Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health care has far too many medical panels

Rocky Bilhartz, MD
Conditions
August 10, 2016
203 Shares
Share
Tweet
Share

We are assembling too many panels of people in the name of health these days. Too many.

They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.

I might have been wrong.

There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.

I was wrong because the medical world is now full of panels. And, paradoxically, it seems more confusing and arbitrary than ever before.

Recently, I’ve taken some interest in economics. I thought I understood it before. That was when I didn’t understand it at all. I used to believe the goal was to create jobs, since jobs obviously drive the economy. I was almost on the right track. Until I realized I wasn’t tracking at all.

Productivity drives the economy. Producing more with less time makes us more prosperous. And, through increased prosperity comes improved standard of living, better health, and so forth.

Creating any job isn’t the goal. I could hire you to go around breaking stuff. This might lead to more work for the glass maker, but squandering wealth is not a path to prosperity for any society. Jobs aren’t the goal. It’s more productive jobs.

But, I’m no economist, so I’ll stop there. Instead, I’ll return to what I do know. It will add more clarity to what I’m trying to explain.

A medical practice advisory was published recently. It came from a panel at the American Academy of Neurology (AAN). But, the Who doesn’t really matter here.

The AAN is not a governmental organization; although, like a myriad of similar organizations in health care, it maintains close ties.

According to its website, the “AAN offers positions in Accounting, Marketing, Communications, Digital Development, Research, Health Policy, Information Systems, Project Management, Administration, Human Resources, and more.”

I presume all of these job opportunities have been fiercely crafted to directly help real patients with actual neurological issues, but if not, I would propose this epitomizes the entire problem with our current medical system.

We’ve turned it over to somebody else — to lobby on behalf of someone else — to decide what is good for us.

I have no real issue with the existence of the AAN or other medical trade associations like it. A group of people should be able to organize for whatever cause if done in peaceful fashion. I’m just pondering what society truly gains from having a system full of various entities geared toward monitoring “state and federal legislation, educating lawmakers about high-quality patient care, and advocating for better policies.”

Said another way, I’m just struggling to understand how the solution to our health care crisis will come from more panels designed to influence the government’s mammoth-sized $3 trillion medical machine.

I keep thinking about how productive jobs are the goal.

Every five years, the U.S. government updates national dietary guidelines. They are used, in part, to shape school lunch menus and the $6 billion a year Women, Infants and Children program. You may have missed it last year, but at least 60 groups and various panels spent more than $15 million lobbying on what the final rendition of these dietary guidelines should say. The American Bakers Association, the Beer Institute, the Livestock Marketing Association, and so on. You just can’t make this stuff up.

We seem to have reached a point where both the means and the end of our federal health machine have led to an end of all its meaning. The panels making decisions “for us” are more accurately making them “to us” with each passing day.

But, I digress; I’ve left you on the edge of your seat. I still haven’t told you about this AAN practice advisory. So, here it goes:

The panel warned against the routine closure of small holes in the heart (known as PFOs) to prevent recurrent strokes of uncertain cause.

Now, the advisory itself wasn’t all that earth-shattering. It was a little humorous. Mainly because an FDA panel just voted to approve this therapy for the exact same indication! Once again, another panel. I nearly rest my case.

But, what really caught my eye about this advisory was the reasoning used, by the panel, for their decision.

The panel actually agreed that data showed a significant reduction in recurrent stroke in patients receiving PFO closure — the very same procedure they were advocating against.

But, they said the number needed to treat (NNT) to prevent 1 stroke during 3 to 4 years of follow up with this procedure was 56 patients. The NNT was 56.

The panel wrote, “Although this result [in favor of PFO closure] is significant, the precision of the pooled studies is consistent with a magnitude of benefit that many would deem unimportant.”

The panel recommended against routine PFO closure.

Not because it wasn’t beneficial.

But, because the panel thought they should decide what magnitude of benefit might be acceptable to you.

The NNT (calculated from randomized controlled trials in medicine) is a fascinating concept. The higher the number, the less absolute benefit thought to exist for a population of people receiving the therapy.

This panel decided that a NNT of 56 was too high for you. It was too little of a benefit.

But, do you have any idea what magnitude of benefit exists for other panel-approved therapies for stoke prevention? I almost hesitate to tell you.

For secondary prevention of stroke using aspirin only, one study pegged the NNT around 217 at 1 year. For secondary prevention of stroke using clopidogrel (Plavix) instead of aspirin, the number needed to justify its added benefit was 221 at 1 year.

In fact, if implemented broadly, the panel’s reasoning would seem to effectively rid medicine of nearly every potentially helpful “evidence-based” treatment currently available. All the while, of course, numerous government funded panels are being assembled to grade and pay doctors on their ability to document how successful they are at getting patients to use these very same therapies.

Our system is at the pinnacle of arbitrariness. And, it’s inviting more ambiguities, errors, and obfuscations with each passing day.

The real choice for any therapy should be yours. Not some panel’s. Not some mammoth machine’s. It should be yours to make with your doctor. Yet, almost nothing I’m aware of in Washington is seriously being pursued that would give this choice back to you. Not from the left. Not from the right.

Instead, the Who, saying the What, is completely burying the You and the Me. It’s burying us 6 feet under — in the name of helping us live.

Rocky Bilhartz is a cardiologist and the author of Finding Truth in Transparency: Our Broken Healthcare System and How We Can Heal It. He can be reached at BilhartzMD.com.

Image credit: Shutterstock.com

Prev

Caring and dedicated physicians are being driven out of medicine

August 9, 2016 Kevin 18
…
Next

Electronic hell records are here. Watch and weep.

August 10, 2016 Kevin 10
…

Tagged as: Cardiology, Neurology

Post navigation

< Previous Post
Caring and dedicated physicians are being driven out of medicine
Next Post >
Electronic hell records are here. Watch and weep.

More by Rocky Bilhartz, MD

  • No matter what Trump does to health care, we must accept an imperfect reality

    Rocky Bilhartz, MD
  • The interference in health care is mesmerizing

    Rocky Bilhartz, MD
  • How butterflies are bad omens for health care

    Rocky Bilhartz, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Major medical groups back mandatory COVID vaccine for health care workers

    Molly Walker
  • The impact of panels early in medical school on informing patient-centered care

    Sangrag Ganguli and Varun Mehta
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Medical trainees need knowledge and education on health care systems and policy

    Daniel Arteaga, MD, MBA and Isobel Rosenthal, MD, MBA
  • The rural health care crisis and medical education

    Nick Richwagen, Evan Chen, and Jacob Riegler

More in Conditions

  • The endless waves of chronic illness

    Michele Luckenbaugh
  • Surviving and thriving after life’s most difficult moments

    Rebecca Fogg, MBA
  • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

    Alexander Rakowsky, MD
  • Lazarus: the dead man brought back to life

    William Lynes, MD
  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Do We Need a Spring COVID-19 Booster?
  • Advances in Diagnosis and Management of Severe Cutaneous Adverse Reactions
  • Are We Losing the Personal Touch Because of the Way We Staff?
  • Orismilast Clears Skin in Moderate-to-Severe Psoriasis
  • Pediatric ICU Cases Becoming More Complex in Recent Years

Meeting Coverage

  • Advances in Diagnosis and Management of Severe Cutaneous Adverse Reactions
  • Orismilast Clears Skin in Moderate-to-Severe Psoriasis
  • New Combinations Promising in Advanced Urothelial Carcinoma
  • No Survival Benefit With CRT Versus Chemo for Locally Advanced Endometrial Cancer
  • Ankle Sprain Physical Therapy Doesn't Shift the Pain Elsewhere
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health care has far too many medical panels
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...