Thursday, June 25, 2009

ABC Primetime Prescription

So did you watch President Obama on ABC's PRIMETIME: Prescription for America last night? Or the additional segment on NIGHTLINE? Yes, it was a one-sided presentation of Obama's goals for health care reform but with pointed questions it seemed to bring up a full picture of the need for change and our options.

The fact is America can't continue with our current health care system, period. We simply cannot afford it. Already 16.3% of our GDP it continues to climb faster than inflation (usually 2x or 3x) and will soon cripple our economy. I enjoyed the comment from the doctor at the Mayo Clinic that we simply can't afford to give all treatments to all people. Every special interest group recognizes that change is going to happen, they just want to protect their interests.

There are several fundamental changes being proposed by the administration. First is a shift from Western medicine's focus on treatments to an emphasis on prevention which is the foundation of Eastern medicine. Since the three leading causes of death in our country are preventable this is self-evident.

The key part of this shift is a change from a nation of medical specialists (80% of doctors today) to relying on primary care doctors. In every other industrialized country the ratio is reversed with 80% primary care doctors and only 20% specialists. Again, doctors have simply followed the money in a system that's evolved to reward procedures instead of results.

If you managed to stay up late you heard the best question of all: Every other industrialized country in the world manages to provide health care for every citizen while spending half of what we do in America. It's time for a change.

Change is coming whether we want it to or not, it has to. Now the challenge is to shape the change for the best future for America.

Wednesday, June 24, 2009

Conflict of Interest

Next time you read a story about drug companies you should probably question the bias of the reporter. According to the Society of Professional Journalists the National Press Foundation has accepted funding from the drug company Pfizer to offer journalism fellowships on cancer issues. This promotion of the opportunity is a direct violation of SPJ's by-laws which state they should "avoid conflicts of interest, real or perceived" and "remain free of associations and activities that may compromise integrity or damage credibility."

But that's not all. At its national conference in Indianapolis coming up in August, this "professional" journalism group will offer a tour of the Eli Lilly drug company corporate headquarters.

And they don't see this as a conflict of interest? Are we surprised at the recent flood of anti-CAM stories showing up in the media? Whatever happened to professional ethics? As a member of the Association of Health Care Journalists this behavior doesn't come as a surprise to me but it is disappointing. Yes there is a war going on for the minds (and wallets) of America during the health care reform effort but journalists are supposed to be objective reporters of events, not PR hacks on the take to promote one viewpoint.

To be fair, some journalists are raising objections about the disappearance of professional standards and I commend their efforts to reform their field before all credibility is lost. Hopefully these organizations will listen before they become the headline in their own story.

Wednesday, June 17, 2009

Medical Cost Conundrum

I've been to the Mayo Clinic in Rochester, Minnesota and I would be the first to say that it is the finest medical facility in America, possibly the world. How does it provide such outstanding service at such reasonable costs? That's the basic question in health care reform today and one of the best articles I've read on the subject came out a couple of weeks ago in the New Yorker magazine.

The Cost Conundrum by Atul Gawande is an outstanding article about what's really involved in health care reform today. Who pays is only part of the puzzle. I've said for a long time that what we're paying for also has to be part of the discussion because complementary and alternative medicine has a lot to offer, that's why more than 1/3 of Americans already use it. What's really at stake in health care reform is the heart and soul of medicine in America today. President Obama recently was raving about the article at a Cabinet meeting and it's been circulating around Washington at the highest levels.

To learn even more about this issue you should read Shannon Brownlee's award-winning book OVERTREATED: Why Too Much Medicine Is Making Us Sicker & Poorer. It will open your eyes and you'll never look at your doctor quite the same way again.

Monday, June 15, 2009

Simple Solutions

There's an old saying that "the most expensive piece of equipment is the doctor's pen." Doctors hate being told what to do, whether it's a government bureaucrat or another doctor. That's why they refuse to accept the common sense of the Dartmouth studies that show variations in Medicare treatments which more than double costs without changing outcomes. The research from the Dartmouth College's Institute of Health Policy and Clinical Practice compares costs and outcomes all across the country and it's caught President Obama's attention as a way to reduce health care costs.

Why would McAllen, Texas, a poor border town, spend $15,000 per year per Medicare patient when Rochester, Minnesota, home of the famous Mayo Clinic, spends half as much? To be fair let's compare it to El Paso since they have similar demographics. El Paso's hospitals rank better than McAllen's is 23 of 25 criteria. Yet McAllen patients get 60% more stress tests with echocardiography, 200% more tests to diagnose carpel tunnel syndrome and 550% more tests to diagnose prostate problems.

Atule Gawande, a Boston surgeon writing in The New Yorker recently said "they get more of what costs more but not more of what they need." Doctors at the Mayo Clinic work on fixed salaries which reduces the incentive for more revenue-producing tests. Developing "best practices" is not only a benefit to patients, it's also one of the ingredients in health care reform.

Thursday, June 11, 2009

Medical Hypocrisy

Reading some of the articles from the medical community coming out against health care reform recently I was struck by a curious bit of hypocrisy by the medical establishment. In the current issue of U.S. News & World Report the "Heart to Heart" column by Dr. Bernadine Healy is a very clear example.

The fourth point in her story is the standard medical fear-mongering about comparative-effectiveness research and standards. In plain language doctors are afraid that studying what a procedure or drug does would lead to standards being established. The Dartmouth research has already shown that Medicare costs more than double in various cities yet the outcomes don't improve ... or may even be worse at the most expensive locations. In other words doctors just don't like being told what to do (or not do) by anyone else, even other doctors.

Doctors are screaming at the top of their lungs at how dangerous and unfair it could be for some government bureaucrat to determine what drug or procedure a patient could get. After all, you might not get that brand new $50,000 per dose wonder drug because only a few people might benefit.

Isn't it interesting that while doctors are fighting for your right to consume every type of drug or medical procedure, regardless of its effectiveness, they're also fighting hard to take away your right to choose complementary and alternative medicine because it may only benefit a small percentage of people? They used to call this kind of talking out of both sides of your mouth hypocrisy. They fight for the rights of a few when it's in their financial interest but fight hard to deny the freedom for everyone to choose to their patients when it might take away business.

Fortunately consumers are beginning to figure out that medicine in America often isn't about saving lives, it's about money. Lots of money. Anyone who doubts that can read Shannon Brownlee's award-winning book OVERTREATED: Why Too Much Medicine Is Making Us Sicker & Poorer.

Friday, June 5, 2009

Medical Bankruptcy

New research in the American Journal of Medicine shows that medical bills were a factor in 62% of bankruptcies in American and 75% of those folks had insurance. The data was from 2007.

If anyone wonders why the health care reform movement is growing stronger this time around, this is the answer.

And the medical community says complementary and alternative medicine is expensive?