In most sectors of the economy, new technology usually brings costs down. But the Congressional Budget Office reports that 50 percent of the recent increases in the cost of health care are attributable to the introduction of new technology, including pharmaceutical drugs.
The following is an excerpt from You Can’t Afford to Get Sick by Andrew Weil, M.D. (Hudson Street Press, 2010). In this best-selling book, Dr. Weil, one of the world's foremost authorities on health, wellness and integrative medicine, explains how we can and why we must transform the American health care system to stop making corporations rich, stop making our society poor, and start each of us on the road to optimum health. This excerpt is from Chapter 2, “Exposing the Myths of American Health Care.”
The rise of scientific medicine in the last century was accompanied and enabled by the phenomenal progress of technology. The benefits of medical technology are obvious. The problems it has caused, including the ways it has warped medical thinking, are not so obvious. But they are very real.
The dazzling effect of technology is a major reason for the health care industry’s lopsided focus on disease management. Priorities of reimbursement both reflect and exacerbate this imbalance. Insurance pays for procedures and drugs, not for lifestyle counseling. This must change if we are to contain costs.
The Congressional Budget Office has reported that 50 percent of the recent increases in the cost of health care are attributable to the introduction of new technology, including pharmaceutical drugs. Something is very wrong here, because in most sectors of the economy, new technology usually brings costs down.
Although I think our high-tech approaches are overrated and overused, I am not a medical Luddite. Medical technology is terrific when it is used appropriately. I would never hesitate to use it for the management of severe, critical, life-threatening conditions. But we are using it for practically everything, and it is costing us far too much — not only in expense but also in harm caused. On top of that, it distracts us from the more important goals of disease prevention and health promotion, and it blinds us to the true nature and source of healing, which is an innate capacity of one’s own body.
The various successes of technological medicine have made the concepts of prevention, health promotion, and the simpler modalities of integrative medicine seem lackluster and old-fashioned. Words like the “healing power of nature” sound distinctly out of context in a contemporary health care facility, with its devices, instruments and drugs. To modern ears, they suggest a bygone era when superstition ruled and the light of scientific knowledge was dim. The time-honored concept of treatment as facilitation of an innate process of healing has been replaced by the belief that treatment itself is the cause of healing and of any recovery. Before the explosive development of medical technology, doctors and patients valued more natural, less invasive therapies, even though these therapies sometimes took more time to help the body heal itself. Today, most doctors and patients prefer drastic interventions that give quick results. Admittedly, treatment of disease is much more exciting than ever before — look at the popularity of television shows about hospitals and operating rooms. Who would want to watch shows about doctors discussing diet with patients?
As a rule, conventional high-tech medicine is most appropriate in a crisis. It is effective for the diagnosis and treatment of severe illness and injury, for diseases involving vital organs, and for other dire conditions. On average, however, such cases represent a minority of the health problems that most physicians see — maybe no more than 20 percent. Therefore, the greatest cost savings we can achieve will come from limiting the use of expensive diagnostic and therapeutic methods to those cases for which they are clearly indicated. This means not ordering magnetic resonance imaging (MRI) scans as the first means of evaluating knee pain or headache. It means not prescribing antidepressant drugs to everyone who is sad. It means not sending all patients with coronary insufficiency to operating rooms for angioplasty.
Besides being expensive, high-tech medicine can be risky. For example, X-rays and computed tomography (CT) scans expose the body to ionizing radiation, which increases the risk of cancer. It is speculated that CT scans being done now will result in as many as 2 percent of the fatal cancers that will occur in the next 10 to 20 years. Even mammograms can be dangerous. For women who are at high risk for breast cancer (by family history, for example), the risk/benefit ratio of mammograms may be favorable, but for women between 40 and 49 who do not have a positive family history, risk may overshadow benefit. Nevertheless, the American Cancer Society urges all American women 40 or older to have regular mammograms.
Similarly, some doctors promote routine CT scans of the chest to detect early lung cancer, but here the risk/benefit ratio is clearly unfavorable. I have known several lucky individuals who were found to have early, treatable malignant lung tumors on CT scans, but in the absence of symptoms and significant risk factors — particularly smoking — routine CT scans of the chest are potentially more harmful than helpful.
In addition, indiscriminate use of the new high-tech scanners frequently turns up anomalous findings that have no clinical significance but still draw the attention of doctors, make patients anxious, and lead to more intensive and invasive testing. Patients in these situations are drawn deeper into the world of hospital medicine, where they may be persuaded to accept unnecessary treatments. The end result is even more expense and sometimes grave physical harm. A healthy man in his mid-40s came to me last year in a state of great anxiety because an MRI scan of his brain, inappropriately ordered to evaluate transient dizziness, showed a slight abnormality that the radiologist reported as “probably irrelevant.” All other tests, including a complete neurological examination, were normal. The man was convinced he had a brain tumor or some other sort of time bomb in his head and had gone to other specialists. He now wanted further testing “from head to toe,” including more brain scans. I had to convince him that his only problem was work-related stress and medically caused anxiety.
As if that is not enough to ponder, consider also that costly diagnostic scans are now a mainstay of “defensive medicine.” That is, doctors order them not for medical reasons but to protect themselves from the ever-present threat of malpractice litigation. The percentage of diagnostic X-rays, CT and MRI scans that fall into this category is high, which is yet another reason for the daunting cost of health care in America. In a sense this is a form of preventive medicine — doctors attempting to prevent lawsuits — but it is hardly one that improves health or health care. Reforming malpractice laws would curb defensive practices and may reduce health care costs by as much as 10 percent. Although this would not be a radical change (in the sense of getting to the root of our health care crisis), it would be a step in the right direction.
One of the worst aspects of overreliance on technology is the complacency it can create in patients. Dr. Elizabeth Steiner of Oregon Health & Science University recently noted, “Now there is a general expectation that we can fix anything with a pill or a procedure. People believe they can live whatever lifestyle they want, and we can wave a magic wand and fix the consequences.” Unfortunately, this is exactly what many of the providers of medical technology want people to believe. A Dartmouth University study found that medical centers often advertise unproven treatments and suggest to consumers that expensive technology results in better care. When patients use highly promoted new procedures, however, they are four times more likely to be disappointed with the results than are patients who use more traditional treatment, according to a Duke University study.
To boost sales of their products, drug companies now routinely sponsor direct-to-consumer ads on television and in print media. Such advertising has created a number of new overnight sensations — before the products were sufficiently evaluated by America’s researchers. The arthritis drug Vioxx is an example. It was marketed directly to consumers so aggressively that 100 million prescriptions were written for it before ten studies revealed that it significantly increased the risk of heart attack. It was then removed from the marketplace. America is one of only two developed countries — New Zealand is the other — that allow this seductive type of advertising that has dangerously warped medical practice.
Technology can work wonders, particularly in a crisis, but it is not the source of health and healing and should not be overused or misused in American health care of the future.
A Less Futuristic Future
We must begin to break our dependence on costly, high-tech medical interventions even though it may seem counterintuitive to take a less “futuristic” path to the future. To do so, medical professionals must recognize the limitations of technology and apply that understanding to medical education, research and practice. Also, patients will need to rethink their own beliefs about the nature of health and healing, the role of treatment, and their expectations of medicine. All this can be done. It is being done at a number of progressive medical institutions in America, including the Arizona Center for Integrative Medicine. We train doctors to value low-tech, “high-touch” methods — such as dietary change and breathing exercises — as alternatives to outrageously priced pharmaceutical drugs and other interventions that are much less cost effective. This effort is quickly gaining momentum and is beginning to change medical practice in our country. But its influence on practitioners and the public is still insignificant compared with that of the pharmaceutical industry.
Making professionals aware of the utility and cost-effectiveness of alternative treatments can do little if most patients continue to be infatuated with medical technology and to prefer quick fixes. People need to recognize and have confidence in their own innate power to heal in order to resist the manipulations of direct-to-consumer drug advertising. Only then will they stop demanding faddish new treatments even when their doctors advise against them. They will also need to accept the fact that medical innovation does not always equate with true progress. None of this will be easy, because as the financial climate of health care worsens, the incentive to use new products of medical technology will increase. As Dr. John Santa, director of the Consumer Reports Health Ratings Center, said recently, “Everybody stands to make a lot of money using the newest drugs and devices. The whole business model is oriented toward rewarding the new and different.”
I would like to see the use of high-tech medicine become a specialty rather than the norm of all practices. Just as trauma management is now concentrated in specialized facilities (Level 1 trauma centers) that serve large regions, we might best reserve high-tech medicine for large, specialized hospitals serving major population centers. Common health problems would then be treated elsewhere in more cost-effective ways. Economics will likely drive this trend. Smaller hospitals and rural health centers will simply not be able to afford the most expensive technological hardware. They will either go out of business or be forced to offer a different kind of care, one based on integrative medicine.
To solve the vast majority of medical problems, we do not need a lot of expensive hardware. It is possible — and often easy — to support the body’s own capacity for healing by addressing lifestyle issues and by drawing from a vast array of more natural, less invasive, safe and effective therapies not currently included in the education and training of our health professionals.
Reprinted with permission from You Can’t Afford to Get Sick, published by Hudson Street Press, 2010.