Few topics or “matters” matter as much or generate as much discussion and political malfeasance as health care, and not really “care,” but coverage. Coverage is where the “easy” money is. “Coverage” is like a giant public works construction project: easy to skim from. It’s virtually impossible to get any graft – or campaign contributions – from individual medical procedures, but insurance conglomerates and hospital corporations and the pharmaceutical industry are deep wells for craven politicians. Consequently, those same politicians are willing to expose the federal budget and debt creation to the medical “field” to the benefit of all, and even of patients sometimes.
Money, money, money. About one-sixth of the U. S. economy is tied to “health care,” but a much smaller fraction is tied to CARE, itself. These are huge industries with gigantic advertising, promotion and bribery budgets. The ever-pure United States calls those filthy bribes campaign contributions… or, they might be “donations” to colleges and universities for research and production of new doctors who, coincidentally, will be fully committed to pharmaceuticals, chemotherapies, surgery and maintenance for life – or death. It’s all expensive.
Cancer is one of the cash cows of medicine: the big shibboleth in human caring and willingness to help others. People fear it, and rightly so. Breast cancer is a powerful subset, and so is pediatric cancer. We love kids and care about their health more than for any older group. Kids are helpless and pathetic; humans feel these things and sacrifice to raise them from complete dependency, to minimal independence, to experimental independence, to sports and education and personality development and, one day, separation into adult-hood. We hate any interruption to these things and sacrifice to facilitate the stages of normal childhood. Cancer is a Hell of an interrupter and we want to pay to stop it. And we do.
Billions of dollars have been raised by the American Cancer Society, for example, and they claim a 79% rate of actual cancer expenditures: mostly for research, but a large amount is for “soft” expenses that help those who are in treatment and their families, and other non-care, non-research uses. A big pile goes to run the Society, of course. To its credit, A.C.S. does a lot of good along the paths it sees fit, and it’s much more efficient than the federal government, a low bar. Sadly, despite its widespread use of children to raise its millions (Relay for Life, anyone?), only a small percentage of ACS dollars are employed to solve pediatric cancers.
In one case Prudence knows well, a 6-year-old girl survived neuroblastoma after much chemo, operations, stem-cell harvests and replacements only to fight through it again 4 years later, with more of many of the same poisons that forced the cancer to retreat the first time. Five years later, more chemotherapy to force a third retreat. “A miracle,” her family declared. 3 years later osteosarcoma attacked her right tibia, part of which was removed with cadaver bone up to the knee. More chemo – same crap as earlier times, same poison to push the cancer back. College and Masters degrees completed, 6 years later the fifth attack and fifth battle with cancer, now in the thoracic cavity pressing on the lung. The bone cancer was a not rare reaction to earlier treatments; the chest problem a recurrence of the bone cancer, by genus. Same poisons prescribed and administered, except she was unable to tolerate any more of it. Twenty years of treatment, constant news about this and that breakthrough therapy, DNA, customized immunology, yada, yada, yada… same attempts to kill the cancer a little faster than the patient.
When the young woman with the lengthy, miraculous, cancer survival history heard what kind of poisons they were planning to pump directly into her bloodstream, she naturally pointed out that it was the same crap she’d received the last time! Was there nothing better? Newer? Apparently not. Bring us your sick children and we will poison them for you in the hope that the cancer cells will die first and we can hold your child back from the brink of death.
Medical students arrive at medical school with science knowledge
–at least biology, maybe chemistry – ready to be taught some skills, mostly about using and understanding the data produced by wonderful diagnostic electronics, and about the latest in pharmacological weapons to counteract natural biological weaknesses, failures, breakdowns, related pains and mental/emotional discords and incongruities. There is a lot to learn. If surgery is the interest, there is a lot of practice. Students develop likes and dislikes that lead them to one specialty or another, or, for many, general health and well-being such as “family” doctors ought to know. Some of these general practitioners are really “internists” who understand “internal medicine” as distinct from “external medicine,” one supposes.
In any case, new doctors are taught according to fairly rigid protocols and traditions by people whose adherence to standards is well known… and respected. Indeed, it is only by proving one’s own adherence to those standards that a doctor will be licensed or safe when sued. “Recognized” standards, “current” protocols, “best” practices – those are the only defense a doctor has. Where is the profit for leaving medical orthodoxy?
Does this mean that “doctors” or “big pharma” are blocking the introduction of miracle cures that an obscure researcher somewhere has developed because traditional medicine would not? Well, “yes,” and “no.” I think, or at least hope fervently, that the answer is “yes” although there is no intent to do so; and that the answer is “no” because there is no intent to do so. But, the inhibition of new ideas is almost inevitable. Thankfully it is not impossible and progress does get made, inventions are developed and made marketable – and trustworthy – and new drugs are eventually approved. So, what’s the problem?
The problem is that the new drugs are rarely giant steps – sometimes they are, but not often. This is because most research is built on previous success and lines of inquiry and wide departure from the reservation is not very likely – it doesn’t get funded. Pharmaceutical manufacturers are looking for sure things. Often the greatest advances are side-effects of drugs, new and old, that coincidentally prove beneficial elsewhere. More power to them.
Similar effects produce medical technology like, for popular example, knee replacements and hip replacements. Now very reliable and long-lasting, such replacements are commonplace, almost to the exclusion of alternatives. Could the damage and erosion of joints be prevented? In most cases. Are there nutritional preventions that are still regarded as anecdotes, not science? Absolutely. Do you suppose that part of every knee replacement is dedicated to learning how to prevent knee replacements? Well, no.
Americans, and most residents of highly developed countries, eat themselves to death, drink and drug themselves to death, smoke themselves to death, fertilize and pesticide ourselves to death, and so on. For all of our health clubs, gyms and YMCA’s, Americans tend, on average, to not take very good care of the bodies we are born with and, now that parts can be replaced by our remarkable “repair, replace and maintain” medicine, there seem to be fewer reasons to worry about the consequences of ice cream, sodas and cheese-burgers and lack of basic exercise regimens. We are told 8 times every half-hour by our flat-screens that we need never suffer from aches, pains, discomforts, anxieties or depressions. There are pills for each of these maladies. In fact, there are separate analgesics for shoulder pains, neck pains, knee and foot pains, back pains, headaches, migraines and insufficient sleep. People who have allowed apnea to intrude on their ability to sleep can get a C-Pap device to counteract it. What’s to worry?
What do all of these OTC chemicals do to us? Some of the long-term effects are known, not the least of which is liver damage, but it’s slow, virtually unnoticeable, until it isn’t – kind of like moderate smoking.
Sugar and alcohol also have cumulative effects, if not simple diabetes, then an acidification of body chemistry that weakens the immune response to invaders. Too much gluten, perhaps? The American diet is awash in wheat and wheat proteins, right down to canned tunafish (only one brand is clean). Tunafish? And lots of other products: vinegar, puddings, many candies, gravies, prepared foods of all kinds include wheat starch, “hydrolyzed vegetable protein” and on and on. Many people know they are allergic to gluten, far more do not… know, that is. Skin problems, digestive problems, immune problems and, of course, weight problems, stem in large part from too much wheat in our diets. The body tends to become allergic in the presence of too much of the same thing – often the food you like the best, as well. But, that’s no problem! There are multiple crèmes and pills to fight off the effects of our odd diets, so many, in fact, that they must be profitable enough to purchase TV advertising nationwide. Do you ever wonder if every prescription for these somewhat dangerous drugs includes a small amount of money to fund prevention of gluten intolerances? Nahh. Bread, cake, doughnuts, fried clams, stuffing, ice cream, mayonnaise, salad dressings, sub-rolls, pita, crackers and… and… whatever, are too tasty to forego and, besides, “they” have things for that.
When Dwight Eisenhower left the presidency he warned America about the encroaching power of the “military-industrial complex.” Rightly so, although that sloppy circle of funding and influence has managed to keep the country fairly safe in an uncontrollable world. One can almost hear the words of a true outsider warning us against the “medical-industrial complex,” although almost no one would listen. On the edge of Boston and Brookline there is a street called Longwood Avenue where hospitals have grown into connected proximity. It’s starting to look like Las Vegas.
The insertion of politics into health care really got moving with the “Great Society” in the mid 1960’s. It hasn’t been all good despite the public intentions of the socialists who caused the Great Society to be codified. Today federal funds feed into the insatiable maw of modern medicine, and to help it along, every Congress adds new mandates for care and coverage. Combined with the primacy of welfare (federalized at the same time) the general interface with patients has trended to impersonal, if not de-personalized, care. The vision for health care is still greater impersonality, robotics and, again, health orthodoxy that satisfies… umm, well, the federal government, and “averages.”
No one is going to stop the money. If we have to borrow from our 5th descendent generation, by God, we’ll do it! No one who needs a new hip, rich or poor, will be denied one! What? Do we want to have a society where there is one level of care for the wealthy and another for the poor? With enough agitation and politics anything that needs a licensed medico to accomplish will be funded. Trans-gender mutilations? Where’s the checkbook? Prudence would advise that there is not enough money, or desks for nameless bureaucrats to sit behind, to provide all the repairs and drugs that are known, to every person who thinks he or she needs them. Maybe robots will provide more even-handed care and cost less than humans. Not so far.