MONEY AND MEDICINE - DVD review

No doubt you're more comfortable knowing that your medical specialist has supreme confidence in her abilities, but a doctor who is unshakably convinced that she can save lives is a whole lot more likely to try to do so... even when there's really no life to be saved.

Director Roger Weisberg's documentary “Money and Medicine” (2012) argues that the main reason America's health care system costs so much (relative to almost any other nation) is that we provide, at least in some areas, far more health care than we really need. This happens because every incentive exists for providers to intercede whenever possible: ordering another test is always the best way to cover your (legal) butt as well as to allow doctors and patients to make the most informed decisions. But the documentary suggests that in many cases tests such as mammograms and PSA's only provide the illusion of security, and that the information they provide seldom has any positive impact on patient health. Seldom isn't never, though, and that's one of the sticking points: early mammograms may, as a whole, have a negative or neutral impact on patient populations, but if they will help one in a thousand, everybody wants the chance to be that one. No matter the cost.

The documentary compares care at two facilities: UCLA Medical Center and Intermountain Medical Center in Utah. UCLA is the more prestigious institution, but Intermountain appears to achieve similar or even superior patient results despite vastly lower rates of medical intervention. Make that “because of” rather than despite lower rates: less medicine equals superior care. At least that's the film's argument, one which I am unfortunately not qualified to assess.

Weisberg hurtles through a series of medical procedures from C-section births to mammograms to prostate screenings (PSA's) with experts testifying that in each case providing fewer of the interventions in question actually leads to superior overall outcomes. Superior for the patients at least, but not necessarily for the hospitals. As one doctor notes, “I'm paid more when I hurt my patients.” The documentary stops short of pointing the fingers at doctors or hospitals looking for a fast buck, but rather claims that even a system filled with practitioners who want nothing but the best for their patients will always be sub-optimal as long as it's structured on a fee-for-service basis.

Patients are part of the problem as well: when doctors ask patients if they want a test performed, the answer is usually yes. Everybody wants more information and greater security of mind, but according to the film even the most widely recommended tests (CT scans, PSA's, etc.) often lead to overdiagnosis and unnecessary treatments that carry substantial risks and side-effects, For example, many patients are run through chemotherapy and radiation regimens for cancers that would never have harmed them had they gone undetected, but detection requires intervention. One practitioner claims that medicine itself is the third leading cause of death in America, though that vague claim isn't fully explained. Perhaps the most telling factoid offered is that when doctors become patients they opt for vastly lower rates of elective procedures than the rest of the patient population.

Weisberg's approach is familiar and repetitive, jumping back and forth between the same few talking heads at the two institutions (as well as a few others), and the movie suffers from overambitious bloat when it tries to tackle the thorny issue of end-of-life care, a subject that really requires its own film. There's also no way for the average viewer to assess the validity of many of the film's bold claims. But the point of the documentary is to provide food for thought, and it certainly does that. It's fair to ask, however, that if early screening doesn't often produce actionable information, is watching a documentary that “gives you something to think about” going to help you make decisions that improve your health care results? My amateur impression is that the best thing to take out of the documentary is to have one question in mind the next time your doctor prescribes a test or procedure: “Would you do this if you were in my shoes?” Which is something you should already have been doing, but a good reminder never hurts.

Video:
The film is presented in a 1.78:1 aspect ratio. The interlaced transfer is perfectly adequate if unremarkable, more than good enough for the material at hand.

Audio:
The DVD is presented in Dolby Digital Stereo. No subtitles are provided.

Extras:
The only extras are three Deleted Scenes, running 13 minutes total.

Film Value:
The DVD cover offers a faux label reading: “WARNING: Excessive medical care may be hazardous to your health.” The film is not as alarmist as the cover promises, but it is consistent in its claims. The health care system is not set up to treat you as well as possible, it is set up to treat you as much as possible.