Overtreated

Continuing with the theme of excesses in medicine, I found a recent publication in JAMA reporting on non–evidence-based implantable cardioverter-defibrillators in the United States. In this retrospective review, of 111,707 patients, 25,145 received non–evidence-based ICD implants (22.5%). This is astonishing given that the average cost of the defibrillators is $30,000.

For a robust and informative read on how systematic overtreatment in the United States is not only costly, but also dangerous, I refer you to Shannon Brownlee’s book, Overtreated. For many, the quantity of care (number of procedures, tests etc) drives reimbursement and simply incentivizes non-evidence based practice. We cover this book in my public health seminar and it provokes emotional discussion.

We seemingly practice medicine in a theater of the absurd where 40 million Americans are uninsured, overtreatment is widespread and costly, and where initiatives to expand access and maintain costs are dubbed as unpatriotic and unconstitutional.

Samuel Beckett would be proud of the absurdity.