The United States spends a greater share of its national wealth on health care than any other nation in the world.  Americans spent $6,714 per capita on healthcare in 2006.  Other industrialized countries spend less than half of what we do per capita.  Yet, with all this money spent, where is the bang for our buck?  Infant mortality is considered the most important measurements of a country's health and yet, in the U.S. 6.71 babies died prior to their first birthday out of every 1,000 babies born alive in 2006 according to the Center for Disease Control.  According to the CIA website's world factbook, the United States is ranked 180th lowest in infant mortality-meaning there are 44 countries who are ranked higher or better than we are and 180 that are lower.  This ranking not only puts us behind all the other industrialized countries in Scandinavia, Europe, and East Asia, but behind nations such as South Korea, Chile, Cuba, Canada, Australia, Slovenia, Israel and the Czech Republic.  An enormous problem in the United States with infant mortality is not death from malaria or diarrheal diseases as in some third world countries, but rather pre-term births, infection, SIDS, and congenital malformations, even when there was good access to healthcare for the mothers. Our nation also ranks poorly on other healthcare issues such as preventable deaths from asthma, circulatory issues and diabetes.  Obesity and excessive lifestyle and overabundance of resources in the hands of many are some of the reasons for these failures.  People in poorer countries simply do not have as much access to food, gluttony and lethargy are not an option for the population to survive.  Daily tasks require physical exertion in order to survive.   

So much physician time & medical resources are devoted to the onerous, wasteful process of called "ruling out."  Medical doctors in the United States are trained not to focus in on the most likely possibility or possibilities of the malady as presented by the patient, but rather to rule out all the possibilities until they get down to the choices of what is left.  For those of you who didn't know, look at your prescription next time that you present for an exam it will show dx for diagnosis with something written after it to appease the insurers as the guess of your diagnosis, then it will also ask the specialist to rule out that your disease is not abc disease.  So patients are sent on a circus of visits with specialists merely to determine what they do NOT have as a medical problem.  Sound wasteful?  Didn't know it was happening?  This is what causes the average American to panic before they present for one of these exams such as a CT scan or MRI because they do not understand that they are NOT currently diagnosed with that particular problem, but that the physician is merely ruling it out.  This ignorance causes unnecessary patient fear and anxiety in addition to the process being financially wasteful.

Medicine is also wasteful when it is practiced defensively.  When a doctor cannot merely focus in on treating the disease at hand, but rather, feels he must use medical resources to constantly, excessively ensure that there is no further cancer, or no other cause, or no better treatment, or that he's not deviating from the standard of care even though some other modality makes both financial & medicinal sense, so that he won't be sued, makes his hands part of the pie of these inflated costs of using excessive diagnostic techniques.  Physicians should be allowed to treat conservatively and with common sense first and foremost.  Physicians should also not be financially rewarded for using their own medical devices excessively or by manufacturers for using theirs in other venues.

Our standard medical visit has gone from one of diagnosis, treatment and cure in the days of not for profit healthcare, to diagnosing a symptom and prescribing a pill or other pharmaceutical remedy on a pad.  With the advent of antibiotics post-World War II, pills began to be seen as the medicinal answer to bacterial infections.  As pharmaceutical innovation slowly prospered, some other categories of drugs were developed to actually cure certain diseases.  Unfortunately, this association between "cure" and "pills" is weak at best in reality.  Most of the pharmaceuticals on the market today are merely palliative remedies to maintain disease states from progression at best.  They are not cures.  What it produces is not a healthy individual but rather a steady stream of revenue for a pill manufacturer if they can convince the doctors to continue prescribing the pill for their patients.  The other arm of this demand is created by the United States' permissive law that no longer restricts the advertising of pharmaceuticals directly to the consumer.  Hence, we are bombarded by commercials for little purple pills, erectile dysfunction, depression and diarrhea on television and in print media which aim to get us as the consumer hounding our doctor for that newest little costly pill that is still under patent.  Most of the underlying studies showing the efficacy of these pills is done by the manufacturer themselves and reviewed by a government arm that is staffed by former pharmaceutical company workers or future pharmaceutical workers.  There is no arm's length science going on in the FDA approval process of drugs.  This is evidenced by all the recalls of drugs in recent years that were found not only to not be helpful for the conditions for which they are prescribed, but have side effects that outweigh any benefit they might provide or are simply downright dangerous.  Hence, we have a sicklier population, on the pharmaceutical welfare line "addicted" and convinced of their need for these drugs by a medical system that is corrupted by pharmaceutical lobbyists gaining favor with politicians to be favored in healthcare policy.  What does that mean?  Lobbyist dollars by healthcare device manufacturers, pharmaceutical companies and certain medical organizations determine the healthcare modalities to which Americans actually have access.  They may be far from the cheapest.  Some older drugs are just as good as newer versions without all the cost and side effects.  The newest versions may be far from the best as they become more and more synthetic.  They may just be patches and not cures, when cures are available in the marketplace elsewhere at a cheaper price and as a final solution not an enslavement.  But, the limitations in the current system to only recognize certain types of medicine and certain pills are the foundation of its own failure.  We have a sicker population that spends more per capita than any other nation in the world.  Limiting Americans to formulary plans while rewarding pharmaceutical manufacturers and insurance companies on the backs of the sick in America is the basis for the failure of the current system.  We do not efficiently nor effectively treat our ill.

I'll speak more about what we can do to make the practice of medicine and the use of our healthcare dollars in America more efficient in my upcoming articles over the next three weeks.