Although I have scheduled posts through the weekend, blogging might be light after that. A relative is struggling from an encounter with Hansonian medicine.
A robust finding in health care economics is that when you compare two populations with similar characteristics, the population on which more is spent on medical care enjoys no better outcomes, where outcomes are usually measured in terms of mortality. Given that we know that some treatments do work, this represents a puzzle.
The most radical way of resolving the puzzle is due to Robin Hanson. He suggests that the treatments that work are offset in the aggregate by treatments that cause harm. It is the latter that I have dubbed “Hansonian medicine.” I have myself witnessed Hansonian medicine take the lives of elderly relatives, although their lives were not shortened by much and their lives almost certainly had been prolonged by previous treatments.
The current episode concerns a recent procedure on a not-so-elderly relative that resulted in a severe infection. Moreover, the condition for which the procedure was undertaken is something that I always suspected may have been brought on by taking statin drugs, so that for years I have said no to doctor recommendations for me to take statins. (Just now, I googled and found that some recent research might support my hypothesis. However, I believe that the consensus is that my personal views are wrong and that statins are a low-cost, high-benefit treatment, which is the opposite of Hansonian medicine.)
I hooe things resolve.
One of my relatives was allowed to fall off an MRI table and died from the fall.
No engineer would let a part fall off a conveyor belt, and if he did, someone would be fired. The hospital I’m sure just paid out of insurance and wrote it off their taxes.
Best wishes to those involved.
In thinking about hansonian medicine, we must remember that there are a fair number of treatments that are very useful when applied with correct indications (i.e. the treatment was given to the right patient) and quite harmful when misapplied.
It’s not that the “treatment” itself is good or useless, it’s that any particular application is good or useless.
Thus the old joke about medical “practice.”
But engineers incorporate human error as part of a process and don’t excuse a process if it depends on fallible humans.
But what incentive do doctors have to perform on patients rather than practice on them? They get paid per procedure.
Even though engineers are expected to employ sound discipline in validating their work, engineering teams most often have quality assurance engineers[1][2] as well who engage in more thorough testing of whole system, because failure modes are generally far more prolific than success
modes.
(you probably already know this, but I am explaining the above for the benefit of those that do not.)
I would argue that “quality assurance” is the role of nurses; at least since the nursing profession was reformed so that they no longer directly report to doctors.
Ultimately, it is the job of the doctor to “solve the problem”. The job of nurses is “patient health”. The doctor fixes the heart, and the nurse makes sure the patient is going to live to enjoy that new heart. Doctors are still responsible for “doing no harm” to the patient, but nurses are generally expected to double check every diagnosis and prescription given by the doctor, to administer the prescriptions and any other care needed to keep the patient healthy, and to make sure the patient is properly educated about their conditions and treatments.
That is not to say that Hansonian Medicine (aka. “iatrogenesis”) is not an issue. I have seen it first hand in my own family. Nursing isn’t a perfect profession by any means. The incentives applied to doctors by our current system might lead to greater laxness with regards to preventing iatrogenesis (incentives that, as you mention, may not be present for engineers). It’s likely that the health care industry is poorly setup to reduce iatrogenesis without significant reform. Consumers often demand to be treated, even when treatment may not be effective. But reducing iatrogenic affects is *hard* because, you know, failure modes are more prolific than success modes.
[1]http://tofspot.blogspot.com/2013/07/ismism.html
[2]http://googletesting.blogspot.com/
My thought would be that ‘mortality’ is not the only thing of value when measuring medical outcomes. You can have treatments which maintain or improve functionality versus others which still save lives, but at the cost of degraded functionality. An example is amputation versus surgery to restore functionality of the limb. Dialysis versus a kidney transplant.
Perhaps after a certain point, truely improving mortality rates becomes too hard or expensive, so excessive money flows into improving functionality and quality of life.
My mother experienced serious side-effects from statins (muscle pain and weakness that I don’t think ever fully resolved), so I’m not at all inclined to take chances on them myself.