Questioning the value of some accepted standards in medicine
Value is an undeniable perspective in the practice of medicine. And value is relative. It's easy to do the math and conclude that most money spent on alt-med is money wasted. It's harder, but maybe just as necessary, to second-guess our own established protocols, like the examples of PSA's and mammograms.
I have another example. ACOG, in all of their scientifically-based wisdom, recommends that CF carrier screening be offered to all couples when at least one member of the couple is Caucasian and pregnant or considering pregnancy. Remember, this test does not cure or prevent any disease and there is no measurable health advantage to this recommendation. Only speculation that the family planning decisions that can occur as a result of a positive test will be valuable to the couple.
The chances (per ACOG) that both partners will be a carrier is 1:841. Each of these couples has a 1:4 chance of conceiving a CF child, so each couple (irrespective of any test result) has a 1 in 3,364 chance of their next conception being a CF child. Let's say each "child-bearing couple" has 3 children. To look at it one way, we should (per ACOG) be doing 2,242 of these tests (one for each partner) for every baby naturally born with CF. Each test currently costs about $400. How far would $896,000 go toward actual care, research, and treatment for each naturally born CF child?
Now, I'm not saying anything, and am only using this as an example of how we are dictating the VALUE of health care. One point I could make is that US health care costs as much as it does compared to other countries because we are willing to pay more related to it.
Another point is that we all should not to be too quick to judge something with no apparent scientifically derived value as having none at all.
dras
1. American College of Obstetricians and Gynecologists, American College of Medical Genetics. Preconception and Prenatal Carrier Screening for Cystic Fibrosis: Clinical and Laboratory Guidelines. Washington, DC: ACOG; Oct 2001
I have another example. ACOG, in all of their scientifically-based wisdom, recommends that CF carrier screening be offered to all couples when at least one member of the couple is Caucasian and pregnant or considering pregnancy. Remember, this test does not cure or prevent any disease and there is no measurable health advantage to this recommendation. Only speculation that the family planning decisions that can occur as a result of a positive test will be valuable to the couple.
The chances (per ACOG) that both partners will be a carrier is 1:841. Each of these couples has a 1:4 chance of conceiving a CF child, so each couple (irrespective of any test result) has a 1 in 3,364 chance of their next conception being a CF child. Let's say each "child-bearing couple" has 3 children. To look at it one way, we should (per ACOG) be doing 2,242 of these tests (one for each partner) for every baby naturally born with CF. Each test currently costs about $400. How far would $896,000 go toward actual care, research, and treatment for each naturally born CF child?
Now, I'm not saying anything, and am only using this as an example of how we are dictating the VALUE of health care. One point I could make is that US health care costs as much as it does compared to other countries because we are willing to pay more related to it.
Another point is that we all should not to be too quick to judge something with no apparent scientifically derived value as having none at all.
dras
1. American College of Obstetricians and Gynecologists, American College of Medical Genetics. Preconception and Prenatal Carrier Screening for Cystic Fibrosis: Clinical and Laboratory Guidelines. Washington, DC: ACOG; Oct 2001
posted by nawledge at
10:24 PM
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