This problem of inappropriate use or overuse of medical procedures is a difficult nut to crack. For one, physicians, hospitals, and the life science industry are all aligned and incentivized to do more procedures. Even at the subconscious level, as graphically portrayed in Atul Gwande's 2009 New Yorker article, "The Cost Conundrum," patients can be seen as representing an ATM. Certainly not all those procedures are carried out in the patients' best interests; the profound regional variability seen in the use of all sorts of procedures and operations across the United States reinforces the fact that appropriateness and need are not the sole determinants of whether patients are subjected to them. And it isn't just across the United States. For every 1,000 people in France, 192 will have an angioplasty or stent procedure. In the United States, the number is more than double at 437. Too few in France, or too many in the U.S.? The difference can't simply be attributed to Americans drinking less French red wine.
In the case of my patient, of course, it didn't just start with the unnecessary procedure, but with the initial response to an advertisement, followed by his trust in his original physicians to make objective recommendations about what the proper course of care would be. Similar problems confront anyone trying to navigate all the medical procedures, operations, prescription medications, vitamins, supplements, herbs, alternative treatments, over-the-counter products, and home devices that confront them. The key to the problem is an empowered, knowledgeable patient, but, as we shall see, extra information need not lead to empowerment. Whether information is pushed to consumers (by the news media or by direct-to-consumer advertising) or pulled out of the system by consumers themselves (by, for example, visiting Google Scholar or a social-networking site developed for sufferers of a particular disease), if a consumer can't make the best, most intelligent use of it, all sorts of trouble can unfold.
Reprinted from The Creative Destruction of Medicine, by Eric Topol, by arrangement with Basic Books. Copyright © 2012 by Eric Topol.