Interested to hear what you physicians think of this article: The Crisis in Medicine: A Provocation - by Akshay Pendyal
Here’s an excerpt:
*At times, I’ve begun to wonder if medicine may be less meaningful, its mission less unassailable, than we like to let on.
**This is, admittedly, a bit of a provocation. Modern biomedicine has, of course, delivered breakthrough treatments over the past century, treatments which have transformed the care of diseases which were once considered incurable. Aspirin for heart attacks. Insulin for diabetes. Potent antibiotics to treat infections caused by highly virulent organisms. These interventions are true marvels of the modern age: they’re safe and effective for conditions that affect millions. We should rightfully celebrate such treatments and work to make them widely and freely available.
**The problem is that for other types of treatments—treatments which now constitute the bulk of medical care—the outlook is far less sanguine. This seems especially pronounced in my field, cardiology. To take just one example: trial after trial has demonstrated the limited effectiveness of stents for many patients with blocked or narrowed heart arteries. But, undeterred, cardiologists have plowed ahead, depositing these little expandable tubes via catheters into hundreds of thousands of patients every year, committing them to long-term medications, and, quite often, setting them up for a lifetime of continued unnecessary testing.
**At times, I even find myself wondering whether we’ve reached a hard limit on progress, at least when it comes to the sorts of “blockbuster” treatments I mentioned earlier—treatments like insulin, which, though it was discovered more than a lifetime ago, has prolonged the lives of and alleviated the suffering of millions.
**Now, our most highly-touted novel treatments also seem to have the nasty habit of failing to replicate in large clinical trials. It’s a familiar scene: a “late-breaking” trial at an international medical conference, the audience waiting with hushed anticipation for the big reveal. A two-fold decrease in mortality! A 30% reduction in hospitalizations! The story gets picked up by all the newswires, the TV commercials for drug X (“ask your doctor about…”) start to appear. Never mind that a subsequent trial—or two, or three—enrolling more patients and performed the following year demonstrates no effect. No matter, use of the device will continue to increase, as health care expenditures in the United States inch ever closer to 20% of GDP.
**And then there’s the work itself. Consider the transformation that medicine, as a vocation, has undergone. As the sociologist Paul Starr wrote in the 1980s, physicians will come to experience “more regulation of the pace and routines of work.” They will be required to meet “standard of performance, whether measured in revenues generated or patients treated per hour.” Starr was prophetic. These days, the job often resembles middle management: the day to day drudgery, the hours in front of a computer, the electronic health record-keeping systems which inflict “death by a thousand clicks.” The operative term in healthcare now is “productivity”: the work of trying to make people better reduced to the “relative value unit,” or RVU, which, along with the QALY, or “quality-adjusted life-year,” have conveniently allowed us to mathematize human flourishing and suffering. *