Why is American health care so expensive?

Today in my inbox I got a letter entitled "ACP addresses medical costs." The American College of Physicians has, indeed,  started to address medical costs , but this letter announced something quite wonderful. It was a free link (for ACP members only, unfortunately) to an online course that addresses some of the most needlessly expensive care that internists order. Although the course is not required, completing it not only gives me continuing medical education hours but maintenance of certification (MOC) points to maintain my internal medicine board certification. Five years ago when I started writing this blog I proposed that in order to reduce healthcare spending in America physicians should be made aware of the cost of everything they order or prescribe and that they should be required to complete continuing medical education on cost effective medical care. Nobody read my blog back then, but apparently other people, namely the physicians of the ACP, must have figured...

Being a doctor is an adventure, or so I thought when I started medical school. It has, in fact, never been boring and has often been exhilarating. But 25 years ago what I longed to do was to go to exotic places where everything was different than it is at home and where I could be really useful. After raising 2 children and doing primary care for about 2 decades, I've finally found enough spare time to go to Africa and it has been pretty great. I just returned from Tanzania about 2 weeks ago after accompanying 11 University of California at Irvine medical students on a project to teach basic ultrasound skills to physicians and clinical officer students in Mwanza, a major city which sits on the shores of Lake Victoria. Using ultrasound at the bedside by a non-radiologist caregiver is gaining acceptance in the US, but still runs into resistance because of issues of competence and training and billing and turf. In Africa, though, you will find good consensus that it is life sa...

Probiotics for the gut are very popular right now, and well so, since overuse of antibiotics has radically changed  the scope of intestinal illness in the US. When we take good effective antibiotics they kill not only the intended bacteria causing infection in our sinuses or lungs or bladders or skin but also quite a few of the innocent bystanders elsewhere in the body. Usually we manage to recover from the damage done, but sometimes we get life threatening overgrowth of bacteria or fungus which can have long lasting ill effects. Replacing bacteria killed with supplements containing beneficial organisms can reduce the harm caused by antibiotics . But that's not what I'm talking about this time. I noticed that some of the people who I love most have bad breath. Sometimes, I've heard, even I have bad breath.  Occasionally, despite having awesome oral hygiene, my mouth tastes kind of skanky and I could definitely believe that it wouldn't be pleasant to be in intimate...

This morning I received an invitation to sign a letter authored by the Lown Institute  in support of an article published in the BMJ (formerly the British Medical Journal) questioning the wisdom of prescribing statin drugs to patients at low risk of cardiovascular disease such as heart attack or stroke. "Statins" such as lipitor (atorvastatin) and zocor (simvastatin) are drugs which reduce cholesterol levels by inhibiting an enzyme on cell membranes. The article  concludes that statin drugs are unlikely to be helpful to patients whose risk of heart disease or stroke is calculated to be less than 20% in 10 years. It was written by Dr. John Abramson, a lecturer at Harvard Medical School and the author of two books about inappropriate use of medications and tests, Harriet Rosenberg, a social scientist from Canada who has written about the lack of good scientific study of statins in women, Nicholas Jewell, a statistician from UC Berkeley and Dr. James M. Wright, a professor at...