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
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