EDITOR’S NOTE
The first few articles presented this month share a common denominator: a lack of emphasis on the root of diseases in our broken health care system. While overemphasizing symptomatic treatment with drugs and surgery, we neglect more important issues like nutrition, and the environment, all the while overemphasizing a deterministic and financial approach to genetics. But, who am I to say so? For some of you The New York Times is. I have included a whole article therefrom for your study. Get a Kleenex box.
Hugo Rodier, MD.
Sampling of the problem
1. 31 year-old woman with palpitations was diagnosed to have the “Long QT syndrome.” What caused it? Soda pop, 2 quarts a day for 15 years. She drank no water for that long. [1]
2. “PPI (acid blockers) and risk of one year mortality and re-hospitalization in older patients discharged from acute care hospitals.” They don’t live as long as those who don’t get Prilosec-like drugs. [2]
3. “Metabolism, longevity and epigenetics.” [3] It is not so much your genes that determine your health, but the food you eat and how it modulates genetic function. Yet, brace yourself for the oncoming onslaught of expensive genetic tests that, lubed with fear, will be pushed down your throat. [4]
4. “Trends in all-cause mortality in mid-life over four decades: Effect of adolescent body-mass index.” [5] Obesity in teens shortens life span.
5. “Caffeine-Containing Medicines Increase the Risk of Hemorrhagic Stroke.” [6]
6. “Nonsteroidal Anti-Inflammatory Drugs Are an Important Cause of Acute Kidney Injury in Children.” [7]
“Hurtling Down the Road to Ruin.” [8]
“A recent New York Times article, (“The $2.7 trillion medical bill”) that focused on colonoscopies highlighted the questionable science, predatory unit pricing, and overutilization that characterize this procedure and much of US healthcare. Patients get routine screenings that, in other industrialized countries, cost one half to one thirtieth of what they do here,
“But Elizabeth Rosenthal, the Times reporter, zeroed in on the root of the crisis, which is how healthcare interests have shaped market and policy forces to their own ends. “The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.”
“Many physicians own a financial stake in the care they deliver.”
“Pricing is typically unrelated to cost or quality, varies wildly among providers.”
Insurance companies may make a percentage of total cost and so are incentivized to allow healthcare to cost more. Every level of the system is rigged.
“The elephant in the room is that US healthcare costs are crushing the larger economy, not because the clinical science demands it, but because corporations and other interest groups have captured both the healthcare marketplace and the regulatory environment that oversees it.
“We are gridlocked, with no apparent hope of improvement. Last year, Florida Governor and former Hospital Corporation of America CEO Rick Scott observed, “How many businesses do you know that want to cut their revenues in half? That’s why the healthcare industry won’t fix the healthcare industry.”
“Following the money, independent of appropriateness, is hardly unique to healthcare. Several recent exposes in the mainstream press have detailed the cleverness of other industries’ market control efforts.
“But lobbying is an opportunity for anyone with the resources. It is impossible not to despair after reading these pieces.
“We’re being propelled by powerful vested interests. Our dearest freedoms are being eroded, our pocketbooks emptied, and the nation’s wealth is relentlessly concentrating into fewer hands.
“Large corporations and Congress, through lobbying, are the principal proponents of these threats to our individual, national, and global futures. Their leaders understand that the long-term outcomes will almost certainly not be favorable, but are distracted by short-term benefits. The rest of us are likely to be pawns, consigned to seek the attention of the few influencers who ultimately value the welfare of the many more than that of the few.
“One can imagine events that could disrupt these downward spirals. Bursting economic bubbles, a national outcry against corporate control, or market-based offerings that exploit commonplace market vacuums could force the pendulum to swing back toward balance and more of an open, egalitarian society. Unlikely, but possible. We prefer to hope that the marketplace of ideas remains the most powerful driver of enlightened self-interest, and that workable solutions abound.
“In healthcare, titanic economic pressures are already creating market opportunities, with many young firms innovating with new approaches that deliver measurably better quality at lower cost.
“But we also need a new Flexner Report, the 1910 study of medical education that revitalized US medicine, establishing a drive toward rigor, science, and professional standards. Now, US healthcare is broken in different ways and needs a clear-eyed, comprehensive reassessment of what we know about care and cost, and how it must be transformed to ameliorate its current threat to our national economic security.”
Interestingly, the author refers to the Flexner Report, named after the Director of the Smithsonian Institute at that time, as commonly remembered by those who have built the present chaotic health care system. While Flexner was correct in rooting out unscientific Medical Schools, he championed an education system focused on treating symptoms, and bereft of holistic, preventive and nutritional teachings. He was roundly opposed on those grounds by the then President of the American, British and Canadian Library Associations, William Osler, MD., who today is hailed as the Father of Modern Medicine. Nice title; perhaps this time we will listen to him from beyond the grave:
“I imagine my ashes on the mantle of this library, enjoying the sight of kindred souls still in the flesh, reading my books, and enjoying them as much as I did.” [9]
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”
“To carefully observe the phenomena of life in all its phases, normal and perverted, to make perfect that most difficult of all arts, the art of observation, to call to aid the science of experimentation, to cultivate the reasoning faculty, so as to be able to know the true from the false, these are our methods. To prevent disease, to relieve suffering and to heal the sick, this is our work.”
“While on the one hand I would encourage you with the firmest faith in a few drugs (the friends you have and their adoption tried,) on the one hand I would urge you to cultivate a keenly skeptical attitude toward the pharmacopeia as a whole.”
Amen.
[2] JAMA Internal Medicine 2013;173:518
[3] J. Cellular Molecular Life Science 2013;70(9):1525
[4] “Genomic medicine just hit the accelerator,” Medscape Internal Medicine Epub July 17 2013
[5] American Diabetes Association 2013 Scientific Sessions; June 22, 2013; Chicago, IL. Abstract 82-OR
[6] Published online before print June 6, 2013, doi: 10.1161/STROKEAHA.111.674077
[7] J. Pediatrics 2013;162;1153
[8] Medscape Internal Medicine June 2st 2013 reporting on NYT article published June 1st 2013
[9] Dr. Osler donated all his books to libraries when he passed away
