Medical Politics

Health care coverage is not health care.

• Politics can be for good or bad
• "Single-Payor" Medicine- Salvation or Scam?
• Medical Authorities - should they dictate your medical care?
• Medical Boards vs "Alternative Medicine" Physicians
• The Cost of Paperwork is a major part of your health care expense
• The Centers for Disease Control
• The Pharmaceutical Lobby
• Pharmaceutical Influence on Academic Medicine
• The Public Relations Industry
• Continuing Medical Education
• Laws must be simple and short
• What you can do

Politics- what does the word mean?

Too often we think of the word "politics" as something dishonorable. And, as too often practiced, it is. Because we humans like to have our own way, because we too often do not shrink from dishonesty and subterfuge, the political process brings out our worst characteristics.

But if we can ignore for a moment the how of politics, let's look at what the word politics refers to. Politics is the process by which a group reaches a decision. We belong to many groups- to a family, a workplace, a town or city, a state, and so on. And each group has to make collective decisions. Even in a workplace, the boss does not hand down orders from on high, but must consider the needs and abilities of her employees. Nor does the physician just give orders to the patient, but needs to convince the patient that a certain course of action is worth pursuing.

When we've got two or more people, we've got shared decision-making. We've got politics.

And that decision-making can occur with openness and honesty, or with subterfuge and dishonesty. In the latter case we are tempted to say, with disgust, "politics!"

What factors influence political decisions?

When the members of a group meet with mutual trust and a sense of security, shared decision-making is easier. Think of a church group deciding how to help the disadvantaged at Thanksgiving, or Churchill and Roosevelt collaborating about the Second World War.

When political decisions go wrong

When the members of the group do not trust each other, or do not feel secure, decision-making is more difficult. The rural hospital administrator may realize that the nursing service in his hospital would serve the patients better by dispensing narcotics when the pharmacist is off duty at night, but fears repercussions from regulatory agencies which prohibit that. The regulatory agencies have been lobbied by people who want protection from medication errors. The agency then establishes rules they hope will decrease pharmacy mistakes. The rules may work for a large urban hospital who have 24/7 pharmacy service, but don't work for a smaller rural hospital. The voters fear mistakes, the regulatory workers fear voter displeasure, the hospital fears the regulatory agencies, and Joe Rural Patient winds up at midnight unable to obtain medical care at a reasonable cost.

So, mistrust and a lack of security poison our political decisions. Ignorance, too, can poison political decisions.

Politics - for Better or Worse

So, politics can proceed in an atmosphere of trust, security, and knowledge, or without those benefits. In the former case, we will reach better decisions. They may not be perfect decisions, and they are unlikely to satisfy everyone, but they should be better than decisions reached in an atmosphere of subterfuge and mistrust. And hopefully all parties concerned will be mature enough to surrender gracefully at times, for no decision pleases everyone.

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Politics and Current Medical Practice - The Negative Consequences

Medical Authorities- should they have total control?

We've all seen the articles in the news. "Experts" say you should have a mammogram every year. Newscasters seem to assume that if the academic authorities say it, it must be true. As of late 2001, the latest slip in the mask is the report in Lancet that editors of the respected Cochrane Review are all too human. They tried to suppress a report that routine mammograms for every woman appear not to save lives. Many such medical procedures are over-sold. They do not benefit people and run up medical costs unnecessarily.

Here is a quote from Scandlen's Health Policy Comments, National Center for Policy Analysis, 10/29/01.

"More important, and more relevant for the issues we deal with here, is the debunking of the academic conceit that science is pure and objective, and therefore all physicians should be required to follow "evidence-based" medicine developed by academicians. In fact, academics are also subject to group-think and peer pressure. They discard inconvenient evidence, and embrace those studies that support their biases. They are free to be political advocates if they want to, but they should not try to require doctors to practice in accordance with such advocacy."

Medical Boards vs Alternative Medicine

Robert J. Sinaiko, M.D. is a highly respected internist and pediatrician in San Francisco who was targeted by the California Medical Board because he treated a child with attention deficit disorder in an unconventional way. Board-certified in Allergy, and believing allergy to contribute to the child's condition, he treated the child without using Ritalin. Unfortunately, the child's parents divorced, and in the custody fight one parent charged the other with negligence (and Dr Sinaiko with negligence) for using this unconventional treatment. In an extremely expensive and time-consuming battle, and despite support from many academic physicians and the President of the California Medical Association, Dr Sinaiko was punished for treating this patient as an individual.

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The Cost of Paperwork

According to a report by the American Hospital Association (AHA), there are thirty federal agencies that regulate hospitals, plus state and regional regulators. Laws governing medical practice grow like kudzu vines. The AHA report tracks a mythical Medicare patient through the hospital to illustrate the web of laws and regulations healthcare workers must deal with. In a survey of 19 emergency departments, they found that for every hour of patient care, another hour of paperwork was required by the physicians and nurses involved.

Overall, paperwork eats up 33 to 50% of the working time of hospital MD's and RN's.

The Centers for Disease Control

The Centers for Disease Control and Prevention (long called the CDC before the last words were added to their title) oversee the Advisory Committee on Immunization Practices (ACIP). As with all CDC committees, there are safeguards to prohibit conflict of interest by committee members. Unlike other CDC committees, the details of these safeguards and conflicts on the ACIP are kept confidential by the CDC. Nicholas Regush of ABC News discusses this in a piece titled "The Vaccine Machine: Is It A Follow-The-Money Operation?"

The Pharmaceutical Lobby

The pharmaceutical industry spends much more on advertising than it does on research. Of the research it does, over half is on "me-too" drugs that increase market share, not on drugs that offer new help for untreatable illness. According to industry watchdog Public Citizen, in a report titled "The Other Drug War: Big Pharma's 625 Washington Lobbyists," the industry spent $262 million for political influence in the 1999-2000 election cycle, more than any other industry.

How does this affect us in Port Townsend? One particularly egregious example is that 5-fluorouracil, a generic cream to treat sun-damaged skin, has gone up in price from $25 to $100. This for a drug developed about 50 years ago. How can that be? Here is one way. Every time the government passes regulations for the health care industry, there is a cost to comply. Pass enough regulation (and tell the consumer it is for his protection), and only a giant corporation can afford the lobbyists and the attorney muscle to understand and comply. And then they can set their price.

Pharmaceutical Influence on Academic Medicine

As a practicing physician, I depend on my colleagues in the universities to help me make decisions about cancer screening, treatment of osteoporosis, and many other aspects of medical care. Frankly, I am getting skeptical of what I am reading in the journals I used to trust. Marcia Angell, MD, former editor of the New England Journal of Medicine, comments on drug company influence on academic medicine in an interview on ABC's Nightline.

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The Food and Drug Administration (the FDA)

Henry I. Miller, a research fellow at the Hoover Institution and the author of To America's Health: A Proposal to Reform the Food and Drug Administration, writes

Drug regulation, a monopoly of the federal Food and Drug Administration (FDA), has become overkill and actually threatens public health. Regulation by the FDA is slow, bureaucratic, and expensive, and drug development in this country is more lengthy and expensive than anywhere in the world. Bringing a single drug to market requires, on average, 115 years and upward of $400 million.

He proposes to follow the example used in other industries as well as in Europe, and remove the government monopoly on medical product approval.

Corporations and Public Relations

In an article titled "Lies, Damn Lies and the Public Relations Industry", John Stauber and Sheldon Rampton point out that when the book Diet for a Poisoned Planet was published, it threatened raisin sales, and was targeted by the raisin industry through their public relations firms. It is now out of print.

Continuing Medical Education

Medscape is a website providing information and continuing education to physicians. A course offered in 2000 on the treatment of osteoarthritis did not mention glucosamine sulfate, not once.

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Laws must be simple and short

"It will be of little avail to the people that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood; if they be repealed or revised before they are promulgated, or undergo such incessant changes that no man who knows what the law is today can guess what it will be tomorrow. Law is defined to be a rule of action; but how can that be a rule, which is little known and less fixed?" James Madison, The Federalist Papers #62

Much health care law today is as James Madison describes: changing, ambiguous, and complex. This is why we see the proliferation of large HMO's and hospital chains. The costs of attorneys, lobbyists, and other experts needed to analyze all these regulations and keep the government happy are becoming too high for smaller organizations.

What you can do

Having read this information is an important step. You need to realize that those who choose to point the finger at any one group, be it physicians, or the government, or the drug companies are engaging in dangerous oversimplification. A thorough analysis of the current health care cost situation would include our legal system and the changing character and expectations of we who live in this country.

I hope you have time to read our other information about health care costs.

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