Sunday, May 13, 2012

Epidemiological surveillance testing is a waste

Only last month, we posted on the Washington state pertussis outbreak. Back then, there were 640 reported cases through March.  A month later there are 1284 total cases, up from 128 the prior year.  To me, these seem like important data. For one, we've used them to sound the alarm over low vaccination rates.  Now an article in today's NY Times highlights the impact that state budget woes have had on the public health infrastructure and how this has blunted the epidemic response.

Skagit County's (pop: 117,000) top medical officer, ER doc Dr. Howard Leibrand, has some choice words for pertussis testing, which I've pasted below:

If the signs are there, he said — especially a persistent, deep cough and indication of contact with a confirmed victim — doctors should simply treat patients with antibiotics. The pertussis test can cost up to $400 and delay treatment by days. About 14.6 percent of Skagit County residents have no health insurance, according to a state study conducted last year, up from 11.6 percent in 2008. 

“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.” 

Since antibiotic overuse has no cost or downsides from a public health perspective and we don't need to understand the scope of the epidemic, this is probably cool.

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