When it comes to America’s spiraling health care costs, the country’s problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country’s medical spending.

Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.

The figures are from a new study by the Department of Health and Human Services, which examined how different U.S. demographics contributed to medical costs. It looked at the $1.26 trillion spent by civilian, non-institutionalized Americans each year on health care.

The top 5% of spenders paid an annual average of $35,829 in doctors’ bills. By comparison, the bottom half paid an average $232 and made up about 3% of total costs.

In 2004 I wrote In Praise of Impersonal Medicine arguing:

I have nothing against my physician but I would prefer to be diagnosed by a computer. A typical physician spends most of the day playing twenty questions. Where does it hurt? Do you have a cough? How high is the patient’s blood pressure? But an expert system can play twenty questions better than most people. An expert system can use the best knowledge in the field, it can stay current with the journals, and it never forgets.

and in 2006 I noted:

The practice of modern medicine is surprisingly primitive … My credit card company knows far more about my shopping history than my physician knows about my medical history.

I now believe that we are on the cusp of major changes to medicine. The thousand dollar genome sequence is less than a year away, Ford has just developed a car seat that can monitor your health, many people are already using wrist monitors to measure heart and sleep patterns. All of this data will soon be combined with massive databases to offer predictive and prescriptive health diagnosis.

But my favourite part of the posting was this comment from Joseph Huntington:

Stay clear of Doctors. I am a lifelong physician. Cardiologist, Head Surgeon, UCLA for 17 years. Medicine today is riskier than any casino. I left the zoo when it became a Federal Collection Center for data that will likely be used in population selection. If you’re a model or athlete, you have nothing to fear. If you’re sub-average, or over age 35 … just sleep well, drink water, walk, breathe deeply, eat mostly fresh things, laugh, love, work honorably and again, stay away from guys like me.

Convenience and laziness top the list of causes of antibiotic resistance. That is because those who misuse these drugs mostly do not pay the cost. Antibiotics work against bacteria, not viruses, yet patients who press their doctors to prescribe them for viral infections such as colds or influenza are seldom harmed by their self-indulgence. Nor are the doctors who write useless prescriptions in order to rid their surgeries of such hypochondriacs. The hypochondriacs can, though, act as breeding grounds for resistant bacteria that may infect others. Even when the drug has been correctly prescribed, those who fail to finish the course are similarly guilty of promoting resistance. In some parts of the world, even prescription is unnecessary. Many antibiotics are bought over the counter, with neither diagnosis nor proper recommendations for use, multiplying still further the number of human reaction vessels from which resistance can emerge.

Nor is the problem confined to people. Analysing official figures, Louise Slaughter, an American congresswoman who is also a microbiologist, calculates that four-fifths of the antibiotics used in America are given to livestock, often to get perfectly healthy animals to grow faster. That is convenient, because it produces cheaper meat, but it creates yet more opportunities for bugs to evolve resistance.

All this matters because antibiotic resistance has both medical and financial costs. It causes longer and more serious illnesses, lengthening people’s stays in hospital and complicating their treatment. Sometimes people die unnecessarily. In one study, which sampled almost 1,400 patients at Cook County hospital in Chicago, researchers found resistant strains of bacteria infecting 188 people, 12 of whom died because they could not be treated adequately. At the moment, resistant bacteria threaten mostly children, the old, cancer patients and the chronically ill (especially those infected with HIV). However, there could be worse to come. Nearly 450,000 new cases of multidrug-resistant tuberculosis are recorded each year; one-third of these people die from the disease. More than a quarter of new cases of TB identified recently in parts of Russia were of this troublesome kind.

Currently, anyone suspected of having high blood pressure is diagnosed by a GP with an inflatable arm cuff. Doctors then call the patient back for additional readings, but these are always taken at their surgery or in hospital.

New draft guidance to be published today by the National Institute for Health and Clinical Excellence (Nice) says as many as one in four people experiences a surging pulse rate on entering a GP’s surgery.

This nervous response, termed “white coat hypertension”, can significantly raise blood pressure readings and many people are being misdiagnosed as a result.

To counter this, Nice is recommending that doctors do not rely solely on readings taken in their own surgeries. After the initial assessment, a patient should be sent home and asked to wear an ambulatory blood pressure monitoring (ABPM) device.

A suspicious mind might wonder if there’s a financial benefit to drug companies large enough to have them pressure physicians to diagnose high blood pressure even in people whose readings are not far off normal.

H/T to Eric Kirkland for the link.

Lorne Gunter gives a bit of credit where it’s due:

Give Allison McGeer credit for being frank about what’s behind this winter’s flu outbreak in Ontario: unnecessary panic over last year’s swine flu “pandemic.” Dr. McGeer, head of infection control at Toronto’s Mount Sinai Hospital, says flu cases are way up this season because vaccinations are way down; and vaccinations are way down, likely, because too much was made of the swine flu by media and officialdom last winter.

It is a medical case of the doctors who cried wolf, in other words.

[. . .]

There is a fine line between erring on the side of caution and crying wolf. And last year, the UN’s World Health Organization (WHO) blew through that barrier with abandon.

Just as it had on SARS and bird flu and the Ebola virus, the WHO overreacted to swine flu, issuing cautions that were out of all proportion to the risk the disease posed to the public. (Remember in 2003 when the WHO recommended people from around the world stay away from Toronto because the city was host to a few hundred SARS infections?)

But unlike those earlier panics, the WHO pulled out every stop on swine flu. It was as if the UN agency had been surprised that its earlier scares had failed to grow into full-blown pandemics; and so they figured that, finally, swine flu was due to become a worldwide infection requiring a dramatic response from international health officials.

As I wrote last year in May, when even the most panic-stricken media outlets were no longer playing the JuggernautOfDoom theme:

This would have been a good opportunity for de-escalating the panic mongering (and perhaps even attempting to rein-in the media, who were equally to blame for the tone of the information getting to the public). They chose, instead, to actively hide the fact that H1N1 cases were running below the level of ordinary seasonal flu cases (total H1N1 deaths: approximately 18,000 — typical annual death toll from seasonal flu: 250,000-500,000).

The biggest problem isn’t that they over-reacted this time, it’s that it has reduced their credibility the next time they start issuing health warnings. And that’s a bad thing. Unless they pull the same stunt next time, too. In which case, we may start hearing talk about setting up competing organizations to do the job the current entities appear to have given up on.

In trials lasting between four and eight years, the patients who had been given aspirin were 21% less likely to die from cancer than those who had been given a placebo. These results were based on 674 cancer deaths, so are unlikely to represent the kind of statistical oddity that can beset studies on cancer risks that sometimes create headlines.

The benefits of aspirin were also apparent many years after the trials had ended. After five years, death rates for all cancers fell by 35% and for gastrointestinal cancers by 54%. A long-term follow-up of patients showed that the 20-year risk of cancer death remained 20% lower in those who had taken aspirin.

The study revealed that the effect takes time to accrue, so aspirin must be taken over a long period. The latent period for improving oesophageal, pancreatic, brain and lung cancer was about five years of aspirin taking on a daily basis. For stomach and colorectal cancer the effects took ten years and for prostate cancer about 15 years. The means by which aspirin prevents cancer is not well understood. It is believed that it inhibits an enzyme that promotes cell proliferation in tumours.

On July 22, Congress held a hearing on direct-to-consumer (DTC) genetic tests, services that analyze your DNA and interpret the results in exchange for a few hundred bucks — no doctor necessary. The hearing could have been a thoughtful national conversation about science, business, and ethics. Alas, it devolved instead into a series of gotcha moments, starring a General Accounting Office sting operation that came off like a cross between the ACORN videos and the world’s worst ad for snake oil.

Time and again, on tape, an undercover agent called up an unidentified testing company and asked an ill-informed question. (“Is it OK if I stop taking my cholesterol meds and instead take the nutritional supplements you sell? If I can manage to get hold of my fiancé’s saliva without him knowing, will you run it through your machines so I can surprise him with the ‘gift’ of his own data?”) And time and again, the phone rep sank to the occasion and made the company look awful. (Sure, lay off the pills and take our supplements! Of course we’ll analyze your fiancé’s spit without his permission even though that’s illegal, unethical, and weird!)

I listened to the tape several times the day it was released, despairing at the way people were taking advantage of gullible, albeit fictional consumers, which was clearly how the congressmen who held the hearing wanted me to react. Then I started to worry about something else. How much time did I even have left to decide whether I was going to take a test myself? Even before the hearing, the FDA had announced its plans to regulate all DTC genetic tests, possibly so heavily as to keep them off the market; the hearing was just the sort of thing that could push it to move faster. What if, by the time I finally decided if I wanted one of these tests, I couldn’t buy one anymore? My credit card was sitting next to my laptop. I did something that in retrospect seems a bit rash. There’s a DNA-collection kit on my desk now, taunting me — because although I bought the thing, I still can’t decide whether I actually want to use it.

The sheer volume of misinformation on DNA testing — combined with public belief in the amazing accuracy of DNA testing (probably induced by watching too many crime investigation TV shows) — leaves the legitimate companies in an awkward situation. The actual DNA self-tests don’t tell you what you might expect, and can tell you things you don’t want to know. Politicians jumping in now (at the prompting of bureaucrats who want more power to regulate) will only make the situation more confused.

H/T to BoingBoing for the link.

Two-thirds of Canadians do not know that Canada has no abortion law, according to a new poll that indicates Canadians are woefully misinformed about a landmark ruling in the country’s history.

The poll, which asked 1,022 Canadian adults about their understanding of the country’s abortion regulations, found that just 22% of Canadians correctly identified a woman’s right to an abortion with no governmental restrictions. Canada has not had legislated abortion rules since 1988, making the country an “absolute outlier” on the issue, according to a medical ethicist.

“There’s really only a very small number of Canadians that correctly identify the current situation in Canada,” says pollster Jaideep Mukerji, who worked on the Angus-Reid poll, which was released on Tuesday. “That could be problematic.”

This was highlighted over the last couple of months, with the government and opposition wrangling over Stephen Harper’s initiative to increase funding for maternal health in the developing world. Because opinions widely differ over what the law covers in Canada, it was easy for the opposition to portray Harper’s plan as being ideological rather than humanitarian due to the exclusion of abortion.

Canadians don’t want to re-open the debate, although most appear to want more restrictions in place.

Good on ordinary Torontonians. Despite all the H1N1/swine flu hype this past winter, just 28.2% of that city’s residents bothered to get vaccinated against the “pandemic;” that’s less than the 35% who usually get shots each year against the seasonal flu.

Even Toronto health care workers couldn’t be stampeded into getting the shots. Only 60% of them bothered.

[. . .]

Even from the start, the World Health Organization and other experts where told this strain of flu was weak and easily defeated. Infection rates never came remotely close to forecasts and death tolls were thankfully much, much lower than for typical seasonal infections.

The trouble, I think, was that so many public health officials have predicted so many pandemics for so long — SARS, bird flu, swine flu — that they simply got caught up in their own warnings and projections. They wouldn’t listen to contrary evidence.

The relevant public health authorities would have served the public interest (and their own credibility for the future) if they’d been much more forthcoming as the early stages of the pandemic showed H1N1 not to be the second coming of the Black Death. Instead, they doubled-down and raised the propaganda bar even higher.

October 27, 2009: Given that regular seasonal flu causes thousands of deaths annually, you’d think it would be good statistical discipline to count the cases of H1N1 separately, both the gauge the severity of the disease and to chart the effectiveness of the vaccination program. Lumping seasonal flu and “flu-like symptoms” together with H1N1 seems a big step backward from normal public health practice.

This would have been a good opportunity for de-escalating the panic mongering (and perhaps even attempting to rein-in the media, who were equally to blame for the tone of the information getting to the public). They chose, instead, to actively hide the fact that H1N1 cases were running below the level of ordinary seasonal flu cases (total H1N1 deaths: approximately 18,000 — typical annual death toll from seasonal flu: 250,000-500,000).

The biggest problem isn’t that they over-reacted this time, it’s that it has reduced their credibility the next time they start issuing health warnings. And that’s a bad thing. Unless they pull the same stunt next time, too. In which case, we may start hearing talk about setting up competing organizations to do the job the current entities appear to have given up on.