The Medical Freedom Channel

I’ve decided this week to use this editorial space to issue an appeal to those who are reading this web channel. No, I’m not asking for money, although I am offering the Blog Ad space for advertising, and will soon be putting some ads up even for some of my own projects. And no, there’s no signup list I plan to gather data from and sell it off to the highest-bidding spam-scam, thereby invading your privacy that way. Actually, all I’d like to know is, in the words of former NYC Mayor Ed Koch, “How’m I doin’?”

This site has been in existence for nearly a year now (minus a slight hiccup in mid-winter when the server crashed without a proper backup in place), and the level of feedback has been, well, not very encouraging. With very few exceptions, response to the daily postings of news and commentary blurbs (and even these weekly editorials) has come from less than a half-dozen people, most of whom know me, the editor, through other means.

That is to say, I often feel like all I am doing is entertaining a few friends now and then, while most of the time these postings just go up, stay for a day and then get replaced by more material that mostly goes unread.

I’ve even tried to put more energy into finding better stories from a wider perspective, and then adding my own snide little “editor’s note” where it seems appropriate to justify including that particular story or rant. Sometimes I forget to, which is usually exactly when a reader decides it’s worth chiding me for “supporting socialism” or some such.

Truth be told, folks, I’m getting more confused every week as to the answer to this healthcare mess. To begin with, I am no longer certain that “the market will fix it” in this situation. The very nature of how “healthcare” is delivered, with all the “trust factors” (the doctor somehow is presumed to know best sometimes, and seeks to “first do no harm” as the Oath says to do) and the distortions of free market models (e.g, balancing stockholder needs with those of the “customer” – when the latter’s life is what is at stake – just seems wrong somehow!), makes conventional “capitalism” almost as much an enemy as an ally.

The competitive model, when applied to neighboring hospitals, means everyone ends up trying to buy their own set of MRI, CAT scanning and sophisticated radiology equipment, just for starters – rather than making agreements, one specializing in one area and the neighboring facility in the other, swapping patients around for those specialized services. As a result, this costs everyone more money, and duplicates effort needlessly.

The same goes for the paradigm of building more hospitals, or buying up existing ones, to raise the overall stock value … and then having to create excuses for keeping those extra beds filled, to justify keeping all the doors open.

Then there is the whole issue of patient safety, as is currently provided so poorly and expensively by regulatory agencies, specifically the Food and Drug Administration. As more and more books are written about the horrors of the FDA (I’m in the midst of one now, but will hold that review for another time, when I’ve finished it. Unlike Maggie Mahar’s work this one does not adapt well to serialization.) – from refusing approval of perfectly-safe products to approving others (too quickly or at all), from requiring strict testing over extended periods to refusing to allow side-by-side product comparisons (only testing vs. placebos) to determine relative effectiveness, and from being too harsh on some pharmaceutical providers and way too easy with others – we just get more evidence that the FDA is just among the worst examples of “why government doesn’t work.”

But how do we improve that unsafe and unhealthy condition? Libertarians might say, oh, all we need is an analogue to Underwriters Laboratories, which the electrical appliance industry uses to certify the safety of their products, thereby policing themselves effectively. Let’s examine that idea:

First off, who is this “industry” that would somehow govern itself? Is it Big Pharma, whose goal seems to be cranking out as many slight variations on existing drugs as it can, promoting new markets for the use of even highly specialized substances, with dangerous and even life-threatening side-effects, so they end up with lawsuits from the families of the people for whom minor ailments were treated with these known poisons?

Maybe the doctors, who are so busy keeping up with increasing patient-loads, processing paperwork for reimbursement from third parties, and ordering multiple tests to avoid being sued for under-prescribing or overlooking possible unseen ailments along the way? Or how about the hospitals, which are too busy trying to make a profit off people who demand more and more services for less and less money, or who think they aren’t paying for it anyway, and so ask for everything the place has, and will threaten a lawsuit if it is not delivered?

Or the insurance providers … Maybe since they are the ones who are approving payment for all of this, they might have a stake in seeing that the medicines being delivered are appropriate, necessary and sufficient. But then how do they know? And how does anyone know, at least without extensive testing of the product, to find side-effects and other ancillary issues before they reach the public, and thus avoid more catastrophes? Maybe it should be an “impartial” panel of alternative healers, who at least have no financial stake in the rise and fall of Big Pharma … except to dance in the ashes?

Meanwhile, should the concern be limited to detecting immediately lethal and crippling side-effects, or should the long-term ones also be tested for? And how about effectiveness? Is that entirely up to the consumer to discern somehow, despite TV advertising blasting away with the advice to “ask your doctor” (who may not know anymore than the drug company’s sales rep has told him, and this is hardly an objective source of information)?

All of these questions must be addressed if the “healthcare” crisis is ever to shift from its quasi-public model toward something more free-market based. And to this editor’s eyes, that transition cannot be a complete one, due to the other factors of life-and-death involved in the overriding issue. Some blend of competition and cooperation must be found, if there is any hope of fixing this mess, and so far, that precise formula is yet to be discovered or presented.

There will be more on this topic to come, but that’s all for now. Be stress-free and smiling; that’s about 90 percent of “good health” anyway.