Here’s an article in the Orlando Sentinel that exemplifies so much of what is wrong with the media’s coverage of health care issues.

Titled “Gastric-bypass surgery patients say goodbye to weight – and diabetes,” the article reads like a promotional brochure for our nation’s ballooning weight-loss surgery industry. It tells the story of one Cynthia Toney, who in addition to being morbidly obese suffered from Type II Diabetes as well as high blood pressure, sleep apnea, heart problems, and joint pain. After having gastric bypass surgery, she was able to give up taking medication for her blood sugar, which has stabilized in the low-normal range.

And – so what? Your blood sugar level is a number on a sheet of paper. Contrary to what we have been led to believe, lowering blood sugar is not a benefit. Lowering blood sugar is a benefit only if it helps you avoid death or some other hard clinical outcome.

People who exercise and eat sensibly tend to be healthier than those who do not. They also tend to have lower blood sugar levels. It takes an astonishingly reductionistic mind-set to assume that a surgical mutilation that has the same effect on blood sugar levels will also have the same effect on the patient’s health. The medical literature is replete with examples of interventions which produce “favorable” results in terms of blood pressure, blood sugar, cholesterol, and bone density, but which had unfortunate side effects for the people who took them, like killing them.  

Given that the effects of this mutilation potentially last a lifetime, I find it odd that there has been only one long-term study that followed patients for more than two years –the Swedish Obese Subjects Study. And what did they find? They found that compared to coventional treatment (which, the paper cheerfully admitted, might mean “no treatment whatsoever”) weight-loss surgery was correlated with a one percent less chance of dying over the next ten years. Do you really think that such a puny advantage can even be measured reliably?  

And that was it – no evidence of any other clinical benefits, other than a modest weight loss, on the order of fifteen percent of starting body weight for patients that got the lap band. The article reports that in the year after having her surgery, Ms. Toney’s weght has dropped from 319 pounds to 152. That sounds great, but if her results are typical, that means her weight will eventualy stabilize at around 270 pounds. Hard to imagine that will make much difference, either for her blood sugar levels or her quality of life in general.  

But here’s where it gets really mendacious. The article goes on to gush:

“Bariatric surgery also is a cost-effective treatment for diabetes. According to the International Diabetes Federation, an American diagnosed at age 50 with Type 2 diabetes will tally up a health-care tab that averages $172,000 in direct medical costs and indirect costs of missed work, lost productivity and premature death. For those diagnosed at age 30, the cost can climb to $305,000. Costs of bariatric surgery range from $18,000 to $30,000.” 

Hold on a minute. They haven’t adduced a shred of evidence that bariatric surgery results in one penny of savings. Do they mean that by spending $18-30,000 we can save ourselves $172,000 or $350,000 in medical costs? That would be true only if the people who get bariatric surgery never require any medical interventions again. To be fair, they don’t come out and make that ridiculous claim, but they sure seem to be trying to leave that impression in the minds of the readers. Otherwise, what is the point of juxtaposing those figures together in the same paragraph?

It might be that a long-term study would show that this mutilation does result in reduced costs and/or improved clinical outcomes for patients. Or it might not. I don’t know. The author of this article doesn’t know either, and neither do the members of the bariatric surgery profession or the manufacturers of medical devices. And they’re not interested in finding out.

I submit that if we don’t have millions of dollars to do a study, then we don’t have billions of dollars to spend on medical interventions on the grounds that it is hypothetically possible that somebody might benefit from them. That’s precisely the mentality that got us into the mess we are in. We spend more per capita on medical interventions that any other nation in the world, with worse outcomes than almost any other developed nation. And people need to face the fact that if it takes years and years and millions of dollars just to determine if a given intervention produces benefits, then any benefits it does produce are likely to be small. Finally, we all need to be on our guard against reporters who ought to be watchdogs of the medical profession but who all too often act like lapdogs.

Photo via Wikimedia Commons