Gauging the real risks and benefits of a medical procedure

As Republicans assail the Affordable Care Act but find nothing to replace it, as Democrats seek Medicare for all, both are failing to address the most salient problem crippling our health care system: wasteful spending.

The Institute of Medicine estimates that we squandered $750 billion in unnecessary medical spending in 2009, and recent estimates put that number closer to $1 trillion a year. In fact, 30 to 50 percent of medical interventions are of low value: They either do not help people, or they harm them. Talk to knowledgeable folks in the medical community and they will tell you that it is folly to tinker with and even expand our health care system until we address the excessive spending.

If we tell health consumers the truth about which interventions work and empower them to control their own medical path, they will drastically reduce the cost of care. Currently, patients are the unwitting victims of unnecessary care that is sold to them deceptively, precluding their ability to make informed decisions. Drug companies spend $5.6 billion a year on direct-to-consumer advertising, which has, in many instances, been defined as misleading prescription drug promotion. Physician groups, the media and researchers are equally complicit in obscuring accurate dissemination of medical data.

The ubiquitous use of “relative numbers” within the medical community to characterize health implications of medical intervention is a primary cause of exaggerated benefits. As Dr. Aron Sousa, a senior associate dean at Michigan State University medical school, says, “relative risk is just another way of lying.”

The use of absolute risk numbers is acknowledged to be far more effective in conveying the true impact of medical intervention than the use of relative risks and may be the key to cutting the cost of care, but it is absent from most medical discourse. For example: Let’s say a headline on the front page of a leading newspaper states “New wonder drug reduces cancer risk by 50 percent.” What does that mean? Fifty percent of what? This is the way the pharmaceutical representatives would explain the benefit of this drug to your doctor and the press — and then on to patients. These are relative numbers.

As it turns out, this new wonder drug reduced the likelihood of cancer from 2 occurrences per 100 people to 1 per 100. So, in relative terms, a 50 percent reduction is correct (comparing 2 to1) but still deceptive and misleading. In absolute terms, it benefits 1 in 100 people, or 1 percent of the population. What a dramatic difference! Clearly, absolute values are far more meaningful to patients and doctors but not nearly as profitable to many in the health care industry and the press, and so we do not see them. If we want to enable patients to make informed decisions that reduce expensive low-value care, insisting on absolute numbers is a crucial first step.

It has been demonstrated that the use of decision-aids, such as graphics that use absolute values and straightforward images, can facilitate doctor/patient communication and save money. Decision aids are becoming a valuable tool in communicating health risks and benefits, and can help spark a revolution in health care spending by empowering the consumers of care to make decisions that are best for them.

This method of patient-centered care can be applied to many medicines, tests and procedures that are excessively costly and largely ineffective. A study of 13,000 doctors found that only 10 percent of them accurately assessed risks and benefits of interventions, typically exaggerating the latter. In another study, when patients used decision aids to assess orthopedic surgical treatments rather than simply listening to doctor advice, they typically chose less invasive options and saved over $1,000 a year for all patients in the system. For change to occur, it must begin at the level of the health care consumer.

Before a doctor orders a test or a drug, she must assure that her patient understands the actual implications of that decision. It is incumbent on insurers, both private and governmental, to insist on this qualification, which can be accomplished through current clinical practice guidelines. And private and public organizations, including the media, can similarly provide health care consumers with easily accessed decision aids that address expensive medical interventions and often misleading pharmaceutical ads. The time for Congress to act sensibly is now, and the solution may be far easier than many of our politicians realize.

Erik Rifkin (erifkin102@aol.com) is an adjunct associate research scientist within the Department of Environmental Health and Engineering at Johns Hopkins University. Dr. Andrew Lazris (email is alazris@ppcmd.com) is a primary care physician who lives in Columbia. They are co-authors, most recently, of the book, "Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor-Patient Communication."

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