Two “very large studies” — one in the United States and one in Europe — showed that “there might be some small mortality benefit but at a very high price for men,” with “very high” rates of impotence and incontinence, Brownlee said.
Many urologists disagree and continue to maintain that aggressive treatment is beneficial, but the main point of the Dartmouth work is that patients should understand their choices.
Brownlee said doctors and hospitals often say they simply do what patients want, but the data doesn’t show consistent trends across all procedures. Hialeah seniors, for example, are three times less likely to have back surgery or knee replacements than the national average.
“A lot of this is called the hidden curriculum,” in which doctors tend to make decisions based on what they were taught during their residency programs, Brownlee said.
In fact, even within South Florida, patterns vary widely. Seniors in Miami Beach get knees replaced and have coronary bypass surgery at about half the national average. In South Miami, they’re much less likely to have angioplasty, while a senior in Miami is 15 times more likely to be given a PSA test than a man in Lebanon, N.H.
The challenge is to find standards of evidence-based medicine, so that unnecessary procedures can be eliminated, said Brownlee, author of the book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.”
“A conservative estimate is that about 30 percent of the money we spend on healthcare is wasted,” Brownlee said. “I think that’s a low estimate.”