The Ailments of American Medicine
This Sunday's New York Times had the leading editorial about the state of American Medicine, and it wasn't a pleasant read. The World Health Organization (WHO) apparently ranked the US in the 37th spot from 191 states, seven years ago. More recently, the highly regarded Commonwealth Fund placed the US in the next to last spot compared with 5 other nations - Australia, Canada, Germany, New Zealand and the United Kingdom, in quality of care and access to it. All major industrialized nations have universal health coverage, whereas the US has 45 million people without, and many more millions with very poor coverage. True, there is more access to health care in the US, but not if you need it at night or on a weekend. On those occasions, you better head to the nearest emergency room. If you're poor, you have less of a chance to get care than if you're well of. The US ranks last among 23 nations as far as infant mortality, and near the bottom in healthy life expectancy at age 60. We're bad at reducing the obesity epidemic, but we're good at reducing smoking. To our credit is that we provide the "right care" for the condition, but poorly in coordinating the care to the chronically ill. We rank first in best survival from cancer conditions, but last when it comes to controlling for chronic conditions such as diabetes. We lag behind our European colleagues in conducting electronic medical records, and in brief, there is allot of work yet to be done. Why is the situation so bleak? I'm sure the answer to that question is very complex, and multi-factorial, but the right question to ask is: "can it be fixed?". The answer to that question should be a resounding: "yes".
Part of the reason for the current state of affairs may be explained in an article I just read in Business Week. It's about the wasted effort Congressman Henry Waxman (D-Calif) has gone to, to try and limit the pharmaceutical industry's promotional advertisement during the first 3 years a new drug is on the market. The drug lobby, of course, won, and the effort was defeated. The only other country where direct to consumer advertising is allowed is New Zealand. The rest of the world thinks its too dangerous. But in the US, contending freedom of speech, TV drug advertising surged to $5.3 billion in 2006, and is steadily rising. Critics of drug companies are alarmed by the combining powers of the drug industry and the media giants, and would like to disengage them at least for the first 3 years that the drug is out.
What is really wrong with the American medical system? Mainly, the fact that it is not about healing, but about profit. These two concepts don't always coincide, and in fact typically, collied. Profit is a great way to move a society from poverty to a self sustaining condition. Case-in-point is China which has made such a move and is today a rich nation. But pure profit should have no role when it comes to healing the sick. The motivation there should be different. Typically, healing should help embolden a person's reputation and stature within the society that he/she is part of, and not necessarily make him richer. But since everything in this society is equated with money, success mandates having it. So healing becomes a business that everyone is devising ways to penetrate. What we see is that some doctors are in it for the money, and some will not get near it for the same reason. Instead of being recruited for the job of healing for altruistic reasons, or volunteering out of a calling, what beckons are the dollars. What should we do??? I believe that (a)the profit motive should be removed from medicine, and (b)that the USA should move towards a single payer system. Lobbying at the congressional level by the pharmaceutical industry, should of course be banned, thus allowing the doctor to give his opinion prior to the patients exposure to biased opinion.
Part of the reason for the current state of affairs may be explained in an article I just read in Business Week. It's about the wasted effort Congressman Henry Waxman (D-Calif) has gone to, to try and limit the pharmaceutical industry's promotional advertisement during the first 3 years a new drug is on the market. The drug lobby, of course, won, and the effort was defeated. The only other country where direct to consumer advertising is allowed is New Zealand. The rest of the world thinks its too dangerous. But in the US, contending freedom of speech, TV drug advertising surged to $5.3 billion in 2006, and is steadily rising. Critics of drug companies are alarmed by the combining powers of the drug industry and the media giants, and would like to disengage them at least for the first 3 years that the drug is out.
What is really wrong with the American medical system? Mainly, the fact that it is not about healing, but about profit. These two concepts don't always coincide, and in fact typically, collied. Profit is a great way to move a society from poverty to a self sustaining condition. Case-in-point is China which has made such a move and is today a rich nation. But pure profit should have no role when it comes to healing the sick. The motivation there should be different. Typically, healing should help embolden a person's reputation and stature within the society that he/she is part of, and not necessarily make him richer. But since everything in this society is equated with money, success mandates having it. So healing becomes a business that everyone is devising ways to penetrate. What we see is that some doctors are in it for the money, and some will not get near it for the same reason. Instead of being recruited for the job of healing for altruistic reasons, or volunteering out of a calling, what beckons are the dollars. What should we do??? I believe that (a)the profit motive should be removed from medicine, and (b)that the USA should move towards a single payer system. Lobbying at the congressional level by the pharmaceutical industry, should of course be banned, thus allowing the doctor to give his opinion prior to the patients exposure to biased opinion.
posted by yair litvin, md at 7:36 PM
1 Comments:
When I read this it brought back a personal experience that was infuriating. Last year I spent close to 48 hours in an emergency room with my very ill father as he lay on a gurney. We were told that the delay was because there were no available hospital beds. After the two days, when finally brought to a room, we passed two complete wings of empty beds and rooms. I asked why all of these rooms were empty and why they could not have been utilized for all the ailing patients waiting in the emergency room to be admitted. The response I received was: "the wings are closed because it is not profitable for the hospital to open them". This was the case on three floors of this hospital. Is this not truly an example of how everything in this society is equated with money and how healing is now a business that everyone is devising ways to penetrate? Spending those two days on the gurney with no food and little water and/or medication was actually detrimental to my Dad's condition. This was a hospital. A place where one would think should be the safest, curative haven for a sick person. In retrospect, keeping Dad home would have been more therapeutic. Sadly, the beckoning dollar has driven these institutions to lose sight of their purpose! If only your suggestion to remove the profit motive from medicine would become reality, perhaps the people and places which were meant to heal would make healing their priority
Post a Comment
<< Home