THE CORRUPTION OF MEDICINE

Medical icon, Hippocrates, refusing the gifts of the Persian king, Artaxerxes, as painted by Girodet. (Wikimedia Commons)

I recently read an advertising pamphlet on line by a major global financial consulting firm. The pamphlet was designed to attract business from major medical institutions which are now undergoing the same digital sea change that has disrupted traditional media markets and financial markets. This might strike the naive medical consumer as odd. But medicine has been big business for some time. By "medicine", I am referring more specifically here to the delivery and consumption of medical services. 

The ancient relationship between doctor and patient was a bond of contractual trust. Before the development of scientifically tested treatments, doctoring was a talent combined with accumulated anecdotal experience and skill. The things that made a particular patient feel better were tried again. The things that killed a patient outright were discarded. In between, there was a vast area of experimentation and guess work. 

As science was applied to doctoring and patenting proven therapies, modern medicine emerged as a more predictable and more generally available service. In other words, it became a marketable  and profitable business. Physicians were transformed from eccentric shamans of widely varied renown to more populous vendors of somewhat more predictable outcomes. 

The merging of capitalism and modern medicine before widely available health insurance produced a multi-tiered system. The most educated and highly skilled physicians catered to those who could afford their fees. These physicians had access to the newest diagnostic equipment and laboratories. Community clinics, or more accessible practices, provided basic care, focused on inexpensive symptom relief. They functioned at a slightly higher level than the barber-surgeons of previous eras. 

Health insurance is a fairly recent phenomenon in America.  Its expansion began with WWII, and it was primarily employment-based. As providing services became less costly due to scientific advancements, insurance companies blossomed with the promise of shareholder profits. Health insurance companies assumed a rather insincere posture of offering community service. However, premiums were paid and policies revoked for non-payment.  

The patient-physician personal relationship has remained cloaked in popular myth as an individually focused and confidential go-to for the relief suffering. And perhaps those who live in small towns with one doctor who is dedicated and accessible still experience medicine in this way. However, urban medicine is no longer an intimate experience between patient and physician. 

Medical institutions have become factories of medical care. No matter what your ailment or health maintenance issue may be, you are placed on the appropriate conveyor belt for treatment. If you have a primary care physician, chances are that doctor has hundreds of patients in their database. 

If you are not fortunate to have a primary care doctor, you are shuttled to the widest medical conveyor belt when you show up with a sudden complaint. That means being squeezed through a narrow opening of provider availability at the the treatment end of that system. Long waits and little actual attention to your needs. Whether or not you are insured, in the USA, the long wait times and small windows of provider attention are the same if you do not become a system subscriber by attaching yourself to a primary physician or specialist. 

Insurance companies are seeking to maintain profits by limiting provider choices and charging out-of-policy copays. They have already succeeded in bailing out of prescription payments in return for moderate premiums by getting the federal government to construct a Medicare-based prescription benefit. Private insurance with prescription benefits is very expensive, unsustainably expensive for the average consumer.

So, while broadcast TV is filled with drug company ads for prescription remedies, thus pushing consumers to physicians for prescriptions, these prescriptions are likely not readily covered by most basic health insurance plans. And the physician visit, which may entail a copay, benefits the medical provider, since the time needed to get the prescription may be reduced since the consumer requests it. 

Medical institutions make a great deal of money from diagnostic tests and routine procedures. Those huge steel and glass buildings found on any medical campus are not all paid for by philanthropists. A major part of the symbiosis of medicine and health insurance exists in the area of diagnostics and routine procedures, like blood work, mammogram and colonoscopy. Added funds come from the pharmaceutical industry who use the hospitals as data farms for their research. 

One result of the eager application of diagnostics and early treatment for profit is a reduction in the overall cost of average human medical care. But it also means reduction in payments to medical institutions for long term care and critical care. Ironically, a healthier modern population is less profitable to medical institutions and more profitable to insurance companies. 

So, where do medical institutions turn for their income streams? One source is Medicare and Medicaid. Medicare is a gold mine for medical institutions, even though they complain that the payment profiles for procedures and hospitalizations are too low. Seniors are potential targets for excessive testing and routine procedures. By exploiting the normal fear of death due to aging, medical institutions gain incomes from prevention testing and the inevitable need for life support. 

Medical institutions also get reimbursed by taxpayers for all the medical care given to the indigent, especially emergency room care. This is a big secret when politicians open borders to unskilled migrants who are not documented or insured. The annual medical costs to taxpayers incurred by illegal migration are astronomical. 

The recent pandemic has been a less-than-accidental windfall for the medical industry. The pharmaceutical industry has been pumping up demand for vaccines steadily. The symbiosis between virologists (like the famed Dr. Fauci) and the pharmaceutical industry is obvious. And, there is nothing surprising about the origin of the recent pandemic. 

China is a major hub of the global pharmaceutical industry. It seems somewhat suspect that the pharmaceutical industry has rapidly produced a vaccine response to the current pandemic yet has failed to produce an HIV vaccine, a vaccine which has been promised for over 30 years.

These pandemic vaccines produced for the USA are being paid for by taxpayers. Profits for the pharmaceutical industry are guaranteed. 

This is an age of money over ethics. And the medical industry has been corrupted by it as much as any other. Just consider, for example, that plastic surgeons and endocrinologists are making fortunes in the USA from surgically and chemically castrating those with a neurotic confusion over their gender identity. 

They have created a product and have steadily promoted it to create a demand, despite the Hippocratic Oath, "First, do no harm." These practitioners have succeeded in this because they take cash or politically state-funded health payments, rather than being vetted by private insurance companies, which could invoke medical ethics to deny payment.

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So, why are business consultants now mining the insecurities of the medical industry in a digital age? For one thing, shopping for medical care is easier than ever. Doctors are listed on line, like catalogue items. Medical institutions must market to compete. Prior to the pandemic, hospital beds were shrinking in number due to lack of demand. Less filled beds meant less income. ICUs were also shrinking. The advent of home care and hospice care for elderly patients had put a big dent in ICU demand. 

So, the pandemic created a flood of taxpayer money into established medical institutions. More ICU beds. More emergency capacity. More intermediate care beds. The pandemic was a boon to a downsizing hospital industry, despite all the sentimental gnashing of teeth by politicians. 

Am I saying that the givers of direct care are all corrupted by this process? Absolutely not. In fact, in many ways, the on line workers have been victims of the corruption of medicine by its big earners. Nurses, nursing assistants, medical residents, technicians, researchers and others have all been admirable in service to those stricken or threatened by the pandemic viruses. 

Their extraordinary labor is due in part to the intentional limiting of the number of graduates from medical schools. A carefully rationed number of physicians by accreditation boards in the USA has ensured high physician salaries. While medical service corporations, pharmaceutical corporations and insurance corporations are all working to increase demand in a capitalist economy, American physicians are being kept in short supply by the medical education establishment. 

The recent pandemic has made this dissonance very evident, yet I do not hear any cries from government officials to increase the output of physicians. Instead, the focus has been to push more money to medical treatment and medical supply companies. 

Pouring government money into health care corporations may well yield the same poor result it has yielded in public education. If the money is spent on shiny buildings and corporate salaries, the net improvement in actual care may be negligible. I would argue that medical care will only improve with a return to a focus on individual patient needs and true primary care, based in disease prevention and integrated treatments, aimed at maintaining the health and quality of life of a whole person, not just one organ system of a person. 

Today's post-pandemic medicine may well become more dominated by the pharmaceutical industry and diagnostics industry. More so than surgical treatment, medical treatment (treatment with drugs, diet and life habit alteration) runs the risk of becoming more expensive, more symptom-focused, more-remedy-oriented and more prone to abuse by on line vendors of quick fixes, advertised via digital media. Preventative medicine may well take a back seat due to its lower profitability to medical providers. 

At the core of medicine's corruption is its change of focus on promoting cures rather than promoting healthy living as prevention of disease. The marketing of castration as a valid cure for a mental problem is perhaps the most stunning example today. However, more subtle symptoms are also emerging: The previously unthinkable requirement of vaccine passports to do business or travel, for example. The wide political movement to legalize more mind altering drugs for public consumption is another example. 

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The respect for physicians has ancient roots. The shaman or healer was elevated and sometimes scapegoated for the good or ill fortune of a human tribe. In many cases, the healer was also to be feared as curse-caster, poisoner and spellbinder. As humans evolved. the secrets of cures were held by a tiny elite of literate healers. Magic and medicine were long entwined. In the early Christian era of Western Civilization, monasteries and convents dispensed medical care with a large dose of religion. 

The digital world of readily available medical information is changing the course of society's relationship with medical providers. Doctors will inevitably become more humanized by this. Patients will inevitably become more informed and demanding of rationales for treatments. This will remove the cloak of magic from the physician's role. The age of the unquestioned physician is already coming to an end. And this is advancement.

However, the capitalist medical industry may pose a threat to this advancement in the doctor-patient relationship. By manipulating digital media, those wishing to sell product to consumers of medical care may well subvert whatever may be left of the ancient pact between doctor and patient, wherein the doctor is bound by the Hippocratic Oath. The promotion of product (cure) over the promotion of whole-person health may well irreparably corrupt medicine as a venerable practice for the good of human society.