What’ wrong with modern health policy
This piece in the New York Times highlights a lot of the problems with modern healthcare, not just in this country but in most developed nations.
The most troubling aspect of this piece is how much modern medicine operates like witch-doctory. The patients in their desperation and their doctors, in their helplessness from lack of a treatment, and perhaps not a little financial incentive, are grasping at straws in their scattershot approach to treatment. They’re throwing spaghetti at the wall and seeing what sticks. For a profession that is arrogant in the extreme in setting itself apart from “alternate” forms of medicine, I see nothing scientific in the sorts of approach depicted in this article. That this lack of method, logic, or rationale is costing us millions, if not billions, is a disgrace and another black mark against the medical profession.
The most easily understood part of the article is the sentiment of the patients on these dubious drugs. When you are dying, especially from illnesses which cause horrendous symtoms, you are likely to try anything. Even if the drugs only alleviate the symptoms, but do nothing to treat the patient otherwise or prolong life, for the patient that’s worth anything.
But this is no different from any other policy issues which we face everyday. If you or your loved ones are the victims of crime, your most immeditate reaction will be to want to take revenge, if you can. Society outlaws such acts because we know that in the cold light of day, when we are not personally faced with such tragedy, that vengeance is detrimental to society as a whole. In the same way that we would not permit a rape victim to take vengeance on her attacker, we should not be letting patients set policy. While their priorities are understandable, it is ultimately based on their own selfish and immediate needs. Just because we understand such impulses and cannot fault them does not mean we should cater to them.
Likewise, it is easy to sympathise with doctors who claim sympathy for their patients. And many are probably genuine in their sympathy. But when they stand to profit in the thousands of dollars by pandering to their patients fears, they are not uninterested parties to this, especially when you have the drug companies throwing money at the doctors.
Ms. Lichter is a prime example of the problems. At 72, how much sense does it make for society to spend precious tens of thousands of dollars on a cocktail of drugs which may be having little treatment effect? Although it sounds callous, it makes more sense for society to spend that money on a treatment of someone young to significantly improve their quality of life for the rest of their life, than prolonging the life of someone whose life expectancy is not long even if they were healthy. If Ms. Lichter was spending her own money on her treatment, that is a different matter and she is free to do what she will. But if society is spending our money on her, it’s not unreasonable to ask if that money can be better spent for the greater benefit of society.
If you think I’m discriminating on the basis of age, look at it another way: those thousands of dollars could potentially be spent to provide more and quicker hip-replacement surgeries for the elderly. For the same cost, many more senior citizens could realise significant improvements to the quality of their lives of many, many years, rather than just one individual living an extra 2 months.
Ms. Lichter also highlights another problem with the system; she has no idea how much the drugs she is taking costs and does not care because she has no price incentive to consider costs. I am an advocate of socialised medicine. I think it’s ridiculous to tell people that we are only going to treat people who are rich and everyone else can go beg. But as long as healthcare is not a costless commodity, we do have to think about cost at some point. What does that mean in practice? It means that we have to consider the cost-effectiveness of treatments and include only the most cost-effective treatments in a socialised healthcare system. A drug that prolongs life for a few months at a cost that goes into six figures over a year is unlikely to pass such a test.
Doesn’t that mean I’ve just exposed myself as a hypocrite, since it will then mean that there will be treatments reserved only for the rich who can afford them, unless we go the route of Canada and ban private healthcare altogether? Well, it does mean exactly that, but there’s no hypocrisy here, unless you cling to an absurd belief that there is an absolute right, and need, to prolong life at any cost. Drugs such as Avastin do not exist in a vacuum, where there are no other calls on our resources. If society is to deem such drugs to be appropriate for use in socialised or subsidised medicine, then we need to recognise and debate the fact that we will end up using precious resources on such drugs; resources which must come from elsewhere, like schools, infrastructure, etc.
I believe that our actions should always be guided by our compassion, but it should never be clouded by our compassion. If we are to follow the former course of action rather than the latter, then we must engage in a sober debate about this most pressing of subjects rather than waiting until the system, and we, are in the emergency room.
