The medical industrial complex and the surge of health costs

“Hey doc, I saw on an ad on the TV last night about this new asthma inhaler.  Shouldn’t I give it a try?”

This type of question would occur several times a week.  When I started practicing medicine it was considered unethical to advertise medical treatments.  Now, we’re bombarded with enticements for tests and treatments.  The inhaler the patient requested cost $264 a month — more than double what he was currently paying for an effective generic inhaler.

Somehow, we have brought into the hype that more is better, and that if you would just get your mammogram or PSA, that early detection would prevent cancer deaths down the line.  A recent study in the British Medical Journal found that the death rate comparing mammography with annual breast exams was no different.  And a significant number mammography patients went though additional surgery, radiation therapy, or chemotherapy — which was unnecessary.  The effectiveness of PSA monitoring remains controversial, and many prostates are being removed where the negative effects far outweigh a theoretical possible benefit.

The evening news ads bombard us with “low T” warnings and erectile dysfunction treatment promotions.  Somehow, testosterone experimentation is happening, much like the era of  hormonal replacement for all menopausal women.  The warnings of these drugs like blindness, rising PSA, or stroke are gentle spoken while watching loving couples swimming or smooching.

A friend is now monitoring her glucose daily, even though she is barely pre-diabetic.  Somehow, she feels the need to be constantly monitored for the condition she does not (yet) have.

A 90-years-old wants his cholesterol checked.  He’d like a drug for it that he saw on TV.  Really?

Most of now have a medically attended birth and medically attended death.  We now have the benefit of effective medications for blood pressure, diabetes, and abnormal lipid panels.  But the medical industrial complex wants us to be major consumers – more visits, more tests, more surgeries.  There is some evidence that may be making the industry nervous as health cost increases seem to have leveled a bit.

The industry to struggling a bit to bring out new blockbuster billion dollar drugs.  The dollars that go into the health care system are coming from our pockets and insurance premiums.  Given the waste and inefficiencies in health care delivery, this hurts the entire economy and has allowed the medical-industrial complex to become bloated.  Obviously a balance is needed.

There is bloat in duplication and overuse of high tech equipment.  The only way to pay off a new scanner is to run more tests.  The incentives are to do more in the fee for service system.  Pharmacy and device sales reps abound in doctors offices and hospitals.  Ethical lines are blurred when free meals and paid lectures are offered to MDs by the industry.  TV and magazine ads drive up cost and utilization.  Administrators want a lucrative bottom line.

Interestingly, we seem to be at a break point in terms of medical costs.  More is being shifted to patients as companies offer only HSA plans and often high deductibles.  More doctors are becoming salaried.  Malpractice settlements have peaked and appear to be declining with subsequent savings in malpractice premiums.  More efficiencies appear to be evolving.  The Congressional Budget Office has reduced its estimates of Medicare spending by 12% (109 billion) by 2020.

My concern is the that medical industrial complex will become even more aggressive.  The possibilities will be more ads, direct mailings, “free” screenings, discounted surgeries, false claims of testing and treatments, etc.

My advice:  be a careful and cautious consumer.  Don’t become medicalized.  And to the medical profession:  be more proactive countering the barrage of biased information we hear and see daily.

Jim deMaine is a pulmonary physician who blogs at End of Life – thoughts from an MD.

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  • JPedersenB

    Wow, I wish we had more doctors like you!

    • James deMaine

      Thanks, though I don’t think I’m in a minority. I think most doctors don’t like the direct advertising and promotions that the medical/pharmaceutical industry is carrying out.

      • JPedersenB

        I certainly hope that you are not in the minority but you must admit that the influence of Pharma in medicine is way too pervasive. Between the lunches, trips, CME, the loading of guideline committees with those friendly to the drug industry, etc., I have lost hope that doctors can actually present an independent viewpoint….

        • James deMaine

          Perhaps lack of trust in doctors is more of a cultural milieu problem created by our confusing and conflicting “system” of health care in th USA.

          I worked at Group Health Cooperative in Seattle – a consumer owned health system in which the physicians were salaried with modest incentives for quality of care. There was no incentive to do unnecessary scans, colonoscopies, etc. We used pharmacists and expert panels to outline “best practices” for use of medications, testing, and procedures. There’s no perfect system, but our patients generally trusted us because they felt we had no hidden agenda.

          I hope you can find a primary care MD whom you can trust to help you navigate through the confusing path when specialists are needed.

  • Eustice Seeney

    Maybe if thy put the crummy side-effects at the beginning of the TV commercial . . .

    • James deMaine

      Good idea! The way it’s done now is really a violation of the informed consent process. What if a surgeon advised a procedure and then sent you to a spa where you could listen to the downside and side-effects of the surgery – all in a soft spoken background voice with music, while you were getting a massage!?

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