One of the problems with a capitalist system is that it is not, in fact, efficient. Any market-based system is based upon growth. But there is only so much that people need, or can even use, and so we have to create new needs, and new services, most of which are very wasteful. This is why we have planned obsolescence in our electronics, and if your cell phone breaks, you’re expected to get a new one. Who fixes things these days? That’s why we have all-new frosted cereals with different shapes every few months. Needs have to be created, growth has to be accomplished; the beast has to be fed. It’s one of the many reasons that some things-say, for instance, medicine-should not be market driven. Because the logic of a system that is always in search of growth is going to have a hefty amount of unnecessary and wasteful services.

I’ve been thinking about this lately because in Wednesday’s Shakesville Blogaround Melissa linked to this post at fat fu about why she won’t get a mammogram.

The biggest reason is I’m scared to death of what they’ll find, and if it’s really what they think it is.  And according to Sandy’s post this week on Junkfood Science this week about mammograms, it looks like my worries have some basis in reality.  Sandy cites this study published in the British Medical Journal (no, really, read it, your eyes will bug out of your head) that was conducted by a Norwegian research team, in which  almost two million breast screenings were examined in multiple countries, and the sentence that leapt out on me was this: The rate of false positive diagnosis after 10 screenings was 50% in the United Stats and 20% in Norway.

The Junkfood Science article goes on to state:

The National Health Services Screening Programme tells women that mammography saves lives and is responsible for dramatic declines in breast cancer mortality since it began twenty years ago. That claim is disputable, [a group of British doctors speaking up about screening] said, and equally explained to improvements in treatment.

Missing is balance. Women don’t hear about the risks. Nor do they hear about the evidence showing that up to half of all breast cancers, and their precursor lesions, found by screening would not likely to have ever done any harm to women in their lifespans if they’d been left alone, they reported.

Yet, if found at screening, they potentially label the woman as a cancer patient: she may then be subjected to the unnecessary traumas of surgery, radiotherapy and perhaps chemotherapy, as well as suffer the potential for serious social and psychological problems. The stigma may continue to the next generation as her daughters can face higher health-insurance premiums when their mother’s overdiagnosis is misinterpreted as high risk. We believe that women should be clearly informed of these harms in order to make their own choice about whether to attend for screening.

One might argue that it’s still better to get treated for a false positive than to let cancer go unrecognized and die, right?  Except false positives have a lot of problems, as the above paragraph points out.  And every treatment involves risks.  The other night at the gym, I read an article in last month’s Harper’s (subscription required), “Sick in the Head,” by Luke Mitchell.

In Overtreated, Shannon Brownlee argues that the major problem of health care in the United States is not that there is too little but that there is too much. We know that people who don’t get enough care have a higher risk of death,” Brownlee told me. “About 30,000 Americans die prematurely each year from lack of access. But getting unnecessary care isn’t any better for you. In fact, about 30,000 Medicare recipients die each year from overtreatment. This sounds counterintuitive until you think about the fact that practically any medical treatment you can name poses some risk.” For instance, doctors regularly test prostate-specific antigen levels in men to see if they have early signs of prostate cancer. As Maggie Mahar, the author of Money-Driven Medicine, explained it to me, this sounds like due diligence, but in fact the National Cancer Institute does not recommend routine PSA testing, because the majority of older men diagnosed with this slow-growing cancer will die of something else before they experience any overt symptoms, whereas if they are treated for prostate cancer, many will experience such side effects as erectile dysfunction, incontinence, and sometimes even death.

We have more or less been sold on the idea that more is better.  But that’s rarely if ever the case, and especially not in health care.  Getting unnecessary procedures is dangerous; not getting necessary procedures is dangerous.  Our current system encourages both those scenarios.  Perhaps the market is not as efficient as we have been led to believe.