Lt is time to criticize our “always more” society. Always further, always faster, always more technology, for what result? A disaster to come, we are all aware of. Curiously, medicine has escaped this criticism of “always more”, it is even a patent counter-example. It is in fact the vertiginous acceleration in the production of scientific work and technical innovations in recent decades that has made MRI or biotherapies possible. But how to think, today, of neurology without brain imaging by magnetic resonance, or the treatment of cancers and inflammatory diseases without monoclonal antibodies? Medicine is the best alibi for technoscientific hubris.
Yes, but lo and behold, it got us addicted. In the utopian hope of being able to overcome death and suffering through the limitless power of our science, all of us, doctors, patients, health authorities, politicians…we are intoxicated by the uninterrupted flow of discoveries that biotechs like to announce to great crashes. And drunkenness sometimes leads to the absurd: a diagnosis made without being supported by a list of results of scholarly complementary examinations has become a suspect diagnosis; the latest treatment put on the market has become de facto the best, in the same way as the latest mobile phone. It is high time to stop this madness.
High technology to respond to anxiety
Yes, it is possible to make a diagnosis without resorting to additional examinations, it is even the most frequent case in dermatology or psychiatry. And yet this often comes as a surprise, because beyond the fascination for technomedicine, everything contributes to pushing for the prescription of paraclinical assessments. The physician’s obligation of means, the increasing legalization of the world of care or, even, the empowerment of patients based on the knowledge available online. There are also more subtle, deeper reasons. The use of high technology is sometimes a simple defense mechanism against the anxiety associated with the risk inherent in any medical act. And why not also mention the non-guilty enjoyment of using the power to prescribe with a simple stroke of the pen a treatment or a sophisticated blood test costing 10 to 100 times the price of the consultation?
Regarding new treatments, if their real added value in terms of effectiveness can often be discussed, in reality, the real problem concerns their price. Regularly, the Commission for Economic Evaluation and Public Health (CEESP) of the High Authority for Health (HAS) points out the unfavorable nature of the cost/effectiveness ratio of the health products it evaluates, in particular new anti-cancer drugs. These treatments may have a clinical benefit, but their cost often greatly exceeds 100,000 euros per patient which, in the opinion of the CEESP, “questions on collective acceptability”. Why do we pay such high prices for these products? Because of their effectiveness and the seriousness of the diseases concerned? A priori, no, because the medico-economic models take this into account. More likely, because these new treatments are fascinating because of the knowledge and technologies they mobilize. This leads to a real problem of health equity: all other things being equal, patients who can benefit from sophisticated treatments will benefit from more national solidarity resources than those requiring medical care. “humans”, considered less prestigious.
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