What happened to healthcare in the USA?

Gosh, it's been a month since I've written anything. Since my last post was an actual anecdote, Ifelt like Andy Rooney, so I'm back with a commentary.

What in the hell happened to healthcare in the USA?

I'm old enough to remember the days of home visits by the family doctor. Usually driving a Cadillac, Lincoln or Chrysler Imperial, probably black and sporting a conspicuous MD tag so that he could park wherever he felt like parking. He would enter the house, smoking a cigarette and carrying the ubiquitous little black bag. He would examine you thoroughly, treat you (shots, stitches, etc) make you better, and be off to see his next patient. The cost was probably ten bucks and no paperwork was ever needed. Maybe he wrote a prescription or scheduled a followup at the office. If surgery was needed, he probably did it himself. I know that my family Doc (Dr. Deutsch) delivered me via C-section, pulled my tonsils at five years old, repaired my knee at fourteen and gave me a talk about responsible sex (no hookers) when I went to France at eighteen years old. He saw me through all of the typical childhood diseases and injuries. He also treated my parents and grandparents. Drugs only played a small part in his treatment regimen. I know that for most of that era, we did not have health insurance. Healthcare did not cause my working class parents to go in debt and medical malpractice had yet to be invented. At some point during the 1960s, we did get Blue Cross/Blue Shield.

At about the same time that health insurance became in vogue, doctors stopped making house calls and drug companies began to play a larger role in "winning" the battle against disease. As technology increased and new drugs came on the market, the cost of healthcare rose sharply along with a loss in personal, individualized care.

The cost of producing "wonder" drugs had increased at such a rate, that the drug companies successfully lobbied our leaders in Washington for faster approval for new drugs so that more people could be saved more quickly. The FDA invented "fast track" in the early '80s so that new drugs could reach that market in a matter of months instead of years. Oh please, help us save the sick people! The drug companies argued that testing a small number of people over a short period of time was just as good as testing a large number of people over a long period of time. After all, getting new drugs on the market was in the interest of the public good.

A good example is insulin. Since the late 1920s, animal based insulins were found to be effective in treating type 1 diabetics. These insulins were stable, predictable and had been modified to work for virtually every metabolistic nuance. There was Regular, NPH, Lente, Ultralente and some mixtures. If a diabetic followed the guidelines as proposed by their doctor, watched their sugar and carb intakes and watched their weight, they could live relatively normal lives. They would occasionally check their sugar with a reagent and later a urine test strip. If the diabetic was bad and did not follow the guidelines, they would get neuropathies, retinopathy, kidney failure and eventually, die. The problem with pork and beef insulin was not their effectiveness, but their lack of profit. Good diabetics would see their doctors two to three times per year and use a bottle or two of insulin per month.

Then came "human insulin." This was the first drug fast-tracked by the FDA after only 40 non-diabetic men were tested for less than six months. This so called "human insulin" is made from yeast or e-coli bacteria and recombinant DNA. It is no more human that a hunk of plastic. In essence it is less closer to human insulin that either pork or beef insulin. Don't take my word for it, check it out. This new insulin works in a similar fashion to the "old " insulin, except that it is not as stable, is metabolized more quickly and has five times greater the side effects. It requires a diabetic to constantly monitor their sugar levels (up to ten times per day), take up to 6 injections per day, perhaps get an insulin pump, visit the doctor more often, get a prescription for glucagon (in case their sugar drops below 50), and get an a1c test every three months. If they don't follow a strict regimen, they will get neuropathies, retinopathy, kidney failure and die. Additionally, if they carefully follow every guideline given by their doctor, they might get an asymptomatic hypoglycemic attack and die. The drug companies make the new insulin for pennies and sell it for major bucks.

My wife is a great example of someone who has suffered as a result of "advances" in medicine.

She was diagnosed with Type 1 Diabetes in 1964, when she was thirteen years old. This was during the early years of Cuba's revolution and the medical system was very similar to the U.S.
Her endocrinologist prescribed a regimen that kept her pretty healthy until the 1990s. Insulin had been improved and routine glucose testing had begun, but my wife had never had an adverse event in more than thirty years. An auto accident in 1994 uncovered the beginnings of neuropathy and some of the other issues that long term diabetics incur. Being an artist, the pain to her extremities was disconcerting. As her condition worsened, we began to see the doctor more often. By 1999, we were told that Eli Lilly had decided to discontinue natural insulins. Through the advice of her doctor, she switched to Humulin L. Within 24 months, her glucose levels were not as controlled as before and another insulin, Humalog R was added. With natural insulin, she was taking one injection daily, with only one major adverse effect from long term usage. Now she was required to take at least three injections every day, test her blood sugar level 3-5 times per day and her other symptoms were progressively worse. Her neuropathy was unbearable and she began having numerous hypoglycemic events. The doctor prescribed an anti-depressant which relieved some of the neuropathic pain, but had side effects that were very unpleasant. When she discontinued the antidepressant, she went through withdrawal and had to resume taking the drug and weaned off of it slowly. Meanwhile, she was having an average of eighteen hypoglycemic events (blood glucose readings below 50) per month. At least ten of these events would have resulted in death had I not been there to assist her. These events culminated on April 30, 2004 at 4:00 a.m. with a glucose reading below 20 and a trip to the ER via ambulance. Some internet research made us aware that a significant number of diabetics are virtually allergic to synthetic insulin and become increaingly resistant to treatment. I also discovered that Eli Lilly was still producing natural insulin, even though most pharmacists and doctors would tell you that it was discontinued. After some resistance, we were able to get a prescription for natural insulin, and my wife's condition showed gradual but sure improvement. She also found a number a natural supplements that, over time, greatly relieved her neuropathic symptoms. Then Eli Lilly did the unthinkable. Due to shrinking market share, natural insulin was discontinued in April 2006. Of course, it pretty hard to increase market share of a product that was perceived to have been discontinued for more than six years! Now the only options were to switch back to a product that would worsen the quality of your life and eventually kill you or, get an import license from the USDA and get the natural insulin from the UK. Our government supports Lilly's decision and the FDA says that they cannot force a company to manufacture an unpopular and unprofitable product that is used by only a small number of people. Go figure! Our decision was obvious.

A diabetic in the '70s would spend less than $10 per month to treat their condition. In 1972, a bottle of insulin cost less than one hour at minimum wage. Today, a diabetic without health insurance would pay in excess of $250 per month if they were lucky. And don't tell me that their quality of life is any better than that 70's diabetic who lived by the book!

What about glucose lowering drugs, cholesterol medicines, blood pressure medicines, anti-depressants, chemotherapy, hormone therapy ... Ninety percent (?) of drugs currently in use were not around twenty or thirty years ago. Nobody knows the long term effects of most the these drugs, because they were never tested for long term results. Every one of these new "wonder" drugs has a list of side effects that would scare a combat veteran. It seems that the main goal of drug therapy is not curing the disease, but keeping the patient dependent on the drug and the seeing doctor for as long as possible. Doctors get their information and continuing education from drug companies. Because of the ever increasing cost of doing business, doctors don't have time to research any of these issues in depth. If they don't see X number of patients per day, they can't survive. Insurance companies pay less and less per treatment each year while other costs keep rising. While doctors are not poor, they are being pressured from all sides to cut costs and see more patients. What a system! You and I suffer from a healthcare system designed to keep big business even bigger with virtually no accountability.

We need to change the basic paradigm of healthcare in the USA. We need to look at how other countries are doing and find a way that meets the needs of the consumers and works towards a goal that will give better healthcare to all americans. Changes in drug approvals and health insurance, along with tort reform in the area of malpractice will contribute to an improvement of the system while allowing everyone to still make a buck. Citizens and professionals in non medical fields need to network with doctors, universities, insurance companies, and yes, drug companies to find common ground to stop the madness and get us back on thre right track. We can't ever go back to the '50s; actually, we can do a whole lot better than that.