Welcome to the year 2022! I initially wished to summarize the year 2021, but then realized that my post “The Move” essentially accomplishes that. Today I encountered a very well-written critique of health care in the year 2021 by Paracelsus, which can be found here. My only criticism of this article is that it doesn’t go far enough. So, my blog site allows me to add all that I wish as I will now do. I strongly encourage you to first read the article by Paracelsus before reading this blog page. I noted a number of areas of concern that were not mentioned in the linked article, though I’m sure you all might add many more.
- Loss of ethics
I have written frequently about my concern that health care has totally lost its ethic, and I will not repeat what I have previously written. On the Feuchtblog.net site, one will find articles that I have written regarding physician assisted suicide and the abandonment of the Hippocratic Oath. Indeed, when I ask physicians as to what the Hippocratic Oath really means, I get nothing but jibberish. They don’t have a clue. Medical ethics has morphed into a creature from the Black Lagoon, something that destroys the meaning of medical ethics. If ethics means nothing more than a common consensus (and not transcendent law), then we are all doomed.
- The purpose for hospitals
The the 4th century, the Cappadocian fathers in central Turkey noted that the tradition in Roman culture was to put the sick and hopelessly infirm out into the woods to die, probably by being eaten by the wolves. They decided that a Christian solution was to reincoporate these people into society, and they provided the outcast what little healthcare there was, nurture, and community. Many of these folk died, but many survived. This was the start of hospital, springing out of monasteries, and providing to the sick perhaps nothing more than community and comfort in death’s hour. We’ve since removed hospitals from the monastery, and we’ve also removed the main objectives or purpose of the hospital from the hospital. Hospitals are now places where the sick go because they are a trouble to their family, where families are often forbidden to see their dying loved ones, where abandonment of the patient to a large impersonal system occurs.
- Advertising in medicine-the commercialization of medicine
Historically, it was considered unethical for a physician or a hospital to advertise. The American Medical Association stood strongly in opposition to physician advertising, that is, until the Supreme Court (sic!) in the 1970’s declared that the AMA was forbidden to forbid physician advertising. This opened up a can of worms. Physicians took to the airwaves and print. Hospitals everywhere, regardless of how incompetent they were, boasted of providing the best healthcare in the state, and drug companies promoted their latest elixers with elderly folk dancing across the boob tube, offering genuine lies regarding the miracles their latest, greatest, but unaffordable new potion. Medicine turned into a commercial industry, and agencies all the way up to the NIH lost their health care focus, and turned instead to profits as the highest good.
- Research-blinded trust in science
During my research years, Dr. DasGupta and Dr. Carl Cohen reminded me incessantly of the need for integrity in research. It indeed was a serious problem in the biological sciences world, the problem of fraud in research often being discussed by Nature or Science as critical issues, involving a large percentage of published papers. Since the 1980’s when I did my research, I can be reassurred that research fraud is more, and not less prominent. Publish or perish is a theme that has intensified in the academic and research world. Yet, we are asked to blindly “trust” science. Is fraudulence in research the reason why standard-of-care recommendations are so frequently changing? Is it why so often public experience doesn’t match the promises of treatment? Is it why prevailing paradigms are so hard to break, even when the paradigms don’t seem to fit reality, and that evidence contrary to the paradigms are soundly rejected simply because it offends the current paradigms?
- The curse of statistics
In the same vein as #4, statistics can be used even in valid research to support an illigitimate claim. I have seen it in cancer care, where a new, expensive but marginally better therapeutic drug (and often with significantly higher toxicity) becomes the standard of care norm. How do they do that? It’s all about how one does statistics, and (as the Paracelsus article above mentions), failure to present data focused on the individual survival benefit mislead the patient to the therapeutic benefits. If Big Pharma were forced to provide data which detailed the number of people required to treat in order to accomplish one favorable outcome, most drugs would go off the market as they would be rejected by patients as worthless. Big Pharma most often looks at surrogate outcomes, which are illegitimate in my book. As an example, statin drugs may lower cholesterol (surrogate effect) yet have minimal to no effect on actual deaths from hypercholesterolemia. True story. As an aside, in medical school, I had a community mentor (physician) who would be presented patients with unsolveable symptoms. His first action would be to stop all the medications that the patient was on. The physician noted that most patients would then proceed to get better. Statistics be damned; physicians are often making patients sicker.
- The Flexner Report as a failure
I am not promoting the Flexner report, as much evidence exists that it was an entire fraud. The Flexner report was produced early in the 20th century with the prolific rise of of medical schools in this country with widely divergent standards of training. The report was correct that many physicians lacked proper training and were devoid of any standard evidence of competence. The Flexner report attempted to provide some means of setting a standard of competence among physicians. I don’t have a complaint about that. My complaint is that our society has essentially trashed the impact of the Flexner report. We no longer require competence among many, and we have abandoned the used of the word “physician” and replaced it with “health care provider”. Nurse practitioners can now play doctor, and though they carry the word “doctor” after their name, it is from a mostly bogus “PhD” that they obtain by doing research substandard by any other standard, though legitimized by the nurse practitioner schools that now exist everywhere. Now, there are physician assistants which abound but who have very marginal training, yet serve the function of a physician in many settings. These extenders are offered standard of care flow charts that define their therapeutic agenda. Health care providers no longer think. Thinking, and personalized care has been thrown out the window.
- Insurance debacle
The insurance industry has a speckled history, starting as a means of providing for the most extreme emergencies in health care. After the insurance industry became self-focused, various physicians joined together to create the “Blues” system (Blue Cross and Blue Shield) to provide a more equitable system for the physician and the patient. Ultimately, what started as a protection against emergencies became the primary means of paying for health care. Costs meanwhile skyrocketed. In the 1950’s, the cost of a night in a hospital bed was commensurate with the cost of staying in a nice hotel room. Now, the cost of a night in the hospital would purchase an insanely luxurious and expensive hotel suite accompanied by servants and abundant frills. A week in the hospital without extraordinary care now will cost the price of an expensive Ferrari or a small home. Without the insurance industry operating as a giant Ponzi scheme, it is inconceivable that anybody could afford health care. I find it especially laughable when some argue about the importance of a free-market system. The free-market system was lost long ago to anybody but the most slickster physicians and a few of the independent family practice doctors. It is likely that independent (not-employed) physicians will soon become as plentiful roaming the earth as the Tyrannasaurus Rex. I realized when I first started a surgery practice that it was a joke establishing a fee for a service that I provided. I was told what I would be paid by the feds and by the insurance companies, who based their reimbursement in proportion to what Medicare paid. Private practice is nearly dead and in 10-20 years will be a historical novelty. The significance of this is that instead of receiving health care from a person, your health care is rendered by a corporation—a big, non-caring corporation whose corporate survival is more important than your survival.
Alternative health care has become a public reaction to the absence of trust in the health care community. During my tenure in a surgery practice, I have occasionally referred patients to chiropractors, and certainly feel that they are an important aspect of the health care community. These practitioners argue that they are scientifically based and are able to provide research papers justifying their practices, yet unbiased review by critical analysis shows weaknesses in the data that cannot be ignored. Because insurors will cover many alternative health costs, the pie of the health care dollar going to conventional medicine is greatly reduced. This might not be all bad, since conventional medicine has departed from its original objectives. Alternative care, regardless of the science, provides solutions that conventional medicine are unwilling or forbidden to explore, and is most fitting for certain types of diseases or as wonderful adjuncts for other diseases best treated in the conventional setting, such as cancer. Even still, alternative care has served as a confounding factor in rendering of health care, and mostly acts as a gadfly to conventional medicine in identifying how they have been deficient in providing true health care to their patients.
- Legal issues
The claim of the legal community is that lawyers are important in preserving the quality of health care. I would argue that the current malpractice environment massive drives up the cost of health care, while simultaneously driving down the quality of health care. This is a long discussion that I’ve discussed in detail in the past, though lost to the graveyard of digital ones and zeros. Suffice it to say that a true market system of health care would provide a much greater impetus for quality health care than the negative threat of a lawsuit.
I am most glad to be out of medicine, which now uses the euphemistic title “health care”. My arguments and those of Paracelsus indicate the loss of the system that once provided real (though sometimes ineffective) care of a patient. I would far rather die in the personal domain of a family, or on a mountain top, than to die in the sterility of a hospital with masked and gowned, over-worked and (often) under-caring physicians and nurses who provide for formulaic treatments of the signs and symptoms that my body happens to be expressing at the moment. Such repulsion of the health care system causes me to seek health care as minimally as possible, and to be as terse as possible when in the health care domain. As Paracelsus noted, the current COVID “crisis” serves to make clear how healthcare has degenerated into the impersonal beast, a henchman of the state, that does not serve the patient’s best interest. Though we can’t live without the healthcare community, it is becoming harder and harder to live with the health care community.