- Machiavelli's Laboratory is a free ebook that I published on April 13, 2010. It is a satiric discourse on scientific ethics, from the perspective of an unethical scientist. Please don't take any of the advice and opinions in the book (or the excerpts featured in this blog) seriously.
This blog continues yesterday's blog on Medical Economics."
Many physicians cannot stop themselves from dividing diseases into two broad categories: God-made diseases and Man-made diseases. God-made diseases are all the awful genetic, developmental, microbiologic, and parasitic, disorders that mankind did not create. These account for most of the diseases of infancy and childhood.
Man-made diseases are those conditions that arise from self-indulgences (over-eating, substance abuse, smoking) or follow directly from the actions of humans (motor vehicle injuries, violent assaults, safety lapses). Man-made diseases account for the vast majority of the diseases of adults.
There is also a grey-zone of diseases where there seems to be some collaboration betwen God and man. Cancer is a good example. Humans did not invent cancer, but human connivance vastly increases the number of cancer occurrences (e.g., smoking, alcohol abuse, over-eating, unsafe sex, meat-intensive diets, pollution of air and water, etc.).
All physicians know that if adults simply behaved better (calorie-restricted diets, no smoking, no substance abuse, moderate and regular exercise, vegetarian or reduced-meat diets, less pollution, defensive and attentive driving, home and occupational safety precautions, fewer wars, less assaulting, better personal hygiene) the health delivery system would shrink from the size of a fungating tumor to the size of an adolescent's pimple.
You might argue that every human will eventually get sick and die. It's just a matter of time before we all need the services of a physician. This is true, but it does not change the fact that clinics are filled with people who have made themselves sick through their own life-style choices. The individuals who have God-given diseases or who have age-related infirmities represent a small fraction of the total number of patient-physician encounters in the U.S.
From the perspective of the pharmaceutical industry and the medical device industry, the best thing about lifestyle diseases is that they persist for the duration of the patient's life. As long as the patient continues his indiscretions, he will continue to need the services of the medical-industrial complex. Most physicians and other members of the medical-industrial complex understand that they would be unemployed if their patients seriously pursued a healthy lifestyle. This is why the status quo is acceptable to so many people.
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- © 2010 Jules Berman
key words: medical-industrial complex, American healthcare, physician reimbursement
