Emanuel infamously suggested that doctors take the Hippocratic Oath too seriously, while Berwick intoned that the federal government must step in between doctors and their patients to curb and redistribute the use of medical resources. To be sure, both of these medico-ghouls are in favor of a single-payer government-controlled system. One wonders if they know who founded government-controlled health care. None other than Adolf Hitler. You could look it up.
Of course, what we do have at the moment is not health care at all. Rather, it is disease care. Inasmuch as there is not enough money in the world to support a disease care system, you would think that the government would be doing all it can to improve public health and encourage prevention. But, you would be wrong. In fact, many preventive programs are having the exact opposite effect.
It was known as early as the mid-1960s that the lipid/cholesterol theory of coronary heart disease was total bunk. Yet, we are still being pummeled with precisely the wrong advice in the advocacy of a low fat/high carb diet. There is no doubt that this course has almost single-handedly caused the current epidemic of obesity and diabetes. And, it has done virtually nothing to lower the incidence of coronary heart disease. Applicable drug sales, however, have skyrocketed. Notably, anti-cholesterol and glycemic control meds have been fraught with serious side effects.
A similar tale can be told of the absurd official recommendations on a low salt diet.
Assuming that all this is not the deliberate result of some star-chamber conspiracy, what went wrong? Chalk it up to egos, massive intertwining bureaucracies, zero accountability, and huge amounts of money. I trust that the ego and monetary components are self-evident.
As to intertwining bureaucracies, consider the effect of USDA grain subsidies on the official dietary recommendations, and the resulting disaster of high carb diets. If the Feds really were concerned with health care, wouldn't they put some subsidies on fruits and vegetables?
As to zero accountability, consider the hundreds of millions of dollars pharmaceutical companies must spend to get a drug through FDA approval, and then consider how many of these approved drugs are taken off the market only a few years later. Why are there never any consequences for the FDA, but only gigantic lawsuits against Big Pharma? Isn't the FDA supposed to be the certification agency of all that is safe and effective? Why is it always held harmless? If your own doctor did something a fraction as calamitous, he would be sued for malpractice.
Perhaps, the quadrual of egos, massive intertwining bureaucracies, zero accountability, and huge amounts of money are simply four sides of the same square, three of which naturally follow from the bureaucracy portion. One could add our obsession with process instead of outcome. Despite the dozens of catastrophic failures, we still must have an unchanged FDA approval process. Despite the decades of poor results from any number of strongly advocated "health" measures, we must still have them in place. Despite the fact that giving insulin to an obese type 2 diabetic will only make him fatter, and increase his "need" for exogenous insulin even more, we must keep on with this nonsensical therapy.
Might I suggest that the first step in improving any health care system is for the individual to take an ownership in his own health, instead of giving his proxy to such an obscenely conflicted enterprise as the federal government and its henchmen?
A few days ago, I was having a conversation with a top addiction medicine doc, based in Arizona. He remarked that these days, addiction medicine is one of the last specialties allowing him the freedom to act like a true physician--a partner and consultant in improving the health of the patient. The addicts who come for treatment sincerely want to get better, and the doctor is their guard and guide. No proxy required, and befitting of our Independence Day.
Michael D. Shaw
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