The City of Too Much Medicine Makes News Again

On November 3rd, this article was updated with news about a federal settlement implicating some McAllen hospitals in a scheme to pay doctors for referrals.

Pity McAllen, Texas. In May, the town came to symbolize almost everything that's wrong with American health care after Dr. Atul Gawande, a medical journalist, described it in the New Yorker as a city with a glut of specialists too eager to perform expensive procedures and tests, the kind of place that demonstrates why medical costs keep spiraling upward nationwide. Gawande's article made such a convincing case against McAllen's medical culture—and against the profit motives that drive much of the health-care system—that the president made it required reading for his staff. One of the town's largest medical groups also just paid $27.5 million to settle allegations that it was giving doctors kickbacks so they would refer patients to its hospitals.

Now, the Allergy and Asthma Foundation of America has named its Fall Allergy Capitals, "the 100 most challenging places to live with allergies" in the country. The absolute worst town on the list? Yep, McAllen again.

The city's double thrashing was not politically motivated. Mike Tringale, the AAFA's director of external affairs, hadn't read the Gawande article until last week, when I sent it to him. And some of the reasons McAllen landed on the bad-allergy list have nothing to do with the health-policy concerns in Gawande's piece—for instance, the fact that the city, at the southern tip of Texas, has lots of pollen, high humidity, and almost no freezing weather.

But there's at least one odd way in which the AAFA's take on medicine in McAllen seems at first glance to contradict Gawande's—and there's a lesson in it for people looking to cut down on health-care costs. According to the AAFA (which is a nonprofit patient group, not a doctor lobby), one of the reasons the city is so hard on allergy sufferers is its lack of board-certified allergists. Is McAllen, the city of too much medicine, somehow also suffering from too few doctors?

Not quite. For the most part, the AAFA report doesn't contradict Gawande's findings about a pervasive culture of overtreatment. If anything, it bolsters them. Take, for instance, Gawande's point that "compared with patients in El Paso and nationwide, patients in McAllen [get] more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care." They get more allergy drugs too, according to the AAFA. "In McAllen, patients are overmedicated for allergies. Their use is off the charts," says Tringale. "They're completely dissatisfied with single solutions. They'll take a prescription medication, an over-the-counter medication, and an eyedrop all at the same time."