Public health VERSUS individual health
Posted by Henry Bauer on 2014/11/23
“Public health and individual health” pointed out that “public health” deals in statistics and averages, and some public-health policies and practices can bring actual harm to some individuals unless physicians recognize the danger and treat each patient as the unique individuals that they are.
It seems that things are even considerably worse than I knew.
“How medical care is being corrupted” reveals that some insurance companies have taken it on themselves to reward doctors for choosing particular drugs and treatments and penalizing them for not doing so. The article is no outsiders’ radical rant: it is by two physicians at Harvard Medical School and is published in the New York Times.
The insurance companies have financial considerations as their prime motive, and their criteria are inevitably statistical and “on the average”. To drive doctors into practicing by the insurance company guidelines means driving doctors not to treat their patients as unique individuals.
Half a century ago already, health-insurance considerations brought into being the damaging belief that “high” blood pressure represents a risk of cardiovascular disease or adverse events, because blood pressure correlates with such events. But it correlates only because both blood pressure and risk of cardiovascular problems both increase with age, naturally and inevitably. No correlations ever prove causation, furthermore. For half a century, medical practice has continued the absurd practice of defining “hypertension” independently of age, thereby classifying as “illness” levels of blood pressure that are perfectly normal at a given age. Something like 75% of American seniors are being exposed chronically, lifelong, to the continuing negative “side” effects of blood-pressure-lowering drugs for no good reason and with no expectable benefit.
The present direct incentives to doctors to harm their patients seems a natural, normal, progression of allowing health-care policies to be determined by the financial marketplace.
You get what you pay for.