Doctors help patients, and they love us for it. We fix bones, replace joints, cure killer infections, and control diabetes with insulin. We use painless scans for diagnosis. Liver, kidney, and heart transplants are now routine. Some patients get cured of lymphomas, leukemia, Hodgkin’s disease, and testicular cancer. Lives are prolonged for myeloma and amyloidosis. Vaccines have saved millions worldwide.
We have complex technologies such as the heart bypass machine and dialysis. We replace diseased heart valves with artificial ones that work. Cardiologists permanently correct irregular rhythms using techniques that would seem natural on Star Trek. Other specialists gift infertile couples with children.
Despite this, many sources agree: For at least half of health care, the potential benefit does not outweigh the harm. For a lot of the rest, supporting evidence that it works is lacking. A review of over 5,000 articles recommends against many of today’s standard practices.
The list below introduces some of the topics in this book, the worst failures of health care, in rough order of wasted resources. The opioid disaster, now killing 50,000 people a year in the U.S., is not even in the top seven. I “knew” a lot because of my degrees and training, but I was wrong about many things.
What I thought: Health insurance protects us against disasters, just like fire insurance.
The truth: Most of the $3.65 trillion in U.S. medical spending (2018) is run through insurance companies before payment, which produces an insanity of wastefulness. These corporations extract fully a fifth—twenty dollars of every hundred!—of whatever they touch for their administration and profits, and they know that if total spending goes up, they get more money.
After the insurance layer has taken its share, only 75 to 80 percent remains for “providers” and suppliers. Every one of these has their own bloated overhead, which they must pay before patients get anything. Hospitals, for example, consume at least 25 percent more for internal expenses. This system creates outrageous total costs.
The smaller but more gloomy insurance story is the workers’ compensation system.
What I thought: Hospitals are bureaucratic, but physicians supervise them to make people better.
The truth: Although many people who work in hospitals are idealistic, most of these corporations are ruthless pirates that are looting the patients who trust them. These companies pay or bully physicians to cooperate with their agendas.
Hospital costs are about a third of U.S. health care. They spend ten to fifteen percent of their receipts just on coding, collections, and other methods to whip money out of the insurance companies.
3. Drugs and medical devices
What I thought: Idealistic scientists wearing white coats develop new miracle drugs and devices all the time.
The truth: The pharmaceutical companies purposefully falsify the studies the FDA requires to patent medications, and the regulator turns a blind eye to it. Concealing negative studies that show little or no efficacy, such as was done with the antidepressants and the statin anti-cholesterol drugs, is just the start of their hoaxes. Because of practices like this, deciphering which medications work has become difficult. Many drugs are ineffective, and a lot are damaging. Some of the worst are the statins, the newer diabetes drugs, the osteoporosis drugs, the influenza vaccine, and the whole psychiatric pharmacy. These are all best-sellers.
The huge implant device industry plays the same games as the pharmaceutical companies and has fewer rules that force them to conduct proper studies.
Here is what I thought about generic drugs: They are just about as good but cheaper than patent medicines, which are a rip-off.
The truth: I was right; patent medicines are a rip-off. Generics are sometimes inactive or even contaminated, however. But they are now 90 percent of the American formulary because of patent drug price-gouging.
4. Journals and the academics of medicine
What I thought: If I studied hard, read journals, went to meetings, and listened rather than talking to my friends, I would become a better physician. Also, if I looked at Internet sources, I would quickly learn about any medical field.
The truth: Doctors’ information sources have been wrecked by corporations. We depend on journals, but their editors have been bought off. They print fraudulent studies containing purposefully confusing math developed by academics who are sponsored by corporations.
Patients’ information sources, on the other hand, are advertising, “advocacy” groups, blogs written by industry, and wall-to-wall internet link-farms. They are all marketing in disguise and create anxiety and spread false information.
5. Mental health
What I thought: Psychiatrists have some strange ideas, but their drugs are effective and treat mental illness just like insulin helps diabetes.
The truth: This is our most expensive and least effective medical sector. Informed commentators now call psychiatry a pseudo-science, and a substantial, credible group—besides Scientology—openly questions their theories and drugs.
Psychiatry is nearly divorced from even the flawed science advising the rest of medicine. The psychiatrists accept the most money from the pharmaceutical industry of any doctor group, which results in their ideas being the most contaminated. Their toxic medications might help a few sick people, but corporations promote them so heavily that one in six U.S. citizens takes them. We mostly ignore the tragic consequences.
6. The heart industry
What I thought: Cardiologists and heart surgeons have effective treatments for coronary artery disease.
The truth: Invasive treatments for this are an immense but dismally ineffective industry. Sham surgery studies have now debunked stents, the tiny devices used to open coronary arteries. These might never work, depending on what you believe. The cardiologists understand the math yet continue placing them for the money.
Coronary artery bypass grafting surgery (CABG) is also useless or harmful. It immediately kills two to nine percent and gives long-term brain damage to a third. A few patients supposedly benefit: The three percent with severe blockage of their one-centimeter “left main” artery. For them, the studies show a five-year survival improvement of twenty percent. But the operation is overwhelmingly performed for patients with other issues. These people suffer the complications with no chance of benefit.
Medications and lifestyle changes work better for coronary heart disease than these hazardous, invasive procedures.
Whether you are a doctor or patient, the painful reality introduced here is running you over.
Robert Yoho is a plastic surgeon and author of Butchered by “Healthcare”: What to Do About Doctors, Big Pharma, and Corrupt Government Ruining Your Health and Medical Care.
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