Why is American health care so expensive?

This week has been really interesting in the medical journals. Although I often question the relevance of population based medical research to guide treatment of individuals, large trials are excellent for helping us question widely held beliefs. Since doctors are often unreasonably convinced that they are right, studies that make us question ourselves are valuable. Last year when reviewing recommendations of the US Preventive Services Task Force and looking at the studies on which these recommendations were based, I began to recommend regular use of aspirin for men over the age of 45 and women over the age of 55 to prevent heart attacks. This month an article came out in the Archives of Internal Medicine that showed that for patients without heart disease, there was no decrease in  mortality with regular aspirin use and that the reduction in risk of heart attack and stroke is really quite small. Risk of bleeding related to taking even a baby aspirin is significant. This only l...

Happy New Year! According to Health Affairs, a journal of health economics, the rise in health care spending in the US is flat, and spending on physician's services rose at an all time low number of 1.8%. The interpretation of this information is that health care, even though it is considered a necessity, has been impacted by the weak economy. That is certainly a factor, but it is interesting to see that health care spending can go down without the quality of care looking catastrophically worse In fact it looks like there are many areas of improved care in the last two years. My guess is that spending came down because there is enough fat (and there is still more fat) that can be cut just by physicians and consumers being aware of what is of value in medicine. We are probably also seeing effects of preparing for and responding to health care reform in a way that has reduced waste. So happy New Year! We have started the year with health care costs that have risen only as fast...

Just today while poking through studies recently released, I came upon an article that added to my growing discomfort with using Pradaxa, an anticoagulant ("blood thinner") that is now being widely used as an alternative for warfarin (coumadin is the brand name) for people with atrial fibrillation in order to reduce their risk for stroke. Atrial fibrillation is a condition in which the atrium (entry chamber) of the heart wiggles rather than beats, and is caused by high blood pressure, valve problems, alcohol abuse and a number of other factors. The wiggling rather than beating atrium can build up blood clots which can migrate into arteries all over the body, but most devastatingly in the brain to cause strokes. Taking an anticoagulant reduces this risk. But blood has a very good reason for clotting, and when it is inhibited from clotting, a person can bleed, sometimes catastrophically, from an injury or an ulcer or a weak area in the tissues of the body. Like the use of any...

Just this last week I saw a couple of ancient people who were at the end of their lives, had been very healthy up until recently and had received close to no medical care for nearly 9 decades. One of them was a devout Christian Scientist and the other was a Seventh Day Adventist. Christian Science began in 1871 based on the teachings of Mary Baker Eddy, and follows her teachings as laid out in her blockbuster bestselling book Science and Health with Key to the Scriptures which has been translated into just about every known written language and outlines the philosophy and practice of healing based on Christian faith. Seventh Day Adventists also have pretty strict health prescriptions and many of them eat a plant based diet, avoiding animal products, especially meat. I have had other Christian Science patients in the past, of great age, and am very curious about what draws them to it and how they weave it into their very healthy lives. Mary Baker Eddy was a "sickly child" w...