One Doctor's Quest to Cut Unneeded Treatments

May 15, 2009— -- We all know about medical malpractice. That is when a physician does something necessary but does it inexcusably poorly. I call that Type I Medical Malpractice.

Type II Medical Malpractice is when a physician or surgeon does the unnecessary, even if it's done well. Type II Medical Malpractice is a scourge in America.

When we think of modern medical miracles, all of us focus on dramatic events: hands are sewn back on, victims of horrific accidents and terrible infections live to work and smile again... the stuff of television programs.

Then there are all the medical miracles that we've come to take for granted: blocked heart vessels are opened or bypassed, breasts are removed for cancer and reconstructed, knees are repaired through tiny punctures... and all else that most want done to them if needed.

Science has learned how to ask whether any modern medical miracle really works. Would we have done as well, even better, without the miracle? Science has learned to do this with experiments that compare patients treated with the new "bell and whistle" compared to those treated the older way. For pharmaceuticals, such experiments are required before the drug is licensed. For procedures and devices, science relies on studies after-the-fact.

The result is that many such studies are available, covering nearly all the medical miracles we have come to take for granted. Many scientists commit vast amounts of time and effort to collecting these studies, assessing their quality, and teasing out whether there is evidence for a miracle. We're talking about thousands of scientists around the world involved in this effort.

Many are participating in the Cochrane Collaboration based at Oxford University in England and supported by monies from various governments. There are other groups including the United States Preventive Services Task Force and a group based in Canada but affiliated with the American College of Physicians. Society is swimming in documents asking whether science could or could not discern any evidence for a positive effect for over 5,000 modern medical and surgical miracles.