Monday, March 26, 2012

American Ideals and Ethical Medicine

Among other things, I thought Peter Conrad’s book was a delightful introduction to how healthcare and medicine are becoming but another American consumer commodity. The factoids concerning the medicalization and practices of pharmaceutical companies appear disturbing and unethical. There is no question that duping the public through the marketing and distribution of drugs is a disturbing occurrence, particularly since health and trusted physicians is involved. But to me these issues merely reflect the American heritage of politics and business. Capitalism and meritocracy both have conflicting interests with the ethical treatment of patients. Universal healthcare contradicts on some level the basic notion relating hard work the allocation of resources among Americans. Most Americans would agree that everyone should have complete and equal access to medical care, but it does not translate so smoothly to our markets. The consumption and sale of pharmaceutical drugs however, fits seamlessly into profit making and capitalist venturing, as apparent by the success of “andropause” medication. Most physicians and studies agree that prescribing testosterone for this unrecognized disorder is questionable, and that progressive androgen deficiency is perfectly natural as one ages. But if there is a market for such products, it is perfectly patriotic for these pharmaceutical companies to advertise and sell them.

It is also disturbing to hear about the gifts and vacations allocated to physicians for prescribing expensive medication, however this is also a problem deeply rooted in our culture and politics. Apart from some silent veil expecting physicians to act devoid of monetary incentives, the current healthcare system has some very distinct routes for medical students to pursue a profit driven career. And after rigorous years in school and graduating with considerable debt, who is to blame physicians for opting for a career in dermatology, a free vacation or Montblanc pens?

In the end, these costs do come out of the pockets of the patients. And this is difficult to face, as on some level they are being manipulated and entering a market they do not fully comprehend. But this is the tragedy of the American consumer across the board. We are constantly being alienated from the true origins and implications of our purchases. When we are buying food for our family, toys for the kids, or pumping fuel into our vehicles. We are kept distanced from intelligent consumerism. This is a particularly complex issue in health, as the theory and intricacies involved in choosing which medicine to consume usually require years of training to fully understand. If we as a nation soldier up and opt for ethical and equal care for patients (which may resolve many healthcare cost issues) we need to decide where the buck stops. I personally believe the political and commercial sectors (i.e. government and drug companies) cannot be expected to make such decisions due to aforementioned American ideals. Medical institutions and education need to instill a sense of greater obligations in physicians, and have a pure emphasis on healing and quality of care. There needs to be a penalty for a system that pays doctors and hospitals set fees for providing services regardless of quality or efficiency, and a discouragement for prescribing profit-driven drugs (such as the propublica information).


  1. I do believe that doctors should be held responsible for ethical care for patients that puts their health before making money. However, I also think that in order to fix this problem, we cannot place all the blame on doctors and drug companies. Drug companies, doctors and the health care system in general are only exploiting the fact that the US is such a consumer driven and individualistic society. Most Americans do agree that everyone should have access to quality healthcare, but no one's willing to give up any of their own personal benefits to achieve this. If the average American actually cared about the negative effects that drug pricing and marketing has on the health of society as a whole, then drug companies would never have become as big as they are now. But since Americans generally values self-interest over the common good, people tend to think about what's best for themselves. If they think buying some miracle drug will cure whatever illness they have, and they have the money to pay for it, they will buy it without even thinking about what effect the price of the drug has on the overall market in terms of who can afford it, or what methods were used to ensure drugs are safe and effective before putting them on the market. And if Americans continue to place more value on (and are still willing to pay more money to) physicians in dermatology and plastic surgery over family medicine and pediatrics then the cycle will continue unless their values change.

  2. I agree that only so much blame can be put on the shoulders of physicians. Ultimately, most practitioners, with very few exceptions, are working for a larger, capitalistic system which responds to consumer demand. Much of the blame for this system, I believe, falls on our own laps. In order to get rid of this system, or to tame it, it is imperative for us to somehow disconnect such a close interaction between the factory operation of medicalization (the drug companies) and the healing operation of medicalization (presumably, doctors.) Instead, I think it would also be wildly helpful if alternative medical practitioners worked side by side with traditional, Western practitioners to conduct more thorough, all-encompassing examinations and to abate our issue with over-medicating the entire society. If the demand for these drugs drops, so too will the power of the industry. As patients, perhaps more appropriately consumers, we continuously demand drug companies to come up with these new and perhaps manipulative ways to cure us and that is no one's fault but our own. We commonly search for the quick fix to abate problems such as allergies, but we neglect and many doctors neglect (or are not wholly educated or aware) to inform us of the natural ways in which we can abate these types of issues. 1 tablespoon of local honey, which contains the pollen of the region, 1 month prior to allergy season will rid allergies for seasonal sufferers. If we were aware that a couple spoonfuls of honey for a few weeks would rid us of these sorts of ailments, would we still rely on Claritin?

  3. I agree with all of you guys that in today's society, our values have become shallow and selfish. We focus so much on what happens on the surface level and try to ignore what's really important. I believe that these Western values have spread to our parts of the world which is even more sad because how Americans think are becoming norms of other societies. And just like Vittoria said how this is a cycle, I am hopeless to think that it can end. I think it'll be a never ending cycle because as humans, we're always going to want more and it can be money, beauty, and other things. Ultimately, we're never satisfied. Doctors can be blamed for a lot of things but in the end I feel like the only thing we can do as patients is be proactive in finding the right doctors or actually develop the doctor-patient relationship. On another note, we should always ask questions just as Angell recommended in the last chapters. Because if we don't ask questions, we are just giving doctors the opportunity to fool us. Obviously, it's wrong for them to fool patients in the first place but it's not like we can stop this corruption. We have to at least do our parts instead of expecting changes from the other side.