Cure and Outrage Coexist Comfortably in American Medicine

The medicine that we are too willing to swallow.

It has only been a lack of time, never of material, that limits the number of entries in this column. (Are any of you out there interested in writing about something?) One has only to open the local newspaper or watch any news program to stumble across things that should cause our ears to perk up, if not make our blood boil. Last Friday’s Courier-Journal provides a typical example. There were no fewer than five different news articles that were exactly on point for issues we have been writing about this past year. The articles highlighted the massive squandering of money and flesh by a broken healthcare system, a substantial risk of the most commonly touted screening procedure, an example of the unconscionable bills that hospitals are willing to present to their patients, a Kentucky hospital being sued for massive but lucrative overtreatment, and a report of still one more widely used treatment for Alzheimer’s syndrome that didn’t work. There seems to be no limit to the amount of abuse the American public is willing to take from the healthcare industry that is supposed to serve them. Fortunately for me, I don’t have much hair to pull out anymore.

Institute of Medicine’s Report On Wasted Care.
We are going to hear a lot more about this important report from the nation’s most prestigious medical organization. It concludes that our nation squanders $750 billion a year, approximately 30 cents of every medical dollar, on care that is medically unnecessary, ineffective, fraudulent, duplicative, or wasted on unnecessary paperwork and bureaucracy. I believe their estimate is understated. Regardless, recovery of this 30% savings could eliminate our current crisis of healthcare access and allow us all to afford the fruits of future medical discoveries that will otherwise be beyond our reach. Read the Institute report here or contact me for a link to a copy.

Radiation from Mammograms Causes Cancer.
Doing things to women’s breasts is a major product line for the healthcare industry. Tremendous marketing resources are aimed at bringing women in the door. Even nonprofit organizations are in on the game. Doing putative good things to women’s breasts is used to help sell a wide variety of unrelated goods and services. Some of this may actually be for the good. Much of it is not.

We have already arrived at a point where we can discuss scientifically about when (not whether) the amount of radiation used in screening mammograms actually causes more cancer than it relieves. Despite this, some organizations that derive their credibility or their income from the business of screening seem to have dug in their heels against more judicious guidelines. The point of the current article was that just as some women may be at higher risk for breast cancer, so to are some women much more sensitive to radiation. How do we protect both groups? I do not have an expert opinion on how this will shake out, but I do have an opinion that sometimes screening for treatable conditions and looking for trouble are two sides of the same coin.

Outrageous Hospital Charges.
We have all heard stories about the $100 aspirin. I can tell you similar stories about our local hospitals. A hospital in Arizona billed a woman $83,046 for a three hour stay. She had been stung by a scorpion and received two doses of an anti-venom at $39,652 per dose. According to the distributors of this FDA approved drug, each dose would have cost the hospital $3780. A 10 fold markup: not bad if you can get away with it, and with desperate people you can get away with a lot.

Who protects us against these violations of trust? Obviously the “market” does not. The market wants to do whatever it can get away with. The patient’s insurance company, Humana, paid the hospital $57,509. When I was a managed care executive, I believed medical insurance companies have an obligation to protect their beneficiaries as much as they can, even when patients and their providers make it difficult to do so. In this case, the hospital was “out of network” so Humana’s leverage was limited. It bothers me however that they paid as much as they did: that’s why the hospitals keep on doing it. The $57,000 of Humana’s payment could take care of a lot of other people.

Adding insult to injury, and kicking the patient twice when she was down, pharmacies in Mexico charge only about $100 a dose for the same product. In the immortal words of Roseanne Roseannadanna, “it makes me want to puke.” Only in America would we put up with this.

Kentucky Hospital Sued Over Treatment.
Another Catholic Health Initiatives hospital has been sued in a possible “Cath For Pay” scandal. Over 300 former patients are suing St. Joseph Hospital in London, Kentucky alleging that patients who did not have coronary artery disease were treated as if they did, with unnecessary cardiac catheterizations, coronary artery stent placements, pacemakers, and even major cardiovascular surgery. Of course, the case has not yet been tried, and one side of the story does not the truth make. However, for another St. Joseph/CHI hospital in Maryland, the charges were sticky enough that there were multi-million dollar settlements, a doctor lost his license, and the hospital became subject to a federal compliance agreement. Overenthusiastic or medically unnecessary cardiac catheterization and surgery is a problem nationally, fueled by the fact that Medicare and insurance companies over-pay for these procedures. Thieves go where the money is, even when they are doctors. Hospitals like to have doctors who bring in lots of money– it’s the American way! I have begun analyzing the frequency of cardiac catheterization in Kentucky hospitals and will be writing more about this subject.

Ginkgo Biloba Didn’t Prevent Alzheimer’s Disease.
French scientists gave Ginkgo (a herbal “remedy”) or a sugar pill for some 5 years to over 2800 older people with memory problems. There was no significant difference between the two groups in terms of who went on to develop diagnosable Alzheimer’s syndrome. Why ever did anyone expect there might be? As one expert on so-called “complementary” medicine was quoted, “Another beautiful herbal theory destroyed by an ugly fact.” It’s not like this was even new news: an earlier study showed the same thing.

In a world where medicine and healthcare are sold like soap powder, we should not be surprised when soap powder is sold as if it were medicine. Vitamin, food-supplement, and related industries have had spectacular success with their lobbying and with support from friendly legislators who help them sell their snake oils. The shelves of my local drugstore are full of elixirs and pills that claim to “support” this body function or another. None of it did I ever learn about in medical school. Its bad enough that mainline drug companies can maneuver to get ineffective drugs used in medical practice. The bar for “alternative therapies” is so low that any dancer can slither under. Even the IOM report above did not take this one on. It has been said that the main difference between man and animals is that man has a compulsion to take medicine. American entrepreneurship makes it all too easy for us to be human.

Final Comment.
I paused here at the end of the article to reflect on why I get so offended when I read about such things. It certainly does not reflect any lack of sympathy for the concerns and fears of the ill: my own family has struggled with all of the above. I think it may be my sense of betrayal by some in the healthcare industry and among the professionals who populate it. People who are sick, or even fear they will become so are most vulnerable to being taken advantage of. There is a large segment of our people that believes it is unfashionable, indeed unconstitutional for our government, acting on our collective behalf, to protect us from predation. I am not among them. I hope I am not alone.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
13 September 2012

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