More Medical Misadventures

How to waste money on pointless treatments.

The Chicago Sun-Times announced bad news for medical sorts who've been pushing flu shots on people for lo these many years:

Seasonal flu shots prevent only about 59 percent of infections in adults — not enough to protect people in a global outbreak, a study has found.

The article had the expected sop to the flu vaccine industry:

The disappointing figure on flu-shot effectiveness will probably come as a surprise to many. But it shouldn’t discourage people from getting vaccinated, Osterholm [the author of a study published in Lancet Infectious Diseases] says.

So even if it works only 2/3 of the time, it's still worth doing?  We'll remember that next time the left complains that tax cuts don't always lead to increased economic growth.

The situation could be worse than vaccine advocates admit - some researchers claim that flu vaccine isn't effective at all.  The 41% who catch the flu after getting the shot are disproportionately older and sicker - just the sort of person who'd be most likely to get flu anyway.  One theory is that most people who didn't get the flu wouldn't have gotten it regardless of whether they took the shot or not, because they were already healthy enough to shrug it off.  Vaccine deniers argue that the observed decline in annual flu deaths over the years is due to better hospital care instead of to the vaccine.

The only way to settle such questions is via a double-blind study where nobody knows who got the real shot or a fake shot until later.  Doing that with enough people and seeing how many of each group got sick would indisputably tell us whether the vaccine works or not.

According to the CDC, this has been done once and got about the same results:

Only one large randomized, controlled trial of influenza vaccine has been conducted among an elderly population. During the 1991-1992 influenza season, a group of Dutch people 60 years of age and older not living in long-term care facilities (e.g., nursing homes) was studied (Govaert et al., 1994). In this study, vaccine efficacy was 58% in preventing clinically-defined influenza with serologic confirmation of infection. There are no published studies of the efficacy or effectiveness of influenza vaccines in preventing laboratory-confirmed, serious outcomes of influenza such as hospitalization, primarily because the size of the study would be large, and therefore, such a study is very expensive to conduct.  [emphasis added]

Vaccine advocates scream that the vaccine is so effective that it would be immoral to conduct such a trial - you'd be sentencing people who got the fake shot to death.  Vaccine deniers counter that there are enough uncertainties about how well the vaccine works that recommending it to everyone is immoral - after all, some people have bad reactions to any vaccine so it's only right to make sure it's otherwise helpful.

One thing is certain - getting a better vaccine through the approval process would be so expensive that the current manufacturer has little to fear from competition, even though the manufacturing technology hasn't changed since the 1940's.  The flu shot is what it is, and you can take it by faith or not, as you prefer.

The "Death Panel" Plan

During the Obamacare debates, we were promised that an all-wise, all-knowing, utterly impartial bureaucracy would decide which medical treatments everyone should get - based solely on scientific data, of course.  Being denied treatment would unavoidably be a death sentence in certain cases, so Sarah Palin memorably christened these committees "death panels."

If the panel decides that it's not worth spending taxpayer dollars to treat your cancer, well, it's death for you.  Not only do the taxpayers save money by not treating you, they don't have to pay Social Security after you're dead.

Arguments about the effectiveness of flu vaccine are nothing compared to the raging mammogram debates during the Obamacare follies.  The New York Times updated the mammogram story and argued that mammograms have been oversold:

While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have.

The problem is that there are four kinds of breast cancer.  Slow-growing cancers can be treated successfully whether they're found early via screening or later by examining a breast for lumps.  Fast-growing cancers are deadly no matter how early they're found.  Women with either of these cancers aren't helped by screening.

There are also innocuous cancers that wouldn't grow enough to do any damage or be found during a breast exam.  It's safe to leave them alone, because the woman will almost certainly die of something else before a super-slow cancer got anywhere.

When such a cancer is found via a mammogram, however, no doctor would dare to suggest doing nothing; the women are treated needlessly.  Women with these cancers are harmed by mammogram screening because it leads to surgery they'd otherwise not receive and which, in the final analysis, benefits them not at all.

A final group of cancers grow fast enough to be dangerous but slowly enough to be cured if they're found in time.  Women with these cancers have their lives saved by receiving mammograms - but that is not the case with most women:

It’s important to remember that of the 138,000 women found to have breast cancer each year as a result of mammography screening, 120,000 to 134,000 are not helped by the test.

Out of 39 million women who get mammograms each year, between 4,000 and 18,000 women are helped.  At best, that's .04%.

Medical Politics Writ Large

There's been so much publicity about mammography that it's pretty much impossible to make rational decisions on the subject.  The panel which published the first report questioning the effectiveness of mammography had to back off - too many women went on the news and swore that mammography had saved their lives.

Mammography absolutely can and does save the lives of individual women, but that is not necessarily true for everyone, or even for all women with breast cancer:

Colin Begg, head of the department of epidemiology and biostatistics at Memorial Sloan-Kettering Cancer Center in New York, said that he supports mammography screening and believes that it does save lives. But he agrees that many women wrongly attribute their survival after cancer to early detection as a result of mammography.

“Of all the women who have a screening test who have breast cancer detected, and eventually survive the cancer, the vast majority would have survived anyway,” Dr. Begg said. “It only saved the lives of a very small fraction of them.”

The notion that screening mammograms aren’t helping large numbers of women can be hard for many women and breast cancer advocates to accept. It also raises questions about whether there are better uses for the hundreds of millions of dollars spent on awareness campaigns and the $5 billion spent annually on mammography screening.  [emphasis added]

Five billion dollars is enough money for a medical effectiveness panel to want to cut mammography if it doesn't help.  On the other hand, five billion dollars is a lot of income for mammography specialists, radiologists, hospitals, and equipment makers.  They'll fight just as hard to preserve their incomes as the medical panel will fight to cut them, perhaps harder.

The underlying problem is that "medical science" is a misnomer.  Medicine is a healing art, not a science in the way that, say, physics is.

If you drop two cannonballs of different sizes off the Leaning Tower of Pisa, they will always hit the ground at the same time; this worked for Galileo centuries ago and it would work for you today if you went there and tried it.  Patients and cancers are nothing like as consistent or predictable; they differ so much that there's often no way to know who'll be helped or hurt by any given procedure.

The bottom line is that modern American medicine is a very big business where sales either come from government or are closely regulated by government.  With all that money subject to political whim, is it any wonder that medical folk spend so much time lobbying and rallying sick people to their cause?

The clear fact that modern medicine on the whole does save lives is very nice, but somewhat beside the point of making money for practitioners.  If you're healed, give thanks.

Will Offensicht is a staff writer for and an internationally published author by a different name.  Read other articles by Will Offensicht or other articles on Bureaucracy.
Reader Comments

It does get even more complicated with a vaccine. Even if a vaccine is only 50% effective that can still cause a significant decrease in the morbidity rate of a flu season beyond that 50%. If the there are half as many people sick then there are half as many people spreading the illness.

This is true of all preventative treatments for communicable illnesses.

While we're on the subject of medical beliefs that aren't true, stop using anti-bacterial soap and cleaners. It doesn't keep you healthy and increases bacterial resistances. The medical community has known this for years but just try to convince the general public that they're doing more harm than good.

"The popularity of antibacterial soaps reached such a peak in past years that in some local communities it was difficult to find products without antibacterial additives, except in health food stores. Studies suggest the use of these products will lead to antimicrobial resistance and thus contribute to the global problem. Triclosan, which was believed to attack bacterial membranes and thus kill indiscriminately, was recently found to inhibit a specific metabolic pathway, making it possible for bacteria to develop resistance. In fact, the study found that E. coli could easily develop resistance to triclosan AND pass on the acquired resistance to other bacteria.

Additionally, a recent study published in the March 2004 Annals of Internal Medicine found that use of antibacterial cleaning and handwashing products did not significantly reduce the burden of infectious disease within a household. This year-long, randomized, double-blind study of over 200 households examined the relationship between use of either antibacterial or non-antibacterial cleaning, laundry, and handwashing products and incidence of infectious disease symptoms including: diarrhea, vomiting; runny nose; cough; sore throat; fever; boils; and conjunctivitis. The study found no significant differences in incidence of infectious disease symptoms between the groups. Ironically, when the authors further evaluated results for the group of individuals who claimed fair or poor health (due to chronic disease), this group had a higher incidence of infectious disease in the antibacterial use group than the non-antibacterial group. The authors’ conclusion states that their findings highlight the need to better educate consumers about the use and limitations of household antibacterial cleaning products."

"Soaps containing triclosan within the range of concentrations commonly used in the community setting (0.1%–0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands. Several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria."

October 27, 2011 10:35 AM

The NYT states that Steve Jobs delayed having his cancer operated on. If his team of the best cancer doctors in the world couldn't decide whether to operate or not, what chance have the Obamacare panels of making good decisions?

A Tumor Is No Clearer in Hindsight
Steve Jobs's decision to delay an operation to remove a tumor may not have been as ill considered as it seems at first blush.

Was Steve Jobs a smart guy who made a stupid decision when it came to his health?

It might seem so, from the broad outlines of what he did in 2003 when a CT scan and other tests found a cancerous tumor in his pancreas. Doctors urged him to have an operation to remove the tumor, but Mr. Jobs put it off and instead tried a vegan diet, juices, herbs, acupuncture and other alternative remedies.

Nine months later, the tumor had grown. Only then did he agree to surgery, during which his doctors found that the cancer had spread to his liver, according to the new biography by Walter Isaacson. Cancer eventually killed him.

The sequence of events has given rise to news articles and blogs based on 20/20 hindsight, speculating that if only Mr. Jobs had had the surgery right away, doctors could have caught the cancer early, before it spread, and saved him.

But there is no way in this life to know what might have been — not in politics, baseball, romance or the stock market, and certainly not in sickness and health. Mr. Jobs’s wish to avoid or delay surgery was not unusual. And given the type of tumor he had and the way it was found, his decision to wait may not have been as ill considered as it seems at first blush.

His wife, Laurene Powell Jobs, declined requests for an interview and for permission to speak to Mr. Jobs’s doctors. But she did allow one of them to comment briefly: Dr. Dean Ornish, a friend of Mr. Jobs who is also a well-known advocate for using diet and lifestyle changes to treat and prevent heart disease.

Dr. Ornish said that when the diagnosis was first made, he advised Mr. Jobs to have the surgery. But in an e-mail message, he added:

“Steve was a very thoughtful person. In deciding whether or not to have major surgery, and when, he spent a few months consulting with a number of physicians and scientists worldwide as well as his team of superb physicians. It was his decision to do this.

“This type of surgery is a big deal and not to be taken lightly. He had surgery when he decided it was what he wanted to do. Nobody could have been more thoughtful and intelligent about how he went about this.

“No one can say whether or not having surgery earlier would have made any difference because of the possibility of micrometastases.”

Micrometastases are the tiny cancers that form in various organs when a tumor starts to spread and seed itself around the body. Dr. Ornish’s comment means that in theory, Mr. Jobs’s tumor could already have spread invisibly to his liver by the time it was first diagnosed. If it had, operating earlier probably would not have made a difference.

Dr. Edward M. Wolin, co-director of the carcinoid and neuroendocrine tumor program at Cedars-Sinai Medical Center in Los Angeles, said that among patients with the kind of cancer Mr. Jobs had, “when they are first found on a scan, about 60 percent of the time it’s already metastasized to the liver.”

Another expert, Dr. Steven K. Libutti, said that based on his reading of the new biography, it seemed likely that Mr. Jobs’s tumor had spread by the time it was found, and the delay in surgery probably did no harm. Dr. Libutti is director of the Montefiore Einstein Center for Cancer Care in New York and of its neuroendocrine tumor program.

(Neither Dr. Wolin nor Dr. Libutti treated Mr. Jobs or knew the details of his illness.)


November 1, 2011 6:51 PM
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