wasteful spending on medical care

Further to yesterday’s post on high US spending on health care, last night I came across a wonderful example of medical spending that is even worse than useless. It is from a fascinating book by neurologist Oliver Sacks.

In 1973 the journal Science published an article that caused an immediate furor. It was entitled “On Being Sane in Insane Places,” and it described how, as an experiment, eight “pseudopatients” with no history of mental illness presented themselves at a variety of hospitals across the United States. Their single complaint was that they “heard voices.” They told hospital staff that they could not really make out what the voices said but that they heard the words “empty,” “hollow,” and “thud.” Apart from this fabrication, they behaved normally and recounted their own (normal) past experiences and medical histories. Nonetheless, all of them were diagnosed as schizophrenic (except one, who was diagnosed with “manic-depressive psychosis”), hospitalized for up to two months, and prescribed antipsychotic medications (which they did not swallow). Once admitted to the mental wards, they continued to speak and behave normally; they reported to the medical staff that their hallucinated voices had disappeared and that they felt fine. They even kept notes on their experiment, quite openly (this was registered in the nursing notes for one pseudopatient as “writing behavior”), but none of the pseudopatients were identified as such by the staff. [FN 1] This experiment, designed by David Rosenhan, a Stanford psychologist (and himself a pseudopatient), emphasized, among other things, that the single symptom of “hearing voices” could suffice for an immediate, categorical diagnosis of schizophrenia even in the absence of any other symptoms or abnormalities of behavior. Psychiatry, and society in general, had been subverted by the almost axiomatic belief that “hearing voices” spelled madness and never occurred except in the context of severe mental disturbance.

[FN] 1. The real patients, however, were more observant. “You’re not crazy,” said one. “You’re a journalist or a professor.”

Oliver Sacks, Hallucinations (Knopf, 2012), pp. 53-54.

Chapter 4 (pp. 53-73) of Hallucinations can be read in its entirety here.

Belief that “hallucinatory voices are almost synonymous with schizophrenia” is common, explains Dr Sacks on p. 58 but “a great misconception, for most people who do hear voices are not schizophrenic”.

Oliver Wolf Sacks (born 1933) died of cancer on August 30th, 2015. Dr Sacks was British, but spent most of his professional life in the United States. He became professor of neurology at the NYU School of Medicine in 1965 and later, from 2007 to 2012, was professor of neurology and psychiatry at Columbia University.

Dr Sacks was not only a talented professor and researcher; he was also a physician and best-selling author of many books. His autobiographical account Awakenings (1973) in 1990 was adapted into a film with the same title, starring Robin Williams as Dr Sacks and Robert De Niro as one of his patients.

I was able to locate an ungated link to David Rosenhan’s article, and will shortly use it to prepare a TdJ. The results of the experiment are interesting, and rather frightening.

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