Bad Medicine

BBC Radio 4 - Crossing Continents, Addicted in Suburbia

"After any injury, many Americans expect to be pain-free. The US consumes around 80% of all opiate painkillers produced in the world. But for too many people their dependence on prescription medication has led them to heroin. Addiction is everywhere, even here in the upmarket suburbs of Lorain county west of Cleveland...

In Ohio, we hear many stories of opiates unnecessarily prescribed even after minor dental work. And across the US, the tentacles of the heroin epidemic reach back to the over-prescription of pills that started in the 1990s. Pain became a fifth vital sign."


Bad Medicine, Part 2: (Drug) Trials and Tribulations - Freakonomics Freakonomics

"The majority of new cancer drugs are marginal, that they offer sort of very small gains at tremendous prices, and to give you an example of that, among 71 drugs approved for the solid cancers, the median improvement in overall survival or how long people lived was just 2.1 months. And those drugs routinely cost over $100,000 per year of treatment or course of treatment."


Bad Medicine, Part 3: Death by Diagnosis - Freakonomics Freakonomics

"ANUPAM JENA: Prescription opioid use has gone up about 300-400 percent since the year 2000. America is a world leader in the consumption of painkillers. Here’s what a 2007 report found:

WAILOO: We were consuming about 83 percent of the world’s oxycodone in the United States. And it is not because we had 83 percent of the world’s pain. It’s because we are a consumer society that believes in the power of the magic pill...

In the late 1980s and early 90s, there was a push to mandate the recognition and treatment of pain. This culminated in the promotion of pain as the fifth vital sign, along with temperature, blood pressure, pulse, and respiratory rate. Which made pain the only vital sign that is determined not by objective measurement, but by the patient’s own assessment...

One result of this prescription onslaught? It is believed to have contributed to a recent uptick in mortality rates. Anupam Jena is a physician and a healthcare economist at Harvard.

JENA: Mortality rates in the U.S. have risen for the first time in 10 years. Which is striking, considering that mortality rates have been falling for at least 100 years...

WAILOO: Yeah, so pain management was really emerging as a recognizable and legitimate area of medical practice and care in the 1960s, early 1970s, with the development of multidisciplinary pain centers... There was a general recognition that you needed more than just drugs to deal with people in chronic pain. You needed social workers, you needed surgeons, you needed psychologists, you needed a wide range of others as well as people with pharmacological expertise. But those multidisciplinary pain centers were really expensive.

WAILOO: And so, you know one of the economic trends, since the 1980s, with the rise of cost containment, is to sort of see drugs as the cheapest and the fastest solution to our problem.

This coincided with a big shift in how drugs are marketed to the public...

“Physicians who do not comply with patient requests,” the authors wrote, “may be the recipients of poor ratings on patient satisfaction scores, possibly resulting in emotional, financial, and professional penalties.” So imagine this. You are a doctor and your patient asks, maybe by name, for a prescription pain-killer. You may think the patient doesn’t really need it; you may, in fact, be worried they’ll abuse it, maybe even sell it. But if that consumer has the ability to punish you professionally … well, you might just write the scrip...

The third-leading cause of death in the U.S., after heart disease and cancer, was … medical error. I’m going to say that again: the third-leading cause of death in the U.S., accounting for 10 percent of deaths annually, is medical error...

If you happen to be treated by a doctor who is 10 years or 15 years out of residency, your mortality within thirty days of being hospitalized is higher... We don’t see this effect among high-volume doctors — doctors who are seeing a lot of patients. So what that suggests that if you are an older doctor who is seeing a lot of patients, you are protected from this adverse effect


The Cost of Satisfaction

"Higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality."