“Monday Musings” for Monday August 22, 2016
Volume VI, No. 34/294
National Institutes of Health Campus, Bethesda, Md.
Ills of American Medicine and Ills of Practitioners of American Medicine
by Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*
Not long ago, I attended a medical symposium. One of the speakers, a bariatric surgeon, presented a paper projecting the need for bariatric surgery in the form of gastric bypass reaching a third of a million cases. Just between you and me, the presenter, a skilled board-certified surgeon, was on the high side of BMR! There is no question that obesity is wreaking havoc on America. Obesity is an epidemic, and morbid obesity is on an exponential rise. Diabetes mellitus, cardiovascular disease, musculoskeletal problems, kidney failure as the result of hypertension, and depression all are caused and exacerbated by obesity. The enormous resources that go into treatment of these illnesses are driving our country into bankruptcy. We are spending nearly 20% of the gross domestic product (GDP) on medicine. It is expected to go over 22% in a short time. No, Obamacare has not caused the cost. Pharma manufactures drugs for obesity on regular basis. For example the US Food and Drug Administration did not approve Accomplia, a proposed weight-loss drug by Sanofi-Aventis SA. The reason given was that the drug while effective in weight loss, appeared to double the rate of suicidal thoughts and behavior. Sanofi is a French drug company. Accomplia is sold in Paris and several other European countries. America’s medical-pharmaceutical complex continues to grow at a leviathan pace. The conspiracy of finding “cure” at the expense of prevention fills the media ads in all three network news, cable and the pages of our newspapers. “Ask your doctor for this wonderful drug that can change your life!…”
A question that constantly occupies my mind is why America does not change its style of crisis intervention to the style of prevention. Why get fat and have all these problems that require treatment, coronary and gastric by-pass, stent, kidney dialysis, depression and loss of work and productivity? Why not preach and promulgate the gospel of prevention and never start on the slippery slopes of getting fat? Let’s do away with cute euphemisms of “overweight,” “plump,” and “obese.” Let’s call a spade a spade, and a fat person, a fat person. And heaven knows we have a lot of fat doctors and clinicians who see and treat patients, just like the bariatric surgeon mentioned above. This is also true of the clergy. We have too many fat clergy. They ought to heal themselves and be a role model for their patients and parishioners.
The neglect for prevention is not a local or an individual issue. It is a national issue. It has to do with the attitude of our government and its vast and numerous institutions.
Let’s consider the toll Alzheimer’s disease is taking on our nation. Because we are living longer, we see more persons afflicted with this unwelcome ill that not only robs memory, but robs personhood and joy of life. The current year, the government agencies through Medicare, Medicaid, the National Institutes of Health, Food and Drug Administration and Center for Disease Control and Prevention (only recently the word prevention was added) are spending 125 billion dollars to support the care of patients afflicted with Alzheimer’s. The amount being spent for discovering a cure or prevention of this illness is infinitesimal. With baby boomers aging and the number of Alzheimer’s patients rising to ten to fifteen millions, the current expenditure of 120 billions will fade in comparison to what will be needed to care for these patients.
The hysteria in media is another unwelcome conspirator that keeps us from quiet, thoughtful, and systematic approach to research and discovery. Take the case of stem cell. Faithful readers of this space recall that several years ago, we discussed the fundamental knowledge of blastocyst consisting of 150 cells, embryonic germ cells, totipotent and pluripotent cells. We discussed the moral dilemma of destroying living embryo to harvest stem cells. We also reported on the paper published in Science that promises stem cells not from embryonic sources, but form adult cell derived from skin and other organs. Recently, Dr. Donald Landry, the interim Chair, Columbia University’s department of medicine, a devout Catholic and former acolyte presented a paper to the President’s Council on Bioethics. The Council consists of heavy hitters and is led by Leon Kass, a University of Chicago philosopher. Dr. Landry is against abortion, death penalty and killing and sacrificing embryos to harvest stem cell. However, he is a doctor and believes that stem cell research and advances could save lives. His solution is extracting stem cells from dead embryos rather than live ones. It is interesting that the media showed no interest in publishing these simple logical and pragmatic solutions. Instead the media continues sensational reporting of the debate by the politicians and talking heads. Also, there have been very few reports on the Science paper cited above.
The Ills of American Medicine
American medicine is advanced and perhaps is the best in the world. But clinical medicine’s self indulgence should be reined in. We invent, coin and codify new diseases and new labels every day. My own specialty, psychiatry, is coming up with a half dozen of new diseases, syndromes and labels, such as “compulsive buying disorder,” “uncontrollable gambling obsession,” and the most recent label that takes the cake, “Involuntary Emotional Expression Disorder or IEED” and “Hoarding”. It seems that the practice of medicine in America takes the motivation, initiative, responsibility and accountability away from the patients. Psychiatry has taken away the concept of sin and repentance. Every bad behavior comes from bad genes, and we just can’t help it! The system glorifies victimhood, passivity and irresponsibility. American medicine seems to excuse, if not reward, delinquent behavior. Getting fat, having too many babies without adequate emotional and financial preparation, living a sedentary lifestyle, use of tobacco, alcohol and drugs are all delinquent behavior.
Some argue that with zero tolerance for delinquent behavior, what happens to compassion. I submit that it is the epitome of compassion to practice preventive medicine and empower patients to take charge of their health. In countries like Singapore, Health Savings Accounts have helped to shift the nation toward prevention. The patients own their health insurance policies and they actively participate in the decision making process concerning their own and their families’ health care. Will we be able to rid American Medicine of the cancer of bureaucracy, and will we allow knowledgeable MDs and reasonable informed patients to prevail, is a question that requires vigorous debate.
“Monday Musings” invites thoughtful clinicians and practitioners to share their wisdom and expertise on how to help the very ill and broken down American system of health care. We are inviting our readers to think that if they were the “Health Czar” of America with unlimited resources, how would they go about fixing America’s medicine and health care, especially care for the mentally ill (brain dysfunction). What strategies would they use to get the system out of ICU and off ventilator? Write to us and tell us what you would do if you were the “Health Czar” with unlimited resource.
*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association; and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a Raleigh, North Carolina writer and dramaturge.