One good way to get an understanding of the vast array of medical services and treatments is to organize them into a spectrum based on some parameter. I earlier looked at medical innovations based on how “fancy” they are, from AI to cleanliness.
https://www.blackliszt.com/2016/09/healthcare-innovation-from-washing-hands-to-ai.html
Another useful spectrum is the time relationship between a medical event that requires attention and the treatment of that event. At one end of the spectrum is treatment to prevent the medical event from taking place. The middle is treatment at nearly the same time as the event. The other end is an event in the past that now needs treatment.
We can understand a great deal about modern changes in healthcare practice and cost by looking at treatments in terms of this spectrum.
First, let’s understand the spectrum a bit more.
Treatment before the event
This a normally called preventative medicine. It is the subject of wellness visits to the doctor, and advice given by experts to people about how they should eat and otherwise behave. Medications and even surgery can be involved. If the treatment works, the event doesn’t happen.
Treatment to detect the event early
This is often called disease screening, a procedure to detect the early presence of a disease that the human doesn’t notice, but could grow into something serious. It could be performed personally or by medical services. The idea is that a problem caught earlier can be treated with greater success than one caught later.
Treatment around the time of the event
This is classic “I know something’s wrong, I need medical help.” It ranges from a bad fever to being hurt in an accident. You don’t make an appointment, you go or get taken to an Emergency Room or Urgent Care.
Treatment long after the event
These are treatments for conditions that are ignored or develop slowly, conditions that might involve some pain or inconvenience. As the condition worsens, medical advice and treatment may be called for. Examples are joint replacements (knee, hip)
Evolution of the spectrum
We all recognize the medical spectrum today. However, it wasn’t always the way it is today. Pre-event treatments were rare prior to the modern world. Most of these had to do with common and personal hygiene.
Prevent the Problem and detect it early
Discovery and implementation of disease prevention methods started in the 1700’s. It’s estimated that between the years 1500 and 1800 scurvy killed about two million sailors. Only in 1747 did a Scottish Naval surgeon publish a book with a trial that proved a cure. Another Scot, Joseph Lister, discovered the benefits of antiseptic surgery.
We’ve come a long way since the acceptance of the long-resisted ways to prevent scurvy and minimize infection. Now we are told to visit the doctor for regular “wellness” visits, during which we may be prescribed medicine to prevent heart failures (blood pressure, cholesterol) and encouraged to get procedures that will detect things like breast cancer and colon cancer early so they can be treated more effectively.
Sounds like a good idea, right? Most folks you talk with agree. There’s just one little problem: the wellness visits are basically sales sessions during which the doctor tries to convince you with tests, numbers and serious words to spend more healthcare dollars taking pills and injections and undergoing procedures that … don’t make you healthier and don’t extend your life.
Here are details about wellness visits, heart health visits, and health insurance company promotions. The links contain details about how and why both prevention and early detection do more harm than good, and in particular don’t lead to longer, healthier lives. Of course, there may be exceptions. But they must be proven, unlike most current practices.
A major barrier to improvement is the wall of secrecy around medical events and tests. There is a proven path to fix this problem in the software world: open source. It will lead to a positive revolution in the medical world as it has in the software world. Here is further detail.
The rest of the spectrum
Emergency care has advanced a fair amount in recent decades. But the changes are more evolutionary and gradual. For patients treated by a system of which they have long been a member, having on-line access to the patient’s medical records has certainly been a plus.
Post event treatments have grown a fair amount in recent decades. Organ transplants can now be achieved with unprecedentedly positive outcomes. Joint and limb replacement have now, in some cases, become routine, which is a big improvement in quality of life for those involved.
Conclusion
The spectrum of the relationship between the time of an event and the response to that event is important for understanding medical care, both quality and cost. While there have been substantial advances in the later parts of the spectrum, it’s clear that the early part of the spectrum has grown by far the most dramatically, mostly from the 1950’s on. It’s also sadly clear that the early part of the spectrum’s contributions to health and longevity are largely negative. If most early-spectrum tests and treatments were dropped (subject to open-source evaluation and testing), costs would be reduced and health improved.
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