Why More Isn't Always Better
Red Herrings, Side Effects, and Superbugs
I remembered an Irish woman who once said to me, "you know, if only you doctors
could find a cure for these wretched antibiotics, you would be doing us all a good
turn." —John Lister1
There were other tests, some of which seemed to me to be more an assertion of the
clinical capability of the hospital than of concern for the well-being of the
patient. —Norman Cousins2
AS WITH buying a house or eating ice cream, it seems that getting more of a good thing is always better. Most of us assume that more medical care can only be a good thing. Americans are convinced that American medicine is the best because we get the most, and that the more we spend for medical care, the better it is.
For many basic medical services, this holds true. Childhood vaccinations, antibiotics for life-threatening infections, and surgery for appendicitis or heart disease can be lifesaving. At a population level, better access to basic services makes a big difference.
But as a nation, we may be at a point of diminishing returns. Increasing our expenditures on health care beyond a certain point may not improve the health of the nation one whit. There could even be a point where spending more for tests, drugs, and surgery will make things worse, leading to irrelevant findings, avoidable side effects, and unnecessary surgery.
Whether, as a society, we've reached that point is a matter of dispute. Everyone in the health-care industry—drug and device makers, hospitals,