“ $250 Billion & What Do You Get? Another Day Older & Doctors’ Neglect....”
If you gave US$26 billion to someone last year to do a job you’d want to get some tangible benefits from that, wouldn’t you? And if you had spent $250 billion over 50 years on a project you might reasonably expect a pretty decent pay-off by now, mightn’t you?
US$26 billion a year, that’s the kind of money the US taxpayer spends on medical research (not including cancer research) every year via the National Institutes of Health (NIH). And this is in the US alone. It doesn’t include similar amounts of money spent by other industrialised countries or the WHO.
This is not to say all this money is a total waste or that great research results are not forthcoming. No, in a way it’s worse than that. Huge amounts of clinical data is amassed that could save the lives of countless people, but it is ignored. Doctors, hospitals and the general public at large just don’t know about it or, if they do, they simply never get around to applying it.
People are dying because their doctors are not keeping up with the latest treatment breakthroughs. Some of them decades old!
And if this is a problem now, don’t think it’s going to get any better any time soon. If things are complicated now, and we are already awash in unused scientific data that could save our lives if only we knew about it, what chance do you reckon we’ve got as we move into the wonderful and infinitely more complex world of gene-centred medicine......?
In September last year the “Wall Street Journal” ran an article showing that today’s doctor’s “often fail to pass on to patients the fruits of any discoveries”, and that these lapses “posed serious threats to the health of the public”. A month earlier the “New England Journal of Medicine” (NEJM), one of the world’s leading scientific publications, reported that “new discoveries and even ‘old’ research was not being translated into clinical practice.”
Former President of the American Heart Association, Dr. Sidney Smith, was quoted by the Wall Street Journal as saying, “for the government to spend US$26 billion a year (NIH 2004 budget) on research and not get the benefits to the patients is crazy. It’s a huge waste and a tragedy”.
The US government funds numerous clinical studies to find better ways to treat cardiovascular and pulmonary diseases and while some gains have been made in disease prevention and treatment, too many doctors and hospitals fail to incorporate the latest findings in their everyday practice. Writing in the NEJM, Dr Claude Lenfant, Director of the National Heart, Lung & Blood Institute also questioned whether the public is getting a proper return on the $250 billion that the NIH has spent since 1950. Despite spending such astronomical sums life expectancy in the US lags behind 22 countries, which Dr. Lenfant attributes to doctors and patients “not applying what we know”.
How Many Lives Lost?
The size of that failure and the cost we pay in lives lost is both tragic and uneccessary. The medical establishment is excruciatingly slow to adopt new concepts and, for reasons that bear some scrutiny, is often fiercely resistant of even simple methods to improve the quality of treatment.
Cancer patients are often shocked to learn that most conventional oncologists are not using the latest information contained in their own journals. A failure that helps explain why more Americans are dying of cancer than ever before, despite another US$200 billion spent in the last 30 years on the so-called “War on Cancer”.
The failure to treat acute heart attack effectively in the light of latest findings costs hundreds of thousands of lives. In the 1980’s clot-busting drugs became available to dissolve a coronary artery clot but emergency room doctors were slow to catch on. More recently, angioplasties have been found to be more effective than clot-busters in saving heart attack patients. Shockingly, current research reveals that in the last quarter of 2002, nearly 33% of all heart attack patients throughout the US taken to hospitals received neither angioplasty nor clot-busting drugs. In other words one third of doctors watched heart attack patients suffer and die while proven therapies available to save their lives went unused.
A class of drugs called beta-blockers used successfully for the treatment of hypertension, angina and for the prevention of second heart attacks have been saving lives in Europe since the mid-60’s. In the US the FDA refused to approve these drugs until 1978 and as recently as 1996 findings show 37.5% of patients who would benefit from beta-blockers were not being treated with them.
Incredibly, despite all that has been said and written about high cholesterol and heart disease over the past 40 years, a recent study showed that 50 - 75% of heart attack patients have not been screened for high cholesterol levels, let alone prescribed proper cholesterol-lowering medications.
A further example of doctor neglect in this area is the failure to use aspirin as a cardiovascular drug. Overwhelming evidence demonstrates that low-dose aspirin is highly effective as a therapy for cardiovascular disease. And yet as late as 2000 aspirin was only being prescribed to one third of patients with coronary artery disease.
Being fat is liable to kill you. Obesity is now widespread and is leading to epidemic levels of strokes, diabetes and heart disease. Despite all the publicity about this a recent survey showed that only 42% of obese adults were advised by their doctors to lose weight and only 34% had been counselled about the need to take regular exercise.
Today many conventional doctors routinely ignore simple proven means of cutting the incidence of heart attack and stroke by omitting to test patients for elevated levels of C-reactive protein, homocysteine and fibrinogen and taking the simple steps needed to lower them.
In the treatment of cancer and congestive heart disease it has long been known that if the patient is anemic his or her chance of survival, particularly among the elderly, is greatly reduced. However, very few physicians bother to test or treat their patients for anemia leading to greatly increased rates of mortality. If your parents or anyone else is in the situation, take note and ensure their doctors test for anemia.
Which is it? Money or Ego?
Sadly, the reasons for this is appalling situation is more than simple ignorance or laziness on the part of doctors. Sometimes doctors actively refuse to entertain compelling research that can save lives for reasons that can only be put down to greed and/or professional or personal ego. An infamous instance of this took place in the 1990’s when a research group clearly showed that spinal fusion surgery usually does no good. Flying in the face of scientific fact orthopedic doctors successfully lobbied Congress to punish the research group, setting back the cause of science-based medicine in the field for years.
Cases like this caused Dr Sidney Smith, Professor of Medicine at the University of North Carolina and a past President of the American Heart Association to state: “a large part of the problem is the real resistance from physicians....many of them independent-minded souls don’t like being told that science knows best”.
That is a pretty shameful statement coming from a prominent physician on his own profession.
Another disturbing factor in all this is the part played in modern medicine by the insurance companies and HMO’s in the name of cost-effective medicine. These organisations, because they are profit-driven and/or shortsighted, often refuse to accept new research findings until forced to, often decades later. What they refuse to see is that these new methods and early diagnoses can prevent and cure people, not just saving lives but saving both the HMO and the insurance companies a bundle of boodle. And that by keeping their clients alive longer they keep on being paid premiums. Prevention is a lot cheaper than cure. It’s good business. Any fool knows that. Greedy and stupid is, well..... stupid! (unless of course, as a publicly quoted company, your professional ethics are dictated by your need to deliver good quarterly results, in which case a lot of inexplicable behaviour comes into focus).
But What about You.....?
The medical profession may well have a lot to answer in all this, but you what about you? You can hardly blame your doctor if he tells you to take your medicine, lose weight, stop smoking and you just say “Yeah, Yeah..., Doc, I know ” and ignore what he says, and then you go get yourself a heart attack because you didn’t do what you were told, now can you? It is all too easy to blame the doctors. The fact is that we the patient are just as much to blame. We’ve heard it all a thousasnd times before. The rest of the information is there if we want to find it. The days are long gone when we looked upon our physicians as Big-Daddy in a white coat, all-knowing and all-seeing, infinite in his understanding and dedication to our particular person and who would always make us whole, no matter what. (Ah, Yes.Wonderful, wonderful days....Ed.). Anyone, in this complex world, who has a serious health challenge would be foolish indeed if they didn’t do their own research. No one can safely abdicate the responsibility for their treatment wholely to their doctor. Indeed no good physician wants this and will encourage you to make informed choices. By the same token only a fool ignores what a good doctor says, given of course that they’ve found one. Getting good medical consultants on your case is plain common sense.
The fact that far too many patients simply do not follow their doctors instructions. A recent survey of coronary artery disease patients showed that 40% of the patients surveyed did not take their medication as prescribed. Smokers continue to ignore their doctors advice to quit, couch potatoes don’t hit the gym or take a hike, the overweight can’t or won’t lose weight, and the chronically stressed twitch their lives away despite anything their doctors tell ‘em. In case you’re in any doubt, a lousy lifestyle will shorten your life and quite possibly kill you. That’s why so many of the chronic diseases that do kill us are described as lifestyle or “optional” diseases.
What are We to Do?
The rapid advances in the biomedical sciences are both alarming and exciting. On the one hand, people are dying because their doctors are not keeping up with the latest treatment breakthroughs. On the other, there’s the sheer amount of life saving data that is available to us. When patients and doctors educate themselves and work together, what were once lifesaving miracles can become routine. Doctors learn about new discoveries at scientific conferences, from medical journals and via the Internet. However, only a tiny fraction of these doctors translate this knowledge into enhanced treatments for their patients. That needs to change.
What we need is something that is being called Translational Medicine. As the phrase implies, it entails the translation of all the diverse scientific findings into therapeutic treatment protocols, which are as comprehensible to the ordinary patient, as it is to their doctor. At the moment such information can only be amassed with considerable effort and only with some basic knowledge of the subject. Part of the problem here for the lay seeker is the sheer amount of un-scientific information out there. Not to mention sheer quackery.
Most of the medical sites merely repeat the dated conventional approach that is essentially the problem. Oceans of other stuff posted online is self-serving sales hype, not to mention all those nostrums pushed by snake-oil salesmen, sundry MLM’ers and a proliferation of other dubious alternative folk. Consumer health magazines are lightweight froth designed solely to promote the products of their advertisers and the scientific journals are really not for the likes of you and me (nor most doctors it seems).
So until government and other organisations in the healthcare field, supported by the private sector, actually see the benefit (profit?) in making such information readily available to the world at large, we are going to have to enlighten ourselves as best we can. We must discuss what we find out with our doctors, find the few print or internet sources of reliable information and talk to other informed persons whom we trust.
Unfortunately given the money and politics of medicine the situation is unlikely to improve until we, the public, insist that it does. The way things are going that won’t happen until the current system becomes as financially bankrupt as it is morally so. Meantime we can only do our best. With our health, as with most things, that is a good place to start.
