Wednesday, November 22, 2006
Ezra Klein has an interesting response to recent news about the use and value of stints and angioplasties. He writes:
Just to freak folks out a bit, angioplasties and stents -- two canonical treatments for blocked arteries -- are rapidly being proven worthless. Not totally worthless in every case, but given their frequency, pretty damn worthless. A similar thing, incidentally, is happening to bypass surgeries, which don't exhibit anything near an efficacy justifying their ubiquity.
Libertarian response: If consumers had more "skin in the game" (and by skin we don't mean actual skin, which is already "in the game," but more financial vulnerability), they'd demand more comparative studies and begin weeding out such ineffective treatments.
Paternalistic liberal response: It's been so hard to conduct studies on these treatments precisely because desperate patients adore their promise and doctors know they'd be considered monsters if they put unsuspecting individuals in a "control group" that was denied a treatment that soon proved effective. Patients are terrible at evaluating care -- look at the holistic health industry, and the limitless range of unproven supplements and treatments -- and skin in the game will always be overwhelmed by lives-on-the-line. On the other hand, if doctors lacked their current incentives for providing such intensive medical procedures, we could begin to make a dent.
Bipartisan response: In 100 years, a good half of our medical treatments will look to our descendants like leeches look to us.
Update response: And yes, leeches are back in use in very limited contexts. Much as the research shows angioplasties should be.