LETTERS FROM THE GLOBAL PROVINCE |
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GP 3 August 2005: The Healthy Society Lance Goes for the Big One. Having just tied up his seventh Tour De France in a big bow, Lance Armstrong has picked his next goal. A blazing headline in USA Today (July 25, 2005) shouted, “ Fighting cancer is new mission for Armstrong.” And why not? He nearly went to the wall with testicular cancer and it was thought he would never race again. He beat the disease and went on to the beat the world on the twists and turns of France. Now he can help stare down death itself. (See www.usatoday.com/sports/cycling/tourdefrance/2005-07-24-armstrong-mission_x.htm.) Already he has a Foundation, and citizens aplenty are wearing its yellow wristband—“LiveStrong.” At last he can move into high gear. Not only the cancer afflicted but all Americans can welcome his entry into the healthcare arena where we spend huge amounts of money for very little result. All the experts who promise to reform our healthcare system have stubbed their toes. We need informed citizen participation and a maverick point of view to begin to get it right on health. Testicular Cancer. Until the 4th quarter of the 20th century, testicular victims died aplenty in search of a cure. Then cisplatin came along and cure rates rose to 90% in those who discovered and treated their ailment early enough. But even in the testicular world, treatments can still very much run amuck. One WP, back in the 80s, was treated with massive chemotherapy, not once but twice, the stubborn disease having staged a comeback. At the end of his treatment, the world’s leading oncologists for his particular variety uniformly advocated a gut-wrenching operation to remove massive amounts of tissue with the thought of warding off a recurrence. The guru at Sloan Kettering said he would then have a 40% chance to live. He did not think those odds sounded good. Following the advice of a brilliant New York surgeon, he skipped the surgery and lives today to tell about it. The operation promised all sorts of very dire side effects; it was not trivial. In this instance, anyway, the world’s foremost experts were simply dead wrong. Heart Surgery. Some three years ago a heart surgeon and also a cardiologist in the Southwestern United States urgently pushed WA, an 86 year old still on his feet but with a troubled heart, to have major heart surgery. As the saying goes, the heart surgery was a great success, but everything else was a disaster. He was bedridden and vastly unhappy for 3 years until his recent death, the victim of a slice and dice system that does not know enough or care enough to let well enough alone when the patient is too darn old for treatment. His heart surgery had delivered him into living death. In this vein, one should read “Is Heart Surgery Worth It?” in Business Week, July 18, 2005, pp. 32-36. There’s large question as to whether all the bypasses and all the angioplasties do much to prolong patient’s lives. A number of very responsible medical figures would clearly cut out 90% of these surgeries, finding them ineffective, costly, and worse. The Dartmouth Atlas of
Health. In fact, the Dartmouth Atlas
of Health (www.dartmouthatlas. It’s a dead certainty that we are spending our health dollars badly. And, as we shall argue later, it’s equally certain that we are spending too much. As we made clear in “Down and Out,” we are not spending enough money on preventive health. Nor are we spending money on other social activities outside of patient care that have a lot to do with the health of our nation. Although we are number one among the nations on earth in total health expenditures, we rank 154 out of 192 amongst a wide assortment of countries, and 28 out of 30 amongst OCED countries, in a 2003 ranking of public health expenditures. In other words, we are spending like crazy on those with a high enough income or good enough insurance to plug the health dike after their lives have become to ebb away. But we are not doing the kinds of public health things that keep bad health from happening. See http://dataranking.com/default.htm. Bleeding the Economy. If we remember rightly, health expenditures now account for about 15% of our economy. Too much. And corporate health bills are expanding between 10 and 15% a year. Soon enough, as this rate, we will be spending everything we have on health. Health costs promise to bankrupt what was once our most important corporation. “For the last few years General Motors Chief Executive Richard Waggoner Jr. has been raising the decibel level of his complaints about health care costs.” See Forbes, April 11, 2005, p. 54. “The cash outlay for … health care came to $5.2 billion last year. … The total future cost to cover its workers and retirees is $77 billion.” Its health care bill makes it hopelessly uncompetitive on the international scene. Andrew Grove’s Retirement. Andrew Grove, who made Intel what it is, is sort of retired these days but manages to keep very busy trying to do something about health care. He is figuring out on the side how Intel can play a profitable part in healthcare reform. He is just out with an article in the Journal of the American Medical Association. “The article, ‘Efficiency in the Health Care Industries,’ was labeled commentary, but it was more akin to a jeremiad. Mr. Grove took dead aim at the lack of efficiency in health.” See the New York Times, July 30, 2005, pp. B1 and B4. The very title, we think, suggests that Mr. Grove is wide of the mark. Efficiency is the second question; effectiveness is the first question. Eventually we can afford to spend a lot of time worrying about the waste, but first we must simply try to get medicine to do something, do enough, that’s worthwhile. We are more concerned about medicine that does nothing or worse, and only tangentially concerned about the bureaucratic morass that adds huge costs and confusion to the system. Grove, incidentally, is as famous for his prostate cancer as he is for his microchips. Fortune ran a very good account of his traffic with the disease. With his bright mind and powerful research tools, he found out all there was to know about prostate cancer and migrated, if we remember rightly, up to Seattle for his treatment. Ironically, we are told by doctors who have reviewed the case, he probably picked the wrong treatment options. That said, we are lucky to have him with us. See www.phoenix5.org/articles/Fortune96Grove.html. The Wrong Questions. As near as we can tell, we are very much getting the wrong answers about how to set health care to rights because we are asking the wrong questions. Much these days is made of providing “integrated health care.” But those looking all the questions posed by our unhealthy society lack an integrated view of society and health, at least as we described integrated in our “The Collapse of the Ivory Tower.” The Healthy Society. It’s a matter of some frustration for us that we cannot paint the outlines of a healthful nation as we try to come to grips with wellness. We know, of course, that it is hard to be a well nation, no matter how many doctors we have, if we are working too many hours, are digitally hounded by all our contrivances, have a mortally sick nation next to us on our Southern border, and are gagged by pollution and over-development at every turn. For sure, as Paul Krugman, the argumentative liberal Princeton economist suggests, the much vilified French have it all over us on vacations, since they simply refuse to work as much (New York Times, July 29, 2005, p. A21). With a “whole” point of view, one would not adopt the negative definition of health put forward by health experts. Essentially, they think of health as the absence of illness, of symptoms, of things that lay the body low. But a barber-shop philosopher knows that a healthy society is a place where happiness abides, songs are sung, jokes are retold too many times, and live seems purposeful. There are sundry groups who think about the healthy society, usually in small places such as New Zealand (www.anewnz.org.nz/page.asp?id=548) or in offbeat foundations we tend to ignore (www.ucl.ac.uk/ichs/). They clearly understand that an individual cannot be healthy if the society around him is sick, no matter how many fitness instructors he sees each week, how much organic food he consumes, how much rhythmic wisdom he imbibes from his yoga instructor. Going Somewhere. We have a friend called Mack who probably should be long in his grave, given the fact that he has had to have his heart drilled out, got himself a little cancer around the throat, and harbors neurological disease. But he is busy raising a grand child, counseling people across America about their lives, and still earning a living from the ample advice he provides corporations. He’s a mess but he does not know it, because he is too busy leading a purposeful life. As we have said, we don’t yet have a clue as to how to redo our health care system because we don’t know what a healthy society looks like. A healthy society was something we had 50 years ago, before medicine became so advanced. But today, yesterday, or tomorrow, we do know that the healthy fellow or the well society will be pockmarked with purpose. P.S. The maverick premier of Alberta Ralph Klein
“plans to hold a international symposium … to study the best elements of
health care systems around the world, trying to spur a national debate over
how to deal with growing waiting lists for medical tests and nonemergency
surgery” (New York Times, Feburary 6, 2005, p. 8). The health-care
debacle affects just about every nation on earth, and it will take global
interchange amongst the world’s citizens to get things turned around (www.rednova.com/news/health/147691/kleins_health_care_summit_could_be_golden_gift_ |
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