There's an issue in the national healthcare conversation that no one is talking about: excessive spending on unnecessary treatments.

On Wall Street there's a system in place -- albeit a broken one -- for overseeing suspect transactions and sniffing out abuse. But spending in the medical-industry marketplace continues to be largely unregulated, leading to a waste of billions of healthcare dollars.

My field of practice -- cardiology -- provides a dramatic example of the needless hemorrhaging of American medical resources.

Cardiologists perform an alarming number of expensive and high-risk interventional surgical procedures -- namely, coronary artery bypass surgery and angioplasty with stent placement -- in men and women with coronary artery disease whose condition is stable. According to the Agency for Healthcare Research and Quality, one in six American healthcare dollars is spent on these cardiac procedures -- a stunning $60 billion every year.

And yet, there is no scientific evidence that such high-cost surgeries are preferable to low-cost lifestyle intervention and medical therapy in stable patients. In fact, the consensus among the most reputable scientific studies concludes that the majority of coronary bypass and angioplasty surgeries performed on medically stable patients are unnecessary.

Counseling medically stable patients about diet, exercise, stress management and smoking cessation is relatively inexpensive and has been proven in dozens of studies to help prevent a future heart attack and lower the risk of cardiovascular death. Unfortunately this proven treatment approach is rarely reimbursed by insurance. In other words, surgical procedure-oriented modern cardiology and the insurance companies that cover it are pound wise and penny foolish -- and no one is watching the shop.

Three major national studies proved that for the majority of patients, bypass surgery is no more effective than conservative medical treatment. And every major study has shown that putting stents in stable patients is no more protective than following a heart-healthy lifestyle and taking medication to reduce cardiac risk.

The studies have also shown that stents sometimes make matters worse, by increasing the chance that a dangerous clot will form in a coronary artery, thus raising the risk of a heart attack or sudden death, as noted in 2006 by an advisory panel to the Food and Drug Administration. Unless the patient was in the midst of a heart attack, the opening of a blocked coronary artery with an angioplasty catheter resulted in a worse outcome compared to management through lifestyle intervention and medication.

There are exceptions, of course -- patients for whom bypass, angioplasty and stents are necessary and lifesaving interventions. These are patients in the throes of a heart attack and those with disabling chest pain despite medical therapy. But such ``unstable'' patients represent only a minority of those undergoing these costly, sometimes risky procedures.

I am certain that my physician colleagues in other areas of medicine can cite similar examples of wasteful spending caused by the excessive overuse of expensive, unnecessary treatment.

As a physician who has been practicing medicine for almost three decades, I propose the following practical solutions to our current healthcare dilemma.

Rather than the government's instituting universal healthcare and a public option for healthcare insurance, patients and doctors alike should insist instead on a sensible approach to medical care in America, emphasizing preventive care and allowing expensive and high-risk procedures only if there is scientific evidence to support them.

In addition, let's adopt legislation that will eliminate frivolous lawsuits that are holding American medicine hostage, forcing doctors to practice defensive medicine, which subjects Americans to needless tests and interventions to the tune of billions of wasted dollars each year.

We should also adopt prescription-drug reform and allow Americans to purchase prescription medications outside the United States at a substantial savings. This will ultimately lower prescription drug costs in America.

Finally, let us institute controls on the health-insurance industry that will lower the cost of health insurance and still allow the industry to compete in a free-market environment. For those who cannot afford insurance because of economic hardship, let us provide low cost or free medical care at teaching hospitals and clinics as well as not-for-profit hospitals and clinics that enjoy significant tax benefits.

This approach will cost us less in the long run than the universal healthcare/public-option proposal now being volleyed about in Congress. It will allow a robust free-market approach to healthcare to continue and prosper. Just as with Wall Street, we need government oversight, not a government takeover.

Dr. Michael D. Ozner is medical director for wellness and prevention at Baptist Health South Florida and author of The Great American Heart Hoax.

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