Philadelphia Reflections

Health Care Rationing, American Style

Hayek

The 2006 annual scientific meeting of the American College of Physicians used six or eight auditoriums simultaneously over a three-day period, to accommodate the gratifying number of new advances in medical science. I wandered into one session devoted to pulmonary embolism because it affects a close member of my family. But every citizen ought to ponder the non-scientific message of this session. Indeed, the anti-scientific message.

It turns out that 1% of the relatives of patients with pulmonary embolism will test positive for inheriting a gene that promotes this often fatal disease. But the speaker, invited as a national authority to speak for the College, cautioned the audience that it would be wrong to test the relatives of their patients with pulmonary embolism for the possibility of running a significant risk of this disease themselves. Why so? We have a pretty good way of preventing this often-fatal disease, by giving blood-thinners, and blood thinners are getting better all the time. So, naturally, there were questions from the audience of doctors. Why in the world wouldn't you test people for this preventable condition?

With obvious discomfort, the speaker did a little tap-dancing in his answers; but here is the substance of it. There is a risk of complications from the therapy, of about 5% a year so you must choose carefully among those who have a positive test. If the individual tests positive but is not treated, he may develop an embolism and sue you for not having treated him. Even if he doesn't develop the condition, he will probably be stigmatized for life and find that health insurance is overpriced or unobtainable. If you treat everybody, you will cause problems more often than the disorder would. So, don't test. If you don't know about the problem, you can't get into trouble for acting in an ambiguous situation.

Personally, I doubt that. If the person has an embolism, a keen lawyer can ask if any relatives ever had the same thing, and if so, the other doctor can be sued for not testing the relatives, hence not discovering, and not preventing the present sad, sad, situation. I'd like to think the rest of the medical profession will join me in disregarding this preposterous advice, testing these families to identify the people who are at risk, and then treating them with the best method then available.

But, you know, in the present climate of managed care and lawsuits, I'm not so sure that's what will happen. Meanwhile, my own children are all going to be urged to go get themselves tested, whether the test is covered by insurance or not.

Originally published: Thursday, June 22, 2006; most-recently modified: Wednesday, May 22, 2019