Those who preach the gospel of the routine physical have to produce the data to show why these physician visits are beneficial. If they cannot, join me and make a new resolution: My medical routine won’t include an annual exam.
He cites controlled experiments showing that the Null Hypothesis is true for the routine physical exam.
Not surprising, really. Ask Robin Hanson.
Pointer from Jason Collins.
That’s funny; all the pundits and wonks assured me that one of the ways that Obamacare would bend the cost curve was by giving people affordable access to the routine check-ups they were avoiding because of high costs, as part of ‘cheap, preventative care’ and instead of ‘stupidly’ wasting a lot more money playing emergency-room clean-up later.
The pundits insisted that people were being penny-wise and pound-foolish. Emmanuel says it turns out they were being pound-wise too.
Ha!
And Emmanuel was one of those pundits- until the bill passed. The reason is pretty simple though- one couldn’t mandate the ACA policies, politically speaking, without giving most of the buyers “something tangible” for their money. If people had been allowed to buy purely catastrophic coverage, most of them would have had nothing paid for by the policy for many years. With the mandated preventative care, they at least get the feeling they received something for their insurance fees, even if that something would have cost less out of pocket in the absence of the mandate. Gruber was right.
Emmanuel is also the one who is planning on dying in his 70’s and who advocates we all do. So I am not sure I could even predict a sign for health outcomes in his world.
I wonder if this holds true for dentists also. Are those annual cleanings/x-rays really doing any good for anyone who doesn’t use meth or smokeless tobacco?
It’s a good question.
The cleanings are surely very valuable. A reminder to floss is also rather important. Both of those things could be done by someone without all that much education, but you will be much better off having them done than not.
XRays one could quibble about, and general inspections one could quibble about. I would tend to think that outside the above categories, any major dental problem you have is going to be really obvious to you. You won’t detect a cavity as early as you would with a regular check up, but you will catch it eventually, and you won’t suffer all that much as a result.
On the flip side, regular dental visits seem relatively safe. To contrast, prostate exams and angiograms are two preventative measures that have a history of leading to painful, expensive, unnecessary procedures. Thus, the negative risks can easily outweight the positive.
I wonder if there is a general phenomenon at work here: from the perspective of the individual, the null hypothesis might not be rejected, and the cost may outweigh the benefit. But from the top-down perspective of ”macro” policy, it still seems sensible to mandate such tests, completely ignoring any costs incurred, while false positives are acknowledged as a cost of doing business. After all, something must be done, and this is something.
It is indeed a general phenomenon in situations of highly uncertain outcomes. In these situations the patient-centric and the population-centric “best decisions” are very different. I explore this idea using a simple example here http://vsglukhov.blogspot.co.uk/2015/01/flu-management-with-anti-viral-drugs.html
My insurer will now require a physical or we will be penalized.