A friend of mine who has recently become an expectant father, found out that he needed to find out his blood type. For those not aware there can be complications if the mother has an RH negative blood type and the baby has RH positive. The complications can be avoided by some injections, but are also unnecessary if the father is also RH negative as the baby will then always be RH negative as well and there is no risk of reaction. This is the case with my wife and I who are both RH negative.
So anyhow, to avoid unnecessary treatment my friend decided to get his blood type determined only to turn up and discover that they were unable to obtain this simple test without a referral from a doctor, which would of course require an appointment and cash.
Annoyed at this waste of resources he sent off an email to a number of friends, several of whom are medical doctors, complaining bitterly at the waste of his time, his money and the government’s money that was involved in this process.
My immediate (and deliberately provocative) response was that it was due to the closed shop that doctors were running where everything has to be processed by one of the union and I think there is certainly something in that. However I want to explore the response from the doctors.
The response from the medical doctors was that it was important for them to refer patients for further tests as without a good knowledge of risks, benefits and interpretation of the results, it would leave patients open to deceptive conduct by pathology labs and others who may advertise to run screening tests that would be completely unnecessary and potentially counterproductive. The example cited was all body CT scans which because of the radiation dose, the high percentage of false positives (as high as 80%) and the risk entailed in biopsies to clearing up the false positives may provide no benefit to a patient who has little reason to suspect cancer. So while my friend may have been able to ask for this test in a situation where it was necessary what about other less educated people and more complicated tests. The question is where do you draw the line?
Firstly I think its an interesting assumption that doctors are more scrupulous than pathology labs, particularly given the schmoozing they get from drug companies. Still I can accept that you may develop a relationship with your GP that you won’t with a lab so they may have more interest in treating you well.
Putting this aside there are two issue here. The first is the actual situation in question. Accepting the argument made above, there is no question in my mind that we should be drawing the line somewhere above the complexity of a test to determine your blood type if the person is willing to pay the full cost of the test themselves. If it is to be in some way subsidised by medicare then there may be some screening necessary in such simple procedures to prevent unnecessary over usage.
The second issue is a broader one. While I support public health care for reasons I have outlined here, I also stated that I didn’t have a problem with wealthy people buying additional layers of health care. The trickier thing is with treatments that may have little or no demonstrated benefit. I have no doubt that such procedures shouldn’t be funded through medicare, but what about people who wish to pay for full body CAT scans? Should we prevent them from buying such procedures?
In general I think the answer is no. Sure if procedures are genuinely carry high risks and these are not being properly explained to consumers then there is reason to perhaps intervene. From what I read on fully body CAT scans the risk is not that high, less I imagine than many other legal activities. How would it compare to cosmetic surgery? Whether people are wasting their money or not is not really my concern.
People waste money every day on activities I think are virtually worthless. I can’t see the point of spending a couple of hundred thousand dollars on a Porsche, personally I think you’ve been conned given it has less storage space than my Astra, costs around 10 times as much, and has the same maximum speed (legal speed that is!). However I’m not going to restrict them from buying them even though they might increase their risk of dying in a high speed crash (perhaps).
This same reasoning of course applies to alternative medicines and other quackery. In general I think my principle stands. If someone is selling placebos and people are willing to buy them despite there being plenty of information around that they have no scientific effect (other than the placebo effect) then they should be free to do so. If it makes people feel better about themselves then all well and good, just like the sports car. Noting that this does not mean that we should not argue against them.
As for my first statement about doctors running a closed shop. I do believe there is an element of this behaviour going on. Its always seemed to me that the gap between doctors and other medical professionals seems unnecessarily large, and there could be more room for low level specialists bridging the gap. More routine things like injections for immunizations etc could easily be done by someone with a nursing background and a small amount of specialist training rather than your GP. However not having enough detailed knowledge of how the medical system works in practice I’ll defer further comment on this. It could be that this occurs to a greater degree than I realise and my comments are unfounded but certainly I have not encountered evidence of this.