Washington. -- Soothed by frequent reports of wondrous progress in medicine, Americans must face up to a little-discussed challenge if health-care reform is to succeed: They're going to have to moderate their faith in medical wizardry. Otherwise, it will be impossible to hold down the costs that threaten to break the national bank, even while millions of people are priced out of the medical market.
Though contemporary medical practice claims to be imbued with the prove-it spirit of science, the fact is that many widely used health-care techniques have never been subjected to independent, objective analysis to determine their value for patients. When they are examined, which isn't often, the results in many instances run counter to medical and popular confidence in the progress of health care, particularly the high-tech variety.
One of the latest examples concerns routine sonograms in uncomplicated pregnancies. Every year, hundreds of thousands of women undergo these tests, at an average cost of $200 per procedure. The tests can reveal various abnormalities, and therefore are anxiously sought by expectant parents. However, abnormalities often are revealed at a stage of pregnancy so advanced that most women decide against abortion.
In any case, when researchers compared the pregnancy outcomes of those who had undergone routine sonograms with those who hadn't, they found virtually no difference in the numbers of birth defects or problem deliveries. The striking difference was in costs -- which could add another $1 billion a year to the national health bill if all uncomplicated pregnancies were subjected to sonograms.
Another example of dubious procedures concerns heart-attack victims who do not respond to emergency treatment. Should they be rushed to a hospital? The urge to do everything possible compels an affirmative answer. But a newly published study based on a review of heart-attack episodes in Memphis and Houston concluded that the chances of survival are "virtually nil" for heart-attack victims who do not respond to emergency treatment outside a hospital.
In the words of one of the researchers on the heart-attack study:
"All of that time and money is spent for little or no benefit in overall survival; this is difficult to justify any longer when health-care costs are coming under such intense scrutiny."
That's terrible news. But there it is.
Many treatment methods gain a foothold because they seem beneficial, or nothing better is available. And after they become established in day-to-day practice, habit takes over and they persist. The process is often abetted by the glowing press reports that hail new medical techniques, thus raising the expectations of patients. Not to be discounted is drumbeating by manufacturers, doctors and other elements of the health-care industry.
For example, complex surgical treatment for prostate cancer has in recent years been hailed as an important medical advance. But recent studies indicate that the procedure adds little or nothing to life expectancy or quality of life.
The study of what works and what doesn't in medicine -- known as "outcomes" research -- is underdeveloped, costly and regarded with disdain by enthusiasts for various procedures. A small government organization, the Agency for Health Care Policy and Research, supports outcomes research. But its resources are puny against the vast number of techniques and procedures that have become standbys in the practice of medicine.
The confidence that a trusting public bestows on the health-care industry is often justified. Modern medicine can claim a good record in the miracle department. And poll after poll shows that a large majority of Americans like their health care and expect it to perform well when needs arise.
But with health-care costs becoming unbearable, the least painful step is to rid the system of costly delusions about what works. Studies show that a surprisingly large number of procedures could be scrapped -- to the benefit of patients and the national economy.
The opinions of medical practitioners merit careful consideration. But let's not forget the countless patients sent to early graves by well-intentioned but misguided practices. We recoil in disbelief at the durability of the leech as a mainstay of medical practice over centuries. Dispassionate research suggests that modern-day equivalents of the leech -- often in high-tech guise -- are not absent from contemporary health care.
Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.