- 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 entry continue's Saturday's blog on Man-Made Epidemics.
Public health measures are often much for effective and much less expensive than the pay-per-complaint practice of medicine so prevalent in the U.S. In Finland, in about 1970, the population had reached its highest incidence of cardiovascular diseases. As a result, public health measures were introduced to improve diet, exercise and other health habits (particularly smoking) in the population. The multi-decade effort, called the North Karelia project, stands as one of the greatest successes in public health intervention.
Here are the results of the North Karelia project (1).
- An increased life expectancy (7 years longer for men and 6 years longer for women).
- Lung cancer death rate reduced 70% in North Karelia
- Heart disease mortality reduced 65% in men.
In the United States, patients hold their encounters with their private physicians with the greatest reverence. Many Americans would fight to the death (more literally than they might imagine) for the right to follow their personal physician's recommendations, even when those recommendations conflict with public health guidelines. We know that physicians commit preventable medical errors every day, accounting for up to 98,000 American deaths each year (2), but that doesn't seem to matter to most of us. We know that public health measures prevent disease, save lives, and extend our life-spans. But Americans seem oblivious of the realities.
If you don't look too closely, U.S. medicine is a simple and effective service. When you get sick, you seek the services of a highly trained doctor, who treats your illness, and you get better. In return, the doctor is paid by some third party (your health insurer or government Medicare), or you pay the doctor yourself. Nothing could be simpler, and nothing could be better.
The only problem is that U.S. medicine does not work very well. The U.S. pays more for health care than any other country in the world (by far), but the U.S. has the lowest life expectancy of any developed country.
When you try to assess overall satisfaction with medical care in the U.S., you're always working with a skewed population: survivors. About 90,000 U.S. citizens die every year from medical errors. Deceased citizens have very little say in the matter. Doctors are among the few professionals who can literally bury their mistakes.
Many of the satisfied living are lulled into a false sense of health, without receiving appropriate care for their illnesses. An obese patient with newly diagnosed type 2 diabetes, hypertension, and hyercholesterolism would probably prefer to be treated with pills than to be told that he must conform to a strict diet and a rigorous exercise program. American medicine, like any other business in America, is designed to keep the customer happy.
Essentially, U.S. medicine is run like any other American enterprise. Doctors make their decisions to maximize personal gain. They expect their patients to do the same. As the U.S. population gets sicker and sicker (and demand more services), doctors get richer and richer.
In the next few blogs, we'll discuss some of the key forces that determine: 1)the total workforce of physicians in the U.S., 2) where physicians are deployed, and 3) how physicians distribute themselves into different healthcare specialties.
REFERENCES
1. Puska P. Successful prevention of non-communicable diseases: 25 year experiences with North Karelia Project in Finland. Public Health Medicine 4:5-7, 2002.
2. To err is human: building a safer health system. Institute of Medicine, November, 1999.
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- © 2010 Jules Berman
key words: medical-industrial complex, American healthcare, physician reimbursement
