Incest in the System
By Dr. Lon Jones, D.O.
Incest in the System
By Dr. Lon Jones, D.O.
In the article about paying the system we saw how the joining of health care and the insurance industry has led to health care becoming the expensive commodity that it is.
The health care industry is a big family with many members. At the bottom there are the doctors, and other primary care-givers. In order to take care of the public they use laboratories and their tests, X-ray and sonographic studies, physical, and a variety of other, therapists, hospitals, and pharmaceutical companies. All of these make up the health care system family. Often they make deals with each other that the people they are supposed to be serving, the public, don't know about. When members of the same family go to bed together it's called incest and that is what is happening in our health care system.
Two recent books by past editors of the prestigious New England Journal of Medicine give us their detailed look at some of the problems that accompany the dealings of the pharmaceutical industry with other members of this family:
Pharmaceutical companies will invite groups of physicians to attend all expense paid meetings where the doctors play the role of advisors to the drug company on how to market their specific drug.
The result of this intercourse is that more of the doctors prescribe the drug and the drug company makes more money.
Most "new" drugs are not new, but old drugs that have been modified in order to continue the patent; studies looking at their efficacy do not compare them against the older and less expensive drugs in the same class.
Study results are commonly written up by researchers on pharmaceutical payrolls and the results are biased in favor of the drugs.
One out of four academic scientists have financial ties to the pharmaceutical industry. These doctors have an important part in bringing drugs to market and to use.
Research is a necessary part of bringing a new drug to market.
Clinical studies are usually the last thing done and they are generally contracted out to leading research schools.
The doctors doing these studies are the ones who speak at most of the continuing education courses that doctors are required to attend to maintain their licenses.
So they get all the 'up-to-date' information and tend to use the 'up-to-date' drugs despite the fact that older generic drugs often do as well.
These are just a few of the many indictments these two doctors lay on the pharmaceutical industry. It is hard not to see the corrupting influence of the profit orientation in all of this. While Angell and Kassirer give their detailed reviews what escapes them is the broader picture of what is happening—these dealings are incestuous.
The government is getting wise to this and has taken some action: they are requiring the pharmaceutical companies and the doctors to be more open in their interactions—they've taken off the bedroom doors.
But the problem with big pharma is only part of the problem:
Hospitals sometimes pay physicians to admit their patients to the paying hospital. (Wall Street Journal, 9 June 2003, p.B2)
Physicians order tests done at a facility in which they invested so they profit from their orders.
Medicare officials overlook excess expenses from their contract insurers. (Blevins, Sue. Medicare's Midlife Crisis)
This problem is bone deep. Deals are how we do business and we are not going to eliminate the profit motive even though "professionals" are supposed to be above that mind set. Business is good in most circumstances and the marketplace is indeed the most effective way of providing a product. The problem with business and the marketplace in the health care industry is that the product is health. Health, however, is not something that can be readily identified except by its absence. And this means that the focus of the marketplace is on making healthy people feel ill. So we have ads showing people in the epitome of health who got there by taking the 'purple pill' or some other drug.
Another problem is that the person ultimately paying for the product, either directly or through insurance, has no voice in, or even knowledge of, the deals that have gone into getting its place in the marketplace so they can not make an informed decision. The goal of the incestuous breeding, as Angell and Kassirer well point out, is profit more than the well being of the patient.
A nicer term for incest is inbreeding.
People who raise plants and animals use inbreeding all the time to make desired traits stronger in the offspring.
But inbreeding always comes with a downside because weaknesses as well as strengths are magnified in the offspring.
Quarter horses are bred to run the quarter mile. Inbreeding the best of these horses finally led to one that fizzled at 3/16th of a mile; he just couldn't make it the whole way. Inbreeding led to this weakness.
Our health care industry is the result of such inbreeding.
We have a high tech, racehorse type of health care system that is very good a treating acute problems, because how it is funded and taught has both allowed and promoted this type of health care.
But the weakness are catching up in expense and poor public health.
When breeders are confronted with such problems they bring back in some of the root stock that has the strengths they need.
The process is called cross-pollination with plants and cross-breeding with animals.
In this way the weaknesses are made less of a problem.
When cross-pollination occurs in the world of ideas many new discoveries often result.
Wouldn't it be nice if our health care system had a breeder! The source of root stock they would most likely tap would be in the science of biology. More articles in Common Sense Medicine discuss what we can learn from biology that current medicine has overlooked.
Health care is not the only example of systemic incest.
President Eisenhower waited until he left office to warn us and future presidents of the dangers and the power he saw associated with the military industrial complex.
The defense industry has now grown to the point of consuming close to 50% of our national budget.
Just as in the health care industry deals are made under the sheets without consideration of the public payer.
Rather than removing the bedroom doors as they have with health care the government has moved to increase the secrecy of their own deals within the military complex; and in other areas too if Vice Pres. Cheney's energy policy can be used as an example.
As in health care this has resulted in a self contained and self reproducing system with a similar pattern of inbred strengths and weaknesses.
The strengths are the obvious high tech, and very profitable, methods of warfare.
The weaknesses, as in health care, are the expenses of the system and its inability to deal with the social issues displayed by guerrilla and tribal/cultural warfare, and even terrorism.
Warfare is not only a violent teacher, it is a teacher of violence. If the solution, as in health care, is cross-pollination and the forgotten roots of the health care industry are in biology, then those of the defense industry are in the civilian control of the military and the state militias.
But civilian control means going out of the system—it means looking for Americans that can cross-pollinate. It might even mean tapping the American Friends Service Committee for the Secretary of Defense.
Notes:
Marcia Angell M.D. The Truth about Drug Companies: How They Deceive Us and What to Do About It. Random House: 2004.
Jerome Kassirer M.D. On the Take: How Big Business is Corrupting American Medicine. Oxfor Univ. Press: 2004.
