Why Less Medical Treatment May Be Good For You

A new book makes a case for managed care.

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For me, that was the monster surprise, how little medical care has any evidence to back it up. I presumed that 21st-century medicine was scientifically based. At least half of it, if not more, is not based on science. High-dose chemotherapy for breast cancer was touted all through the 1990s as a woman's best chance, and it had very poor evidence to back it up. And when the double-blind clinical trials were finally done, it turned out it was killing people.

Have you had your own experience with being overtreated?

I had TMJ, the pain in your jaw. It all started about the time I started writing this book. I was told I needed braces and a six-hour surgery that would break my jaw. I was already in the braces when I thought, gee, I wonder what the evidence is for this. It turns out they've been doing this surgery for 20 years, and there's no evidence that it's any better than doing nothing. And then it turns out a lot of things can go wrong, not the least being the danger of anesthesia for six hours. And it would be $20,000 out of my own pocket, and that was just for the surgeon's fees. I said the heck with it, and I put two little tiny plastic things on my teeth. And I try to calm myself down before I go to sleep at night, and to not grind my teeth.

Given this fragmented system, what can I do to make sure I get the best medical care possible?

Every patient simply has to ask, do I really need this? That's hard to do when you're really, really sick in the hospital. That means you need a family member who will act as your coordinator. Ask questions, ask if the new drug will have an interaction with the old drug. Ask people to wash their hands before they touch the patient. This simple procedure is one of the most important things for preventing infection. And it's the one that's most often forgotten.