An excerpt from The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield).
Myth 1: “The United States boasts the best health care in the world.”
Betsy Lehman trusted her life to the American health care system. An award-winning journalist, Lehman was a rising star at the Boston Globe, where she wrote extensively about health care issues. So when the mother of two was diagnosed with a particularly aggressive type of breast cancer, she knew instinctively where to go to receive outstanding care. Lehman selected a top-notch teaching hospital that has long been recognized as one of the nation’s leading cancer hospitals.
Lehman had done her research. She knew that her best chance for survival was to undergo an experimental stem-cell transplant designed to kill the cancer cells that were systematically circulating throughout her body. She also knew that cyclophosphamide, one of the chemotherapeutic agents she would be given before the transplant, would have a powerful effect on her body.
Lehman’s treatment would occur over a four-day period. Each day she would receive a precise dose that was determined by measuring the surface area of her body. In total, she was to receive slightly more than 6,500 milligrams of cyclophosphamide. Due to a cascade of errors, she received the full 6,500 milligram dose every day for four consecutive days.
Despite the grievous error, Lehman appeared to be surviving the treatment — that is, until immediately before her scheduled discharge. Although she protested that something was desperately wrong, her caregivers ignored her pleas for help. She never returned home. She died in the hospital from the massive overdose of the drugs purportedly used to heal her. There was no question as to culpability. The leadership of the hospital immediately accepted that responsibility.
Ironically, according to an article in the New York Times, an autopsy performed at the time of death showed no signs of cancer.
Betsy Lehman was a well-educated, well-known professional who sought care at a hospital considered to be one of the finest in the world. Yet she didn’t survive the encounter. Is this American health care at its best?
Before concluding that such tragic outcomes are the rare outliers in health care, consider what Time magazine had to say shortly after Lehman’s death: “Lehman’s case,” Time said, “is just one of a spate of medical foul-ups that have made headlines in recent weeks. In two Florida incidents, a doctor amputated the wrong foot of a diabetic man, and a hospital worker mistakenly turned off a stroke victim’s breathing machine. In Michigan a surgeon doing a mastectomy removed a woman’s healthy breast instead of the diseased one.”
Lehman’s faith was misplaced twenty years ago, and our faith is arguably still misplaced today.
A culture of greed
We have vested the medical community with the cultural authority to oversee our health care system and manage our health. For the first half of the twentieth century, physicians seemed to view this trust as sacred and worked toward the betterment of health care — at a patient level as well as a system level. Then things began to change.
First, the supply of physicians grew dramatically, as did the rate of specialization within the medical profession. “Since 1965,” (Arnold) Relman has noted, “the number of physicians has grown four times faster than the population: 160 percent for physician growth versus 36 percent for population growth.”
At the same time, empowered by tremendous technological advances, medicine moved from being a profession built upon the quality and longevity of a trusting patient/physician relationship to a technocracy in which physicians armed with increasingly specialized knowledge and access to sophisticated treatment modalities intervene on “cases.”
As a result, once driven by a combination of altruism and a fervor for harnessing scientific knowledge for the benefit of society, medicine has been increasingly replaced by entrepreneurism and greed. This factor is the most insidious of all and applies not only to a segment of the physician population but to many other stakeholders within the health care delivery system.
In a beautifully worded editorial appearing in the Annals of Internal Medicine on March 15, 1996, Christine Cassell, MD, reminds us that “medicine is, at its center, a moral enterprise grounded in a covenant of trust. Today this covenant of trust is significantly threatened. From within there is growing legitimization of the physician’s materialistic self-interest; from without, for-profit forces press the physician into the role of commercial agent to enhance the profitability of health care organizations.”
If America is ever to boast of delivering the best health care in the world, the system will require transformational change. Patients can advocate for such change, and should, but ultimately it is physicians who must be the architects of change.
Myth 2: “Shopping for health care is like shopping for a car; you base your decisions on good information.”
Marketing misinformation
A tremendous void of information is troubling enough. Misinformation designed to influence the uninformed consumer further exacerbates the problem, rendering intelligent decision making a Herculean challenge for consumers. Hospital marketing departments then add insult to injury by spending millions of dollars on exaggerated claims and erroneous assertions.
At times, these exaggerated claims of expertise cross the line from merely deceptive to outright egregious. A great example can be seen in the advertising for a community hospital in a Southeastern city.
The hospital launched an advertising campaign that proudly announced its expertise in the esoteric field of deep-brain stimulation – a delicate brain surgery in which a surgeon inserts electrodes into selected regions of the brain to ameliorate conditions ranging from seizures to intractable depression. This procedure has traditionally been the domain of major academic medical centers. In this case, the hospital bore no similarity to an “academic medical center.” Rather, it had a single neurosurgeon who performed the procedures, and his training consisted of a weekend course.
Flying blind
So how do consumers make decisions regarding their health? Many of us predicate our conclusions on blind trust or the advice of well-wishing friends or family. Whether we get the care we need is a crapshoot.
John Leifer is founder and publisher The Leifer Report, and is the author of The Myths of Modern Medicine: The Alarming Truth about American Health Care.
