You do not have to look far to understand why U.S. health care is so expensive and uneven in quality. A recurrent offender advertises walk-in ultrasound testing of blood vessels and whatever other asymptomatic part you may choose to pay for. Worried older folks can feel lucky that it appears that Medicare would reimburse for the tests. But in fact, the whole course of tests and treatments encouraged by these ads will not improve your life expectancy — and could even have some chance of decreasing it.
Shouldn't we read these solicitations as symptoms of a very readily eliminated illness that plagues our health care system? An asymptomatic 65-year-old found to have an arterial abnormality in this mobile horror chamber is almost certain to succumb, eventually, to something else. That is, of course, unless you are told of it, go to your doctor scared, and your doctor injudiciously arranges an angiogram or a procedure. And so this harmfully profiteering practice of persuasion keeps our country's medical wheels turning.
It is worth wondering: If this test is medically indicated, why has the doctor not already ordered it? And if the testing is done and produced a normal result, the question of how often to get rechecked could arise.
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One person in the ad tells of having a narrowing of the carotid artery (one of the two main arteries in the neck that go to the brain) discovered and therefore having an operation to correct it. That is very bad news for both patients seeking quality care and a country looking to control health costs. That expensive operation carries a risk of stroke and is only done in selected cases, almost never on someone totally asymptomatic (apparently the case with this patient). Money was wasted and the patient needlessly endangered.
This is not an argument for denial. Another smiling patient in that offensive advertisement is said to have had an aortic aneurysm found and repaired, which certainly could have saved his life. Not said was how urgent the aortic abnormality was, or whether cofactors such as obesity, hypertension or cardiac disease, which commonly coexist with aneurysms, might have tipped off the family doctor that the test was needed. Yet, even if a panel of doctors were to recommend that every adult have their aorta imaged to rule out the rare spontaneous aneurysm, responsible doctors surely would not recommend imaging the carotid artery in a patient without symptoms.
Is this advertising really so bad? Everybody takes ads with a grain of salt these days — right?
No. This is harmful profiteering. In "Selling Sickness," Ray Moynihan and Alan Cassels state: "With promotional campaigns that exploit our deepest fears of death, decay and disease, the $500 billion pharmaceutical industry is changing what it means to be human ... Because as Wall Street knows well, there's a lot of money to be made telling healthy people they're sick." The creation of this market for well people has been an explicit, aggressive strategy by drug companies. They document this in conditions ranging from high cholesterol or high blood pressure to attention deficit disorder, osteoporosis and "premenstrual dysphoric disorder."
There may be medical aspects to these conditions. The problem is that the routine of prescribing an expensive medicine with possible side effects, or doing a serious, risky operation, has become accepted by doctors and is expected by the public far in excess of a reasonable likelihood of benefit.
Moreover, these ads are expensive. The country can little afford the money spent by profitable hospitals, clinics and testing facilities to drive up their market share through advertisements. That money is needed by our health care system to extend coverage that will keep people healthy and protected from medical bankruptcy, and to help the nation's finances.
Other developed countries prohibit such medical advertising. There are good, responsible medical newsletters in the U.S. that help people think about their options realistically (although we could do better). Media fests about testing and treatment controversies highlight our lack of an authoritative national process for determining optimal care and publicizing that information.
Nevertheless, preying on people's weaknesses and fears to try to influence how they choose their medical care is ridiculous, harmful and expensive. It is time to stop it.
Dr. James Burdick, a professor of surgery at Johns Hopkins University School of Medicine, had a career as a transplant surgeon and was director of the Division of Transplantation in the Department of Health and Human Services. A frequent op-ed contributor on health care issues, he is writing a book detailing his doctors' plan for health reform. His email is email@example.com.