We Have Met the Enemy, and They Are Us: Dr. John Abramson is somewhat of an anomaly. For starters, he's a family physician on the faculty of Harvard Medical School - an institution not known for its warm embrace of the family medicine concept. (In its place, they have something called the Department of Ambulatory Care and Prevention, staffed largely by internists and pediatricians and masters of public health, and oddly enough, funded by an HMO.) Which brings us to his other claim to anomalism - the publication of his book, Overdosed America : The Broken Promise of American Medicine. While other academics and health policy analysts point directly to the pharmaceutical industry as the root of all evil in our current healthcare system, Dr. Abramson correctly notes that the real roots of our problems lie in our culture - from the academic and health policy system to the professional and popular cultural mileau.
Now, as healthcare systems go, ours isn't too shabby. We have the luxury of taking clean water and cheap, unspoiled food for granted. We live our lives free of the threat of death by bacteria. Most of us, no matter how poor, can find a doctor to take care of us in our hour of need. We don't wait for months for CAT scans or heart surgery, or to get an appointment with a doctor. We have a medical establishment that believes strongly in the importance of practicing medicine only with scientifically proven treatments - aka "evidence-based medicine." We have third party payers who monitor the quality of care by our physicians based on guidelines written by experts in their fields. However, as Dr. Abramson points out - an awful lot of the healthcare we get isn't the worth the money we pay. If our healthcare system were a car, it would be a Jaguar - fast, expensive, and beautiful on the surface, but little to offer for the long-haul.
Part of the problem is the elusive nature of this thing called health. Like happiness, it's difficult to nail down. That's why our founding fathers claimed a right to the pursuit of happiness rather than the state of happiness. If only we were so wise when it came to defining our goals for health. Today, health and disease have much broader meanings than they did fifteen years ago. Fifteen years ago, disease meant illnesses caused by a malfunctioning of the body or outside invader, such as cancer or infections; today, disease includes the normal changes of aging, such as osteoporosis and thickening waist lines. Twenty years ago, to be healthy meant to be of sound mind and body; today it means a fine obsession with various biomedical measures of the body - from cholesterol level breakdowns to bone density values. What's more, we have a pill or a procedure to treat each of those biomedical measures of health. Is your LDL cholesterol a smidgen above the recommended guidelines? We can bring it down for just over a hundred dollars a month. Is your body mass index forever over 25? We can readjust your stomach to bring it down. Even better, we have insurance companies who are willing to pay for all of this. And if they don't, we'll pressure them until they do.
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