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Some hopeful developments in the medical field

   

 

I think the American health-care system is basically broken. It shows the effect of heavy lobbying by the pharmaceutical industry, insurance companies, HMOs, hospitals, and the A.M.A., tilted toward subsidizing expensive procedures and products that mainly improve the bottom line of those institutions.

We need to focus on reducing costs rather than providing universal insurance coverage. Otherwise, it’s estimated that in the late 21st century health care will consume more than half of GNP. Yes, the bean counters have a role to play in this debate - me, being a former cost accountant.

I think that prevention is a cost-effective approach to medicine. If people can recognize dangerous illnesses early in the game, then the illnesses can be treated more cheaply and with a better success rate. But the uninsured fear even seeing a doctor since the fees are high. The likely result will be a prescription for expensive pills.

Therefore, let the government provide free service - not unlimited expensive service, of course, but basic service such as an annual physical and record-keeping assistance. Therefore, I am proposing a three-pronged service - all free - which should cost the government less than $50 billion a year to benefit all 300 million U.S. residents.

First would be a bare-bones physical, once a year, which would be a generic examination - hence, cheap - with some tailoring to a patient’s known health risks. This would provide basic information and recommendations but, beyond that, nothing. It would be up to the patient to decide whether to contact a doctor.

Second would be genetic testing. This technology is in its infancy. A basic procedure would be developed to assess various health risks so this information could be factored into treatment decisions.

Third would be a website. The results of the annual physicals could be posted there for easy retrieval. Additionally, the website might give simple medical information about types of illnesses or disease related to a patient’s data and questioning.

With respect to genetic testing, there are private companies that will assess a person’s DNA for health risks. Three of these are Decode Genetics, 23andme, and Navigenics. The cost is approximately $1,000. However, if millions of people were genetically tested, costs would come down. This type of information would be invaluable in treatment and prescription decisions.

Come to think of it, a genetic profile of the patient is essential for prescribing medications. The drug companies are continually developing drugs and testing them on groups of people. Those that are shown effective to groups are approved. But, writes Dr. Bernadine Healy in U.S. News & World Report:

“Template care is increasingly at odds with the emergence of personalized medicine, a new discipline driven by the exploding knowledge of the human genome that guides treatment tailored to the individual patient. And this is what today’s medical students will be practicing tomorrow.”

“Thanks to ever better, faster, and cheaper sequencing technology, researchers have shown the many ways our 25,000 or so genes can vary. One little glitch - a misspelling, a hunk of DNA lost or added, or a gene altered by interplay with other genes and molecules - can affect disease susceptibility or treatment. Already, researchers have tied genetic differences to many diseases, including diabetes, heart failure, autism, restless leg syndrome, multiple sclerosis, and rheumatoid arthritis. Imagine this in medical practice. Knowing your patient’s risk early on would bring more targeted prevention.”

(U.S. News & World Report, April 7 & 14, 2008, p. 59)

With respect to medical information on the web, Google is experimenting with a pilot program to store personal medical records for several thousand patients at the Cleveland Clinic. An advantage would be that patients could access this record no matter where they received treatment. Microsoft is offering a similar service.

A new venture from a firm based in Plymouth, Minnesota, which is called carol.com, aims to facilitate a medical market place where customers could post information about their particular ailments and solicit bids from prospective health-care providers. Patients could also post reviews of the treatment that they have received. In other words, carol.com would help people compare prices and services from available service providers.

In short, new technologies in the areas of computers and medicine could both lower costs and improve the quality of medical treatment. With little additional expense, the federal government could help to bring this system into being.

 

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