A New Golden Age of Medicine

Imagine the 1950s in medicine. Within a generation, public health advances had eliminated communicable diseases; medical discovery brought antibiotics, vaccines, and new medicines; and surgeons performed daring operations to correct conditions of the heart and brain. The family doctor was an approachable, respected professional who often performed house calls. With memories of premature deaths and disability caused by now-treatable conditions, people were grateful for the work of medicine.

Ahead of the establishment of Medicare in 1965, the government discovered that some seniors and the chronically ill did face financial difficulty due to medical expenses. In general, though, medical care was affordable for the out-of-pocket payer: Walt Lillehei was the best in his field, and charged just $400 (or $4,000 today) for each cutting-edge heart surgery he performed in the 1950s, and often did not deposit the check, anyway (1). There were fewer healthcare administrators and managers to take a cut from the surgeon’s pocket; in contrast to today, hospitals were run by experienced physicians, not businessmen.

Things changed. Institutional Review Boards for medical research, informed consent for every procedure, the rights revolution of the 1970s (both on the new age left and the religious right), legalization of physician-assisted suicide, and widespread skepticism seemed to slow progress. Research doctors no longer worked in clinical practice. FDA regulations and the threat of massive lawsuits forced a risk-adverse approach to new medicines, devices, and treatments, to the detriment of patients waiting for a cure.

The convolutedness of medical billing forced a focus on quantity over quality, and closed many private practices: few new doctors today imagine opening their own office. Access to healthcare has improved marginally- many Americans remain uninsured and delay medical treatment due to cost. 1 million Americans declare bankruptcy each year due to medical expenses (2).

At some point, things have to get better. Recently, my friend quit his job in finance and went to medical school, following his old passion: he conducted small public-health research projects in high school, and his father is a physician. Operation Warp Speed, the American effort to discover and produce vaccines against COVID-19, was a demonstration of new prowess. The leading vaccines use mRNA research, which had been conducted behind the scenes for decades, and finally implemented for cancer treatment ten years ago. It is being released to the American public on Emergency Use Authorization: a breakthrough of red tape. Due to the costs of approval, promising treatments for small populations and the developing world had been left to wither, as there was no commercial viability. Hopefully, the new public focus on medical research and clinical trials will push government officials to do what is right for patients. This could be the herald of a new golden age in medicine.

 

(1) King of Hearts, book by G. Wayne Miller

(2) Medical Bankruptcy Statistics (thebalance.com)

Coronavirus: Vaccine is Here and Now

 

But how to get in into peoples’ arms?

On the administration of the vaccine, mathematicians and their game theories have surpassed credentialled public health professionals in predicting how to proceed. Health experts did not predict that a significant number of workers would decline the vaccine (up to 40%), because of immunity acquired from previous exposure, personal choice, or even the preference of an anti-vax supervisor. The “discouraging supervisor” has not been discussed in the media, but will come into greater view if vaccination clinics maintain limited hours which shift workers find difficult to access. There has been hesitance to release unused doses of vaccine, even as early expiration dates come near.

In New York, Governor Cuomo ordered that healthcare providers who circumvented state-mandated priority groups for vaccination would be fined $1 million, and their license revoked. This is not a general statement about maintaining fair distribution of the vaccine, but a substantiated threat as ParCare Community Health Network, a New York State provider, was sanctioned for “fraud” in vaccinating over 800 high-risk adults ahead of schedule before New Year’s Day. This action has had a chilling effect on providers in the state, who have since allowed unused doses to go to waste, instead of administering them to the general public.

As the vaccine is becoming available to greater populations, bureaucracy and appointment-based systems are hampering the effective distribution of the vaccine. At some hospital systems, there is an hour of administrative work for each dose of the vaccine given. As a result, it is not uncommon for a hospital to vaccinate only 20 of its staff in a day. A well-planned clinic, such as the military Branch Health Clinics, should deliver at least 400 doses per day. A Pfizer vial contains five doses, and must be used within six hours of its opening. Emergencies and medical deferrals can cause planned recipients to miss their doses, and in the interest of public health, another recipient must be found. In rural areas, it will be necessary to relax priority groups to ensure that vaccine does not go to waste. I know a ship’s officer who drove 8 hours to get his vaccine in Norfolk, Virginia; this is not a viable option for senior citizens or low-income individuals. Centralized vaccination centers, as Florida and other southern states have set up, have shown great effectiveness in reaching target groups. Nobody likes to wait in line, but practical evidence shows that a queue is necessary to administer the vaccine without waste.

Implosion in Georgia

 To be honest, it feels surreal to be living through today. An insurrection at the US Capitol (with one fatality) that disrupted the conduct of business. The Republican Party of Virginia (or at least individual leaders) are condemning the President in his last two weeks of office.

Both US Senate seats in Georgia appear to be going to Democrats Warnock, and yes, Ossoff. The latter seemed to exude the white privilege that has come under scrutiny in recent years: come from money, fail upwards, and be confident that you’re right, even at 33 years of age. (Yes, even Joe Kennedy III hit the wall this year). For him to win is nothing short of an implosion in the Peachtree State. Outgoing President Trump did everything to cause chaos during the campaign, and apparently some of his loyalists sat out this special election in protest.