David Leonhardt’s column today suggests that maybe I’m not quite as out of touch as I thought I was about the realities of healthcare for most people. His piece is about slow-growing, early-stage prostate cancers, and to make a long story short, it turns out there are lots of different treatments for it but pretty much zero evidence about which one works best. However, the price tags range from about $2,000 for doing nothing (“watchful waiting”) to $50,000 for the latest whiz bang proton radiation therapy.
A fascinating series of pilot programs, including for prostate cancer, has shown that when patients have clinical information about treatments, they often choose a less invasive one. Some come to see that the risks and side effects of more invasive care are not worth the small — or nonexistent — benefits. “We want the thing that makes us better,” says Dr. Peter B. Bach, a pulmonary specialist at Memorial Sloan-Kettering Cancer Center, “not the thing that is niftier.”
When I read about healthcare, pretty much the only thing I hear is that everyone wants infinite amounts of it. And they always want the latest and greatest stuff.
Not me. My motto is, “That healthcare is best that cares the least.” Or something like that. Basically, I prefer to get the minimum reasonable amount of healthcare possible, and I have a strong preference for the simplest, oldest, best-known treatments. I’m not exactly a fanatic about this, but generally speaking I think that most new treatments turn out not to be nearly as effective as we think, and the more time you spend around hospitals the better your chances of catastrophe.
Does that make me an outlier? It seems like it. But maybe the difference is just information: I read an awful lot about this stuff, and it’s convinced me that there are dangers to overtreatment just as there are dangers to undertreatment. Leonhardt’s “fascinating series of pilot programs” suggests that with better information, more people might agree.