From the first days of my practice 21 years ago when medical tools were relatively inexpensive to today when a million dollars is not considered a lot to spend on a sophisticated medical appa-ratus, I have been concerned with the benefits of medical care versus their costs. Long before it was fashionable, I was teaching that the expensive annual medical examination provided little information compared to its cost. The routine chest X-ray or electrocardiogram are worthless for the asymptomatic person yet millions are done today. Many operations such as hysterectomy and tonsillectomy have been shown to be wholly unnecessary and even harmful to patients. Yet these continue to be done and paid for by insurers or employers.
Myths abound as to the value of a certain treatment.
For example, one drug for dissolving blood clots in the heart costs more by a factor of 1,000 than another drug yet the former drug is no better in large scientific studies. Its continued use is shown by the recent announcement of huge profits by the company that developed it. It is critical to study even the most established medical practices to ensure their effectiveness. I consider this the most important obligation of the physician after patient care. Since my days as a fellow in endocrinology at the University of California in San Francisco, I have taught both physicians and non-physicians and am able to easily communicate with either group.