of it enables you to avoid death or a heart attack or some other clinical outcome.)
Why don't they mention this in their ads? "Pravachol may protect you from a heart attack or premature death -- but it probably won't."
Moreover, some of these newer drugs have been approved on the basis of lower cholesterol levels, without showing ANY clinical benefits at all.
Not everyone is as impressed with the "miracles" of modern medicine as you seem to think we ought to be. Having been to Africa, and having met people living in mud huts struggling to survive, I find this fearful, fussy obsession with cholesterol numbers, blood pressure, etc. quite unseemly.
I don't begrudge people these interventions if they really want them. But I don't want 'em. And I don't want to have to pay for someone's expensive name-brand drugs if a generic drug will do just as well. And the burden of proof ought to be on the drug companies. Currently there is no requirement that new medicines be shown to be any better than existing generic remedies before being approved. That needs to change. Despite our differences, I appreciate your reading and commenting.
Good for you. I've often thought what we need is a ribbon for, "Ya gotta die of something."
Thanks for commenting.
The problem with many of these studies is that they are trying to achieve a specific result, having been paid for by someone with a financial interest in the outcome. Yes, even academic institutions.
Additionally, in order to understand the conclusions of studies, one needs to read the specifics, which are long and mostly boring, but important. These studies have very specific requirements as to who is included and excluded, resulting in studies that don't accurately reflect real-world performance.
I do agree that we have drugs that don't do much--if anything--more than generics already available. I also agree that many new drugs (and vaccines) are approved far too quickly, having been inappropriately fast-tracked because of their stated resemblance to other drugs. However, I repeat that generics are not always equal to brand name drugs in every patient. Blood thinners, for example, fall into that category. Test results for certain patients would remain uncontrolled on the generic version, but would level out on the brand name, or a different generic version. Not all generics are equal.
I will also say that a very good friend of mine worked in quality control for a pharmeceutical manufacturer. Problems with the product reported to management were continually ignored, as were violations until an employee ratted the company out to the FDA. Things changed for the duration of the "investigation", but returned to their previous state as soon as the FDA left the plant. I personally take the drug they make there, and I absolutely refuse to use their generic version due to safety concerns.
I will also repeat that clinical depression does exist, but it is grossly overdiagnosed. Until the guidelines for diagnosis are changed, the makers of antidepressants will benefit. Only those with true clinical depression (chemical imbalance) will benefit from the action of the drug. Those who were correctly diagnosed deserve the treatment, regardless of how many are misdiagnosed. The fault lies with the medical profession (who need to change guidelines for diagnosis and institute strict education requirements with regard to prescribing new drugs), the FCC (who need to stop drug advertisements), and the pharmeceutical industry (who need to stop the ads and ensure that docs are better informed about new drugs).
I think that you want to limit healthcare costs. So do I. But we cannot take the easier route and cut treatments that truly work on those they are intended for because they are overprescribed. Instead, we need to change the guidelines for diagnosis, ensure that providers are fully educated about new drugs, stop fast-tracking new drugs, and stop drug ads. We also need single-payer universal healthcare that works in order for providers to afford to spend enough time with patients to properly diagnose and treat us.
To sos: I've said many times in this forum that we need to have a single-payer system of medicine, like they have in the UK, in which treatments are evaluated for effectiveness and those which do not produce clinically significant benefits are not funded. But that will take years. In the meantime, I agree that the Medicare, Medicaid, etc should not pay for any drug which is advertised. That would effectively put an end to drug company advertising. I also agree that new medicines should not be approved unless they can be shown to be better than old medicines, and that the testing of new drugs ought to be done by the FDA, not by the drug companies or the CRO's. The drug companies would do the preliminary studies, but final testing and approval would be carried out by the FDA, which would prioritize drugs for testing based on these preliminary results. Drug companies which displayed a pattern of reporting overly optimistic results for the preliminary studies could be barred from future participation in the process. And finally, the FDA needs to be properly funded by the taxpyers, not by "user fees" from the drug companies.
But most of all, I think people need to see that health is PRIMARILY a product of certain ways of living, and not primarily a commodity manfactured by the drug companies or some government bureaucracy, which they can vend to us or withhold from us at their pleasure.
As always, thanks for reading and commenting.
Hence the warnings to the public in general urging them not to request antibiotics for everything.
If one were to follow your no treatment, no medication plan, I would have died many times over, although I prescribe to the first let your body try to heal itself. Many times it does. It is the times when it does not that are the problem.
I don't blame doctors for wishing to treat cancers, nor patients who chose to try to beat the odds. Those I have known who have dealt with cancers and won (or lost) made their own choices about treatment and each choice has its own set of fears, challenges and requires bravery of the sort I hope I never have to display.
While some doctors are arrogant, and quite convinced that what they were taught in medical school is completely accurate, most I have dealt with are compassionate and rather humble and surely undeserving of the blanket scorn you have offered here for their profession.
On those rare occasions when I do avail myself of the services of the medical profession, I have to say that my interactions with them have been entirely positive. I have not tried to present a balanced description of the medical profession, because what is needed is a balanced debate.
It's an undeniable fact that our Medical-Industrial Complex is driving hundreds of thousands of people into bankruptcy annually, not to mention killing 200,000+ people a year. I say 200,000-plus because nobody knows the true figure, and nobody seems very interested in finding out.
In addition, there is an additional price we pay, one I don't know how to measure, but one which I am sure is there nonetheless. I believe we are giving up yet another little piece of our humanity every time we cede responsibility for our lives to the medical profession. We live in a society in which cutting open a person's abdominal cavity and putting a band around his stomach, or slicing out part of his intestine, is considered normal, and expecting a person to exercise a modicum of self-control is considered, well, nuts. As long as that is the case, I will continued to speak out against the excesses of the medical profession.
Thanks for reading and commenting.