Im Prozess der Neugestaltung des amerikanischen Gesundheitswesens durch Obama stellt sich natürlich die Frage, inwiefern die europäischen Systeme als Vorbild dienen können. Ein Blog-Artikel vom Ökonomen Greg Mankiw äußert sich dazu skeptisch, am Beispiel von PSA-Screenings gegen Prostata-Krebs, die in den USA viel weiter verbreitet sind. Aber er verpasst meiner Meinung nach einen wichtigen Teil des Bildes:

Hier sein Zitat:

Should we envy European healthcare?
Gary Becker says the answer is no:
A recent excellent unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania compare mortality rates for breast and prostate cancer. These are two of the most common and deadly forms of cancer–in the United States prostate cancer is the second leading cause of male cancer deaths, and breast cancer is the leading cause of female cancer deaths. These forms of cancer also appear to be less sensitive to known attributes of diet and other kinds of non-medical behavior than are lung cancer and many other cancers.

These authors show that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries.

Preston and Hu show that this more aggressive detection and treatment were apparently effective in producing a better bottom line since death rates from breast and prostate cancer declined during the past 20 [years] by much more in the US than in 15 comparison countries of Europe and Japan.

Ich erinnerte mich sofort, dass vor nicht allzu langer Zeit Studien berichtet wurden, die den Nutzen genau dieser Screenings in Frage stellen. Eine kurze Internetrecherche bringt mich zu Cancer Research UK und Artikel vom März 2009, in dem aktuelle, groß angelegte Studien zum Thema, publiziert im New England Journal of Medicine, berichtet werden:

The European study suggests that one prostate cancer death could be prevented for every 1,410 men screened and 48 men treated during a ten-year period.

However, the results also show that many men may have undergone unnecessary biopsies as a result of PSA testing. Among the 73,000 men who were screened, more than 17,000 biopsies were performed — many more than in the non-screening group.

Writing in an accompanying editorial in the New England Journal of Medicine, Dr Michael Barry, from Massachusetts General Hospital and Harvard Medical School, concludes that routine PSA screening has a „modest effect“ at best on prostate cancer mortality during the first ten years of follow-up, and that this benefit „comes at the cost of substantial over-diagnosis and overtreatment“.

„It is important to remember that the key question is not whether PSA screening is effective, but whether it does more good than harm,“ he noted.

„Some well-informed clinicians and patients will still see these trade-offs as favourable, others will see them as unfavourable. As a result, a shared decision-making approach to PSA screening, as recommended by most guidelines, seems more appropriate than ever.“

Ich glaube, dass hier eher eine Überversorgung und Behandlung im amerikanischen Gesundheitssystem auszumachen ist. Was ja auch irgendwie zu erwarten ist, wenn die medizinischen Institutionen ganz normale gewinnorientierte Unternehmen sind.