I WAS WRONG ABOUT HEALTHCARE
Wholly unprepared… we take the step into the afternoon of life; worse still, we take this step with the false assumption that our truths and ideals will serve as before. But we cannot live the afternoon of life according to the program of life’s morning—for what was great in the morning will be little at evening, and what in the morning was true will at evening have become a lie.
— Carl Jung
Doctors help patients, and they love us for it. We fix bones, replace joints, cure killer infections, and control diabetes with insulin. We use painless scans for diagnosis. Liver, kidney, and heart transplants are now routine. Some patients get cured of lymphomas, leukemia, Hodgkin’s disease, and testicular cancer. Lives are prolonged for myeloma and amyloidosis. Vaccines have saved millions worldwide.
We have complex technologies such as the heart bypass machine and dialysis. We replace diseased heart valves with artificial ones that work. Cardiologists permanently correct irregular rhythms using techniques that would seem natural on Star Trek. Other specialists gift infertile couples with children.
Despite this, many sources agree: for at least half of healthcare, the potential benefit does not outweigh the harm. For a lot of the rest, supporting evidence that it works is lacking. A review of over 5000 articles recommends against many of today’s standard practices.
The list below introduces some of the topics in this book, the worst failures of healthcare, in rough order of wasted resources. The opioid disaster, now killing 50,000 people a year in the US, is not even in the top seven. I “knew” a lot because of my degrees and training, but I was wrong about many things.
What I thought: health insurance protects us against disasters, just like fire insurance.
The truth: Most of the $3.65 trillion in US medical spending (2018) is run through insurance companies before payment, which produces an insanity of wastefulness. These corporations extract fully a fifth—twenty dollars of every hundred!—of whatever they touch for their administration and profits, and they know that if total spending goes up, they get more money.
After the insurance layer has taken its share, only 75-80 percent remains for “providers” and suppliers. Every one of these has their own bloated overhead, which they must pay before patients get anything. Hospitals, for example, consume at least 25 percent more for internal expenses. This system creates outrageous total costs.
The smaller but more gloomy insurance story is the workers compensation system.
What I thought: hospitals are bureaucratic, but physicians supervise them to make people better.
The truth: Although many people who work in hospitals are idealistic, most of these corporations are ruthless pirates that are looting the patients who trust them. These companies pay or bully physicians to cooperate with their agendas.
Hospital costs are about a third of US healthcare. They spend ten to fifteen percent of their receipts just on coding, collections, and other methods to whip money out of the insurance companies.
3) Drugs and medical devices.
What I thought: Idealistic scientists wearing white coats develop new miracle drugs and devices all the time.
The truth: The pharmaceutical companies purposefully falsify the studies the FDA requires to patent medications, and the regulator turns a blind eye to it. Concealing negative studies that show little or no efficacy, such as was done with the antidepressants and the statin anti-cholesterol drugs, is just the start of their hoaxes. Because of practices like this, deciphering which medications work has become difficult. Many drugs are ineffective, and a lot are damaging. Some of the worst are the statins, the newer diabetes drugs, the osteoporosis drugs, the influenza vaccine, and the whole psychiatric pharmacy. These are all best-sellers.
The huge implant device industry plays the same games as the pharmaceutical companies and has fewer rules that force them to conduct proper studies.
Here is what I thought about generic drugs: they are just about as good but cheaper than patent medicines, which are a rip-off.
The truth: I was right; patent medicines are a rip-off. Generics are sometimes inactive or even contaminated, however. But they are now 90 percent of the American formulary because of patent drug price-gouging.
4) Journals and the academics of medicine:
What I thought: If I studied hard, read journals, went to meetings, and listened rather than talking to my friends, I would become a better physician. Also, if I looked at Internet sources, I would quickly learn about any medical field.
The truth: Doctors’ information sources have been wrecked by corporations. We depend on journals, but their editors have been bought off. They print fraudulent studies containing purposefully confusing math developed by academics who are sponsored by corporations.
Patients’ information sources, on the other hand, are advertising, “advocacy” groups, blogs written by industry, and wall-to-wall internet link-farms. They are all marketing in disguise and create anxiety and spread false information.
5) Mental Health.
What I thought: psychiatrists have some strange ideas, but their drugs are effective and treat mental illness just like insulin helps diabetes.
The truth: This is our most expensive and least effective medical sector. Informed commentators now call psychiatry a pseudo-science, and a substantial, credible group—besides Scientology—openly questions their theories and drugs.
Psychiatry is nearly divorced from even the flawed science advising the rest of medicine. The psychiatrists accept the most money from the pharmaceutical industry of any doctor group, which results in their ideas being the most contaminated. Their toxic medications might help a few sick people, but corporations promote them so heavily that one in six US citizens takes them. We mostly ignore the tragic consequences.
6) The heart industry.
What I thought: cardiologists and heart surgeons have effective treatments for coronary artery disease.
The truth: Invasive treatments for this are an immense but dismally ineffective industry. Sham surgery studies have now debunked stents, the tiny devices used to open coronary arteries. These might never work, depending on what you believe. The cardiologists understand the math yet continue placing them for the money.
Coronary artery bypass grafting surgery (CABG) is also useless or harmful. It immediately kills two to nine percent and gives long-term brain damage to a third. A few patients supposedly benefit: the three percent with severe blockage of their one-centimeter “left main” artery. For them, the studies show a five-year survival improvement of twenty (20) percent. But the operation is overwhelmingly performed for patients with other issues. These people suffer the complications with no chance of benefit.
Medications and lifestyle changes work better for coronary heart disease than these hazardous, invasive procedures.
7) Back pain.
What I thought: prolonged recovery might be the rule after back injuries, but the treatments, including surgery, help.
The truth: Unfortunately, our therapies are failures. Studies show every single one is an expensive, sometimes risky placebo. These include surgery, chiropractic, and the ultrasound and vibrators used by traditional physical therapists. Addictive opioid pain pills are prescribed long-term for chronic back pain, which is another disaster. Graduated exercise is the only treatment that helps these agonizing problems.
8) The opioid debacle.
(Omitted for brevity in this excerpt.)
9) Oncology or cancer treatment.
What I thought: we have a lot of cures and the science is advancing rapidly.
The truth: This is a heavily hyped sales pitch created by the industry. Cancer is the second leading cause of death after heart disease, but only a scant few treatments cure or even significantly prolong life. Although pain relief counts, extending life is the critical measure of success, and if the patient dies sooner of something else, it is a failure. Most of our toxic, over-advertised, extortionately priced treatments offer less than two months of prolonged survival.
Two-thirds of cancer doctors’ income comes from retailing drugs, or rather getting “rebates” for selling them. This is legal for corporations, but it would likely be criminal fee-splitting if done between physicians. Whatever the legalities, manipulating patient care with financial incentives has overwhelming potential for abuse. This must be banned.
10) The amphetamine tragedy.
What I thought: amphetamine abuse is mainly an issue for poor people in ghettos.
The truth: As with opioids, the pharmaceutical companies’ products are virtually identical to and produce the same disastrous effects as street drugs. Addicts use high doses, which make health destruction inevitable for this small group. Patients use lower doses, but prescriptions are so universal that this disaster is far more significant.
Corporations manipulate captive, well-paid psychiatrists to expand the indications for these drugs, despite the brain damage and behavior deterioration they cause. Nine percent of our children (a figure cited by the Centers for Disease Control) supposedly have “attention deficit hyperactivity disorder” (ADHD). Psychiatrists recommend medicating them. Many of our other kids get these medications from their friends.
The recent claim is that adults, including older people, also have an epidemic of ADHD, so they get prescriptions also. Some children now buy the drugs from their neighborhood senior citizen.
What I thought: mammograms save women from breast cancer.
The truth: Mammograms used to check women without lumps or other indications are a waste of time, money, and emotional energy. Millions of these tests are performed each year, hundreds of thousands of them are positive or unclear, and untold women get repeated mammograms and ultrasound examinations to chase the findings. After this, biopsies and surgeries are done to evaluate and cut out the areas of concern.
This process is expensive, and each procedure is a little risky. But the math does not work—patients do not live longer after accounting for the hazards of the invasive procedures that ensue after a mammographic finding. We would be better off if the system only evaluated women with lumps they find themselves.
12) Colon cancer.
What I thought: colonoscopy saves us from colon cancer.
The truth: Colonoscopy for random patients looking for colon cancer has no benefit.
This tumor is the second most frequent cancer killer after lung cancer. US gastroenterologists look inside the colon to identify small cancers and pre-cancers before they spread. Since surgeons can often cure these in their early stages by cutting out a section of the colon, this screening program seems reasonable. But examining patients without symptoms or known disease does not increase the average time they live.
13) Prostate cancer.
What I thought: urologists save men from dying of prostate cancer by checking a blood test on everyone over a certain age.
The truth: This does not work. The standard routine is to check the prostate-specific antigen (PSA) in the blood, and when it is high, to do painful biopsies. If cancer is seen, a removal operation called “radical prostatectomy” is often recommended. This commonly results in impotence and incontinence and saves no lives overall. Other therapies for the early stages of this cancer are also ineffective and damaging.
Even though about 75 percent of older men get prostate cancer before they die, it is only fatal in two percent. The tumor is usually inactive, and an aggressive approach does more harm than good.
14) Endoscopic knee surgery for arthritic knee and hip pain.
What I thought: if my knees hurt, an endoscopic operation will help.
The truth: Sham surgery studies compared patients who had this procedure versus those who only had incisions and anesthesia. There was no difference—the operation was a failure. The orthopedists know this, but they still perform this somewhat risky surgery. The costs in the US are $4 billion a year.
Whether you are a doctor or patient, the painful reality introduced here is running you over. The next two chapters explain how it all started and developed.