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Medicine is NOT an industry. The industrialisation of medicine should stop

The "industrialisation" of medicine is a recent phenomenon.
It has resulted in:
1. Unrealistic expectations of those who can afford it or have access to it.
2. It has taken away from providing "basic affordable" health care to millions and concentrated on "state-of-the-art" for a few.
3. It has diverted both medical teaching and medical practise from basic conversations with a patient to a series of "tests and investigations" which more often than not are designed to help those who "possess the equipment"
4. It has resulted in virtually complete loss of faith, between the treated and the treating , more litigation, paper work and time spent "covering every eventuality" as doctors
5. Like super-markets the "hospital chains" have taken common sense and good food away from local shops and farmers markets to concrete and glass structures where the "shopper" is bewildered and ends up spending more than she/he needs.

We need to understand that the vast majority of us do NOT need expensive, state-of-the-art medical care. We do not need to pay vast amounts of money to "insure" ourselves and neither do we need to pay vast amounts of money to live.

We need to make 80 % of medical care a 'corner-shop" , non-litigious, relationship of trust between doctor and patient.
We should try and stop the uncontrolled proliferation/continuation of the "medical hypermarket". and its attendant "industries --pharmaceutical, device manufacturing, medical tourism - and go back to the basics.

  • Jun 9 2012: Hi Ishika,
    It seems the debate is losing momentum. However, as time runs out I can't help make yet one more comment. We have discussed enough about the problems. Now about the solution(s). None , so far I can see. The simple reason being the hypocrisy is not limited to the 'medical industry'. The whole community as in West Bengal, India is a consortium of incompetence and corruption- whatever the field, whatever the profession. Patients would criticise and yet go to the same health care facility again and again. They make it up by explointing society in their own domain. So eveybody has his/her revenge in his/her own way and feel that they have somehow reached an equilibrium. We,you and I have failed to show reason to a handful of colleagues in our own hospital setup. Won't you agree that it's impossible in this era of socio-political degeneration to teach people right from wrong?
    Does't that also explain the very few responses to your initiative on this forum?
    I have escaped it in my own way. I advise others to escape West Bengal and India- the chances of a slightly more honest world is there beyond the frontiers. Over and out. Bye
  • May 31 2012: Hi Ishika,
    I'm at it once more. The health care industry is quite akin to the war industry! Paradoxical though it might seem. And of couse here too the US leads the world. It's business at its best. Let's have a war any part of the world, or should I say the Universe and the US is at the helm of affairs. If you don't have war the huge money that's been invested in the manufacture of weapons gets locked. So a good turn over needs a good war. A good war gives you plenty of patients and plenty patients need plenty medicines and the MNCs have a field day! America is the only country in the history of mankind which ensured that fighter planes drop bombs at night and loaves in the morning over the same war zone. And we all learn from the US. No sarcasm there. We all depend on American text books, American universities are real good and most of all it's a country where individual freedom gets its maximum meaning.
    The health industry thrives on a similar pattern. See all the free camps conducted by the corporate hospitals- it's a big fishing net to bring in the catch from the suburbs. Philanthropy at its wicked best. Put in a stent in a patient of IHD who is 72 and save his heart; withholding the fact that he also has renal cancer and would have only 1/2 to 1 year to live. Business thrives. Accolades rain down on co-operative docs. Some retire with a national award like Padmasree. I know of at least 2 such illustrious crooks who let all the surgeries be done by their juniors simply because they were no good at them themselves, and retired with garlands and Padmasree.
    So how do we tackle such an avalanche of corruption? With globalis
    ation the whole world is at it. Marches, Walks and Meetings don't take you very far. Gandhian principles of non co-operation is very outdated in this techno-savvy world. So I have got my own small shell where from I continue to practise Pediatrics freelance -the rest of the world can become a
    Great Corrupt Consortium. Bye.
  • May 31 2012: Good morning Rhona

    This debate I chose to start is not about any one individual. Not you positive or negative and not me with all my faults, my negativity my disappointments.
    It is about what affects millions of people today.

    To re-emphasise what I said before the issue in question is "What if you need medical treatment?". No matter how much you focus or take care of yourself there is a possibility that you may fall and injure yourself badly, you may be part of an accident which was somebody else's fault, you may be part of a disease epidemic just because of where you were there at a particular point in time. A child is born with a congenital malformation often for reasons unknown to parents who are perfectly healthy and have taken good care of themselves. That child "cannot focus" and has no negative or positive thoughts as regards its malformation. Can those parents "ignore the medical industry" ? They can if they choose not to do anything for that child. They can say "let this one go and we will have another". More often than not they seek medical help. What can we do for them sensibly without impoverishing them financially and emotionally?

    The attitude of "I'm OK Jack" is something we can afford to indulge in, in times of peace and prosperity. While eminently desirable conditions they also bring out the most selfish aspects of human nature.

    Thank you for your good wishes for "all I love". Unfortunately I choose to love the profession I chose and detest all that it has become. This debate centres around that. Not you, not me but all the people who have to be a part of it - often for no fault of theirs. It cannot be ignored.
  • May 29 2012: Hi Ishika,
    An afterthought:
    "Greed" is an infectious disease, we know it. It's potentially more infectious than Varicella! And do we need a vaccine for this or not? But again we will need a pharmaceutical house to fund the research and get it in the market and allow them the patent. Back to square one are we?
    I've started enjoying this debate. It's keeping away from my crime thrillers.
    Real time crime is always so much more interesting!!
    Good night.
  • May 29 2012: Hi Ishika,
    A few more thoughts to share:
    1. A medical college hospital would give one a floor bed if one happens to get admitted through the ER. Of course the filth, the flies and the stink comes free. And most survive, inspite of all these. But it's onty the people who don't have medical insurance who go to such facilities. And they are the teeming millions. The govt. gives two hoots about paying the doctors in health service a respectable salary by the current market standards, not taking into account the emergencies a doctor has to atted to and the nasty circumstances under which a doctor in a govt. hospital has to work. And the goons one has to face on duty as a doctor. We have had our share of this shit as residents, haven't we? Anyone in his/ her right mind and ability would refrain from joining the govt. health services as it is in West Bengal.

    2. So the other alternative is the corporate hospitals. And all providing tertiary care! Even when you don't need any. They are simply "evil". They exploit the patients and the doctors simultaneously! Asked some of my colleagues in such set-ups and know for sure that they blackmail you to prescribe to their fiscal needs, take part of (1/3) of your earning as service charge or whatever head that suits them. A doctor is also goaded to arrange seminars/ CMEs with the sole purpose of influencing the community-practicing doctors to send over "their more difficult patients".To awe them, convince them,confuse them and ultimately corrupt them. So the corporate doctor acts the salesman for the hospital; either naively or with guile. In return the corporate house will organise TV interviews and put ads (with photographs) of the "faithful" doctor in the dailes!!. The ethics booklet we were handed over on getting our medical registration from the MCI clearly states that a doctor is not to advertise his practice on the media. But he isn't doing it, the corporate hospital is! "What a wonderful world".Don't fight it ,escape it! Bye
    • May 31 2012: Subhanu
      Thank goodness there is TED to escape to! It is possible to be a part of either system and still not give in to it but it takes its own toll.

      The one thing which keeps me going is the fact that you and I deal with children. When a child I treated as a babe, thought it would never make the grade ,walks into my outpatients three months/years down the line looking wonderful it just makes my day! Its one reason I keep going. The other is that paediatric surgery is so fascinating --almost every week I see something I have never seen before and it sends me rushing to the books and journals and internet. Stimulating. What other profession allows us this ? A life-long interest in the subject we chose.
      I have opted out of the "industry". I refuse to opt out of what I chose as a profession. It is a philosophy more than it is a science - medicine.
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    R H

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    May 28 2012: Thank you, Ishika, for voicing what has become its own rampant 'disease' of corporate malfeasance and an afront to every citizen. I live in the USA, and the amount of construction for hospitals, medical facilities, and pharmaceutical companies offices in my area alone (Chicago) is in the multi-billions of dollars and of such opulence that no commercial company would dare build such edificies in this economy for fear of reprisal. This is just one facet of the problem that I see. Its much bigger, and more sinister of a problem, in my opinion.. I do not blame the practitioners.They are just as victimized by this 'disease' as the patients with obscene costs of liability insurance, over-testing for fear of litigations, and more and more incentive to be concerned for their own welfare rather than their patients. I believe you are not alone in your disgust of the evolution of the practice of medicine amongst your peers. We once had a thousand physicians/surgeons march on the state capital building because there were no qualified surgical trauma practitioners in the rural parts of the state (about 4/5) because they couldn't afford the required malpractice insurance and serve their communities. Doctors couldn't afford to serve! So who's running this catastrophe? Like the detectives say: Just follow the money.
    • May 29 2012: RH - you have put it so well "rampant disease of corporate malfeasance". I am going to use that.

      I do not blame anyone - not industry for bringing yet another "profession/vocation" under its umbrella, not practitioners and not patients. What I think is that we should acknowledge the way we are going and change it. The dialogue has to start and it has to take on a momentum which in itself will force change - perhaps not in my life time but change.

      As someone (I forget who), said "the majority are never right"!! Just because this is the way the majority are going in terms of health "care" does not mean that this is right.

      Bring back those people, those thousand practitioners who marched on the state capital building!! Those are the people who we need to change current medical practise. People who care.
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        R H

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        May 29 2012: I wish I were as kind as you. That's probably why you're the concerned type of doctor you seem to be. But I am trying. How to change it? For me, the problem is: outrageous cost. The way to combat high cost is to provide the same, or similar, service for less. But it's not that simple, is it? I have heard that many people have traveled to foreign countries for medical procedures because they're cheaper. If I run a medical providing service, that's bad news. The problem with that is most people are subjected to their insurance limitations and are not covered for foreign services. The cost of the foreign services are beyond most peoples ability to absorb such a one-time charge. So the 'market' becomes closed. This is 'good news' if I run a service. It limits competition. I can keep prices high, and insurance companies can continue to charge high fees because of the 'high prices' of service in a (effectively) closed market. Very 'fat' producing. There's also limited service providers because of the high cost of entry. There's limited alternative service providers because of medical/insurance/gov't collusion and the realities of the service being provided. On top of this, there's been a culture created that we must pay for 'Rolls Royce' quality - definitely in the best interest of the providors and evident by the style of medical facilities and providor facilities under construction - with mearly adequate service. Again, because of this 'closed market' dynamic. This system feeds on itself and has evolved into this situation which you so eloquently described. Every other industry only dreams of a market like this (except military production. They have it too). Nobody wants to die or be sick, but everybody deserves access to care without 20-30% of their income taken 'just in case'.
        • May 29 2012: RH
          Its all about "approach to life" (and illness/death)- that's the way I look at it.
          Don't know whether most people think of me as "kind". "Weird" is probably more appropriate but concerned they agree!

          I do not have medical insurance. I refuse to have medical insurance because the children I treat are refused medical insurance in my country - the minute someone uses the word "congenital" the insurance companies are out of there and the laws do not favour the children. By refusing insurance I hope that it makes me more sympathetic to those I treat. Stupid? Possibly!

          I am deeply sceptical of the entire insurance industry. It never seems to help when it is most needed.The fine print is illegible and dangerous to your health!
          Insurance has insinuated itself into our lives dangerously.Promising and failing to deliver. One of the biggest cons - before or after ENRON/BARINGS BANK - is for future generations to judge!

          Looking at it in an extremely simplistic way I say - I love Italian food. Good Italian food. On my current earnings, where I live I can probably afford to eat that once a year (or less).
          No insurance.
          if I were diagnosed with something "treatable" I would go and find the best MY money could buy. If it were something dreadful like a cancer with a poor prognosis - I would shout hurray! Throw a party and go somewhere like Brazil and dance for the remaining three months with nothing more to lose and a finite time to do it in. Pack lots of pain-killers.

          This probably sounds terribly irresponsible and "wierd" but this is personal and do-able.
          My concern remains for the children who are the future and for who "insurance" and current industrialised medicine does not work - not in my country.
          Like you I ask "How can we do this?"
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        R H

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        May 29 2012: I think you may have the answer - not to participate. The system has priced itself out of reality. I agree with your assessment that it is a 'big con'. It has become a privelged for the most fortunate and a dream for the rest. Similar to a hunger strike, our 'insurance strike' could be the one act to raise awareness and ultimate change. Thank you for you.
        • May 30 2012: Or as Gandhiji started it "The Non-Cooperation Movement" ! One of the most effective peaceful movements in history.
          Yes! That is what we need - "We the people - REFUSE"
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        R H

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        May 30 2012: I apologize for continuing to respond to your comments, but this conversation has had a most profound effect on me. I read about the 'Movement' you referred to. From what I read, it took a couple of massacres to galvanized people to act enmasse. Unfortunately, it is this kind of 'emotional trauma' which is often necessary to get mass buy-in for these types of significant systematic changes. People seem to have to be 'shocked' out of their comfort zone to rally for an issue. It also helps if they have little to lose. Through this conversation I have been led to see that 'reason', rational 'evaluation', and 'consideration', only lead to endless debate and compromise to the point that the originally effective solution is often discarded for an ineffective 'agreed upon' result - which is usually the least interfering for the 'haves', and lacks substance for the 'have-nots'. Capitalistic prosperity seems to solidify this lack of action and marginally effective response (although I understand that the French Revolution was initiated by the middle-class). For mass buy-in, it seems that only drastic emotional response to tragedy is effective. So maybe there are other alternatives. We, as individuals, could decide, like you have, to refuse to participate. Have little to lose or take, yet continue our professions and lead by example.We could take it a step further and organize our own 'communities' of like-minded individuals and seek to do business with them only, as much as possible, and possibly evolve into an actual thriving community. Or, we could spend our efforts not trying to subvert the system, but rallying support for equal economic opportunity so everyone could afford proper care. Yes, these are drastic, or 'pie in the sky', solutions. But this issue is so significant and huge in influence, that drastic response may be the only solution. I see no end to this malfeasance. It's just too big.
        • May 31 2012: Good morning RH

          If this debate makes one person think differently it will have served its purpose as far as I am concerned.

          For every "movement" in this world of ours which has changed people's thoughts and actions there has to be a critical mass and a critical time. It will happen when enough people feel that they have had 'enough of the old system" and they will have change at all costs.
          Sometimes all we can do is instil those thoughts into the minds of others, "debate", throw ideas around and never see anything concrete happening in our individual lifetimes. But we would have sowed the seeds of change and if it is important enough for that "critical mass of people" it wil happen.
  • May 28 2012: Hi Ishika,
    You know how much I agree on this issue.
    1. If we really had good primary and secondary level care in India and West Bengal in particular, wpe wouldn't be needing tertiary care much. People would be OK at the local hospital or clinic facility. But 'industry' would suffer from 'money-mia'
    2.Most corporate hospitals in Kolkata set revenue standards to be fulfilled by the doctors on their panels, so that the conveyor belt of the heath-care factory keeps rolling. In other words 'Show me the money or you can quit'
    3. Blindly mimicking the Americans and extrapolating their methods of 'doing every test for everybody' is a disaster for our country which has a meagre public heath budget but has given the multitude of unethical persons to order investigations at large.
    4. A good clinician can diagnose most (>95%) cases in his OPD without a single investigation. I've been fortunate to train under such illustrious doctors in Kolkata and Aligarh.
    5. Diagnosing after a battery of tests is a clerk's job. One needn't study the science and art of medical therapeutics if one can't trust his/ her gray cells.
    6. Most medical research is today sponsered by pharmaceutical houses which definitely puts the results of the studies in question. And what I understand, this is not limited to our own India.
    7. The day commerce overtook science all across the world with the US illuminating the tortuous path, 'the ethics died'. So heathcare among other things is looked upon as yet another business or
    ganisation, and patients would soon have a new title- 'customers'.
    8. Exploitation is at the core of it all. Brands sell. Just like a fifty year old buys Rs. 6000/-worth branded trainers solely for his morning walk and no more. Getting treated at a 5-star hospital, or should I say a 5-star hotel where some health care is also provided, adds to the social status and credibility of a person.
    9. The present state-of-the-art hospitals touch everying but the lives of their patients.
    • May 29 2012: Subhanu good morning.

      Working in the same system the two of us are part of the small surviving group of medical dinosaurs!
      I started this debate on TED just to see whether there are a few more dinosaurs out there or not.

      Read RH's comment. He puts it so well
  • May 28 2012: Stewart, Rhona

    Just to get back to the point of the debate - "the industrialisation of medicine".
    Trying to stay healthy is to a certain extent in your hands and then there is genetics and environment....

    We accept that "you" a "patient", is "ill". Ill enough to need a doctor/hospital and then take it from there!
    Stewart - 'chicken-and-egg" situation -- when it comes to "suing" and we have not heard the last word on that yet.
    My reading tells me that the US is responsible, for the slew of ambulance-chasing lawyers and all that goes with it. I may be wrong. My reading also tells me that after years of pursuing the legal route to "redressal", Americans are encouraging patients/doctors/lawyers to "TALK" and settle.

    I am trying to say that doctors are "human", patients are "human" -- to start with. We will die. Inevitable. Do we need systems which promise us that "for a price" we will live without disease or death". All we have to do is pay the price, have the tests, keep up with the insurance or travel halfway around the world to live forever - disease-free?
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      May 28 2012: I agree with you there, medicine shouldn't be profitable, which is what I interpreted as the meaning of industrialised, if you seek to make a profit you aren't thinking of patients at MOST it should be self sustaining, Though to me there is one problem in achieving this, it's only with the money of private companies that some medicines are even being produced and they're all about profit and that will never change and I don't think any government even the US has the funds to offer a completely public healthcare service free for everyone :(
      • May 29 2012: Profit is not a bad thing Stewart. Its "greed" that is destroying medicine.

        "X" produces a drug. It costs him "Y" dollars and ten years.
        If one looks at the actual costs X will in probability recover his Y dollars AND a substantial profit in 3 years. But the "industry" wants Y dollars times a hundred in one year and continue to want and want and want. So there is indiscriminate "pushing" of the drug through reps and drug company-sponsored "conferences" and dinners. The drug which should be used perhaps in a tertiary -level hospital is now on the shelves of every little town pharmacy being touted as "the thing to cure everything" - at a price.
  • May 28 2012: Let's put them out of business by staying as healthy as we can. In other words, let each of us accept responsibilty for our own health and not use the medical establishment as substitute mommydaddys. We are each in the best position to have positive impacts on our own health, e.g., eating, drinking, driving, body moving. Anything positive is possible.
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      May 28 2012: YEA LETS REVOLT! lets not get vaccines, lets bring back all the diseases I was made immune against, I don't want my kids having a measles or rubella jab! Cause they're already so immune to it! That's ridiculously stupid what you just said, we have medicine and healthcare because of the body's incapability of looking after itself. You probably would not be alive today if it wasn't for medical healthcare and all the vaccines you've probably had and all your parents etc have had
      • May 28 2012: stewart, I wonder if you are meaning to say that you are powerless to affect your physical well-being. I wonder to what extent you would acknowledge that your choices have an impact on your physical and psychological health, if any.
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          May 28 2012: there are tonnes of things i can do to stay healthy, exercise reduces my risk of diabetes and heart disease, by not smoking I vastly reduce my chances of cancer, brain damage, heart+lung disease. By eating right I can boost my energy levels and my immune system, but what I can't do, is cure myself by doing any of these. If I get sick, I take medicine because it works better than my body. If I get really sick I go to the hospital where they go above and beyond the capabilities of of being able to cure ourselves. But by suggesting that we scrap medical healthcare you promote mass death, widespread disease and suffering. There's a reason we have it and when people like you say we don't need it, well it just throws all the work that has ever been put into medicine straight back into the researchers and doctors and politicians faces. It shows this almost arrogance that the human body is beyond medicine.
      • May 28 2012: Good evening Stewart (Evening in Kolkata)
        Thank you for joining in. I was afraid everyone would just say "another crank" and move on
        By the way I am a paediatric surgeon. Did all my basic training in India and my paediatric surgical training in England. I work in India. In Kolkata.
        I am not talking about "vaccines". That is part of the basic armamentarium. That is one of the points I am trying to make. If we would only spend more time and money on vaccines, clean water, sanitation and simple stuff - life would be good! Better than good! NOT a battery of expensive tests and random indiscriminate use of antibiotics.
        I am talking about the "industrialisation" of medicine which is what I encounter on a daily basis. People ending up in " state-of-the-art" hospitals where they end up never getting a common-sense opinion. Every abdominal pain in a child is "appendicitis" which needs an immediate hospitalisation and surgery -- if you want the good of the hospital! Hey did you know that less than 12% of childhood abdominal pain is due to appendicitis and that there is enoug evidence to show that you can treat appendicitis WITHOUT surgery? Did you?
        Think about it.
        By the way the British NHS I trained in encouraged me to think "common sense" - as opposed to the one which is currently in place
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          May 28 2012: You make great points Ishika! Would you agree though that needless tests for every disease going may also by due to the new culture of "suing" doctors etc for not finding a certain disease etc and they're now forced into this method in fear of being sued for malpractice. Also would you agree that hospitals are also state of the art due to lawsuits etc if per say a disease was picked up whilst in hospital etc etc. I completely agree that healthcare should be for everyone, time should not be wasted on tests for everything but with compromise that doctors check for a reasonable amount of diseases or conditions etc. I say that mainly because me uncle was admitted to hospital with kidney pain and low and behold he had lung cancer so the checks also saved him.
    • May 28 2012: Good evening Rhona

      Yes staying healthy is part of it. What I am trying to emphasise is what happens when you do fall ill and need a doctor. Do you have to end up in a "state-of the-art hospital" having lots of tests or can you make it to the local doctor who listens to you and treats you with common sense - to start with?
      Are you willing to do that as an individual? Does the system in which you live. encourage that? Or do you have to wait for hours spend lots of money and then be told that there is not a lot wrong with you - simply to justify the cost of equipment and laboratories and doctors and patients insurance. Maybe even end up being admitted/operated.
      That is what the industrialisation of medicine means to me in real terms
      • May 30 2012: I guess all that aggravation and disappointment and all those negative thoughts and feelings you just expressed, Ishika, is related to why I choose the approach to health that I choose. I think the best policy is to live your life in such a way that you are not even aware that such a thing as any part of the medical industry, field or whatever you choose to call it - exists at all. You can depend on you to take good care of your good self. Thank you for taking good care of your good self. It is a free country. You can focus on whatever you choose to focus on and I choose to focus on what I choose to focus on. If we disagree about anything, I'll just assume I am right and you are wrong. I hope you are okay with that. Happy Today to you and all you love.
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    May 28 2012: Just for context what is the public healthcare like in India or is it all Private healthcare which is kind of what you've described
    • May 28 2012: Stewart
      Public healthcare in India leaves a lot, actually a helluva lot, to be desired.
      There are some wonderful postgraduate institutions where a lot of us trained - but basic healthcare !!!!
      Private healthcare has been encouraged at the expense of developing public healthcare and it is an "industry" .
      An industry we dont need in its present avatar