NYTs Practice Of Medicine

In another one of those long, in this case 4278 words, articles by the New York Times, “Weighing the Costs of a Look Inside the Heart,” it again demonstrates its failure to conduct or convey elemental journalistic research. And, again, an agenda appears at work. The result is that certain key facts and distinctions are omitted, which surely could have found space within this long article, that would have conveyed more and important information.

The agenda is rationing of health care. Rationing is inherent in the various schemes for “universal” or “single-payer” or “government-run” or “nationalized” health care. There’s no doubt that some degree of rationing already occurs for those relatively few who truly can’t afford insurance or co-pays but earn a bit too much to benefit from government programs. But, by shifting their earnings and taxes to the benefit of those few, the schemes would subject everyone else to rationing.

I’m a decades-long participant in HMOs, and even advocate them in areas like mine where their panels are so large and inclusive of the quality providers that there’s nothing material to be gained by not being in one. However, most prefer more freedom of choice, as in PPOs, though their premiums are higher, and polls consistently show overwhelming majorities not favoring government-run health care. The fear is tangible and sometimes real that in case of an extreme circumstance or particular set of facts they will be denied covered care.

It’s true, as the NYTs article says, that we collectively overuse medical care, and that costs. The problem is that, first, most of that is a personal decision and, second, the only way to drastically cut that cost would be wholesale imposed rationing that would often discriminate against many cases where the extra measure would save lives or make them more salutary. Third, many of the treatments proposed for rationing show demonstrated benefits but are, while not 100% proven – whatever that means, if even possible, discriminated against due to their cost. In that case, it’s ironic that those who advocate greater preventive medicine, also advocate against preventive medicine.

The gist of the NYTs article is that overuse of heart CT scans is expensive, deliver large doses of radiation, may be spurred by self-interest profits by some doctor owners of CT machines, and the test and diagnoses not certain. As generalizations, that may be so. But, the NYTs fails to mention there are large-scale, reputable studies of those cases where it is proper and beneficial.

For example, the American Heart Association and American College of Cardiology Foundation in 2007 examined all the literature and studies to reach a “Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain.” Patients who either score low or high (high already evident for additional treatment) on risk predictors are not indicated for the test. Patients who are scored intermediate risks are indicated for the test, as “such patients may be reclassified to a higher risk status based on high CAC score, and subsequent patient management may be modified”. Many other peer journal articles affirm this finding. This test, calcium scoring, is – as the NYTs mentions only briefly in passing – “a less extensive form of scanning,” but is grouped in with the NYTs negativity toward coronary CT scanning in general.

The NYTs article ends with a quote from an opponent of CT scanning, “We’re spending a lot of money on technology of unclear benefit and risk.” The NYTs want us to forfeit individual or independent expert judgments to centralized government-run entities whose track-record on cost-benefit analysis is proven repeatedly faulty and causing higher risks. No thank you to a British National Health Service.