Monday, May 23, 2011

All harm and no benefit: Wake up and smell the pus!

Ideas are a little bit like a pimple: There needs to be enough pressure that builds up to cause one to erupt into consciousness. So it has been with my thinking around value of certain consumables. And the more I think about it, the more I am convinced that the law of diminishing returns is scowling at us from its perch. Here are 3 examples that I hope will drive this point home.

Take cigarettes. They cost money to manufacture, they cost a boat load of money to buy, yet what do they produce that is of value? A rise in the teen's coolness quotient? A brief relaxation effect? Appetite control? Sultriness? A tax base? All of this is so squashed by the sheer size of the risk of disease and death that cigarettes cause as to make any of these potentially perceived "benefits" infinitesimally small, thus bringing the harm in the harm-benefit ratio into the range of infinity. So, huge investment, personal and societal, for a negative return.

Next comes food. I am sorry, but I am going to stop wringing hands and apologizing for being convinced that there is in fact unequivocal scientific proof (yes, I did say "scientific proof") that our gargantuan and infinitely dysfunctional food production system is poisoning our public. Obesity is but one manifestation of this diseased production. The potentially more catastrophic consequences include accelerated deforestation with the consequent extinctions and climate change, which is rapidly moving from the realm of abstract future into the concrete present. Many have written about the science behind all this, and I will not belabor it here. Yet it is clear that this is another example of ever-increasing investment and subsidies made at the peril of environmental and public health. So, again, we have a cigarette-like situation, where the numerator of harm overwhelms the denominator of benefit to such and absurd degree that it threatens to stamp us out, like a drunken Godzilla strolling down a city street, pulverizing everything to dust.

And of course, we must bring in "healthcare." I put it in quotes because there is so little health in this healthcare paradigm. It is striking to me how the "prevention" conversation has been hijacked by the vocabulary of "screening." And don't you practically feel like a criminal refusing some screening test or another, or worse yet, refusing to comply with your annual check-up? At the same time, every day we hear about harm due to overzealous search for what is wrong with us. Healthy people walk into a place of "healthcare" delivery and walk out at best with a handful of pills and a bunch of ICD-9 codes attached to them, or at worst end up dead (or so close to it that they wish the job had been completed). I am sure you all remember the paper in the Archives of Internal Medicine that precipitated this post, where a healthy woman ended up needing a heart transplant because of the dogged search for a diagnosis that did not exist. More recently, several lay press articles, including this one, have highlighted data on an increase in potentially life-threatening post-biopsy infections among men undergoing a prostate biopsy. And the kicker is that the PSA test, which is what usually leads to a biopsy, has been so convincingly characterized as completely unreliable that it is difficult to believe that anyone still submits himself to it. And to top it all off, Archives of Internal Medicine has just published this paper on screening for heart disease in asymptomatic people (this means schmos like you and I who hang out in our offices without any heart symptoms). And, not surprisingly, they found an increase in the diagnosis and treatment of heart disease among those screened compared to those not screened, and absolutely no impact on the outcomes! All harm or potential harm and no benefit! We should be outraged, but instead we demand more intervention.

Given our peaceful acceptance of pushing (yes, pushing) harmful stuff on the public without any pretense at benefit, just as the brazen strategies of the tobacco and monocultured foods have done for so long, it is not surprising that we are willing to dive head first into this quicksand of harm. It attests to how effective the PR industry's brainwashing is. But really, isn't it time to wake up and smell the pus?      

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