Society, Behavior, Environment – Missed Opportunities In American Medicine

Posted: February 8, 2019 in Uncategorized

“How is it possible, since the United States spends more on health care than any other country in the world, that for the third consecutive year, life expectancy in the US has declined?”

Stanford’s pioneering behavioral scientist [Robert M. Kaplan] draws on a lifetime of research and experience guiding the NIH to make the case that America needs to radically rethink its approach to health care if it wants to stop overspending and overprescribing and improve people’s lives.

American science produces the best — and most expensive — medical treatments in the world. Yet U.S. citizens lag behind their global peers in life expectancy and quality of life. Robert Kaplan brings together extensive data to make the case that health care priorities in the United States are sorely misplaced. America’s medical system is invested in attacking disease, but not in addressing the social, behavioral, and environmental problems that engender disease in the first place. Medicine is important, but many Americans act as though it were all-important.

The United States stakes much of its health funding on the promise of high-tech diagnostics and miracle treatments, while ignoring strong evidence that many of the most significant pathways to health are nonmedical. Americans spend millions on drugs for high cholesterol, which increase life expectancy by only six to eight months on average. But they underfund education, which might extend life expectancy by as much as twelve years. Wars on infectious disease have paid off, but clinical trials for chronic conditions—costing billions—rarely confirm that new treatments extend life. Meanwhile, the National Institutes of Health spends just 3 percent of its budget on research on the social and behavioral determinants of health, even though these factors account for 50 percent of premature deaths.

America’s failure to take prevention seriously costs lives. More than Medicine argues that we need a shakeup in how we invest resources, and it offers a bold new vision for longer, healthier living.

  1. Palmer Lee-Mesa says:

    While a lack of preventative care in U.S. healthcare settings is a contributing factor to our deteriorating health, privatized healthcare seems to be a somewhat equal threat. Doctors working in places such as McAllen, Texas (where Medicare pays one of the highest amounts in the U.S.) make their money from how many tests and diagnoses they give to patients. Essentially, the more tests and treatments they run, the more money the doctors get. This has led to an abundance of wholly unnecessary tests from doctors who aim to make more money instead of helping treat patients. With each test or treatment comes an inherent risk of further injury as well as a more outstanding bill to pay, making privatization a significant threat to the health and spending of patients. Luckily, Intermountain is much more socialized. Doctors make a flat salary, regardless of how many tests they run. Patients are treated by a group of physicians in most cases and can thus get better treatments. All of these result in better patient outcomes and less expensive bills.

    • Yes. Our focus in American medicine seems to be on providing the very best treatment available, not matter the cost. Tests and treatments are regularly performed not because they are essential, but simply because they are possible. Friends of mine who work closely with upper administrators and major hospitals tell that little attention is paid to diminishing returns for investment of resources. The millions and millions of dollars that are spent to squeeze a few additional months or days out of a person in the nineties might be spent on improving the lives of dozens of persons in the prime of life. While no one wants to deprive any single persons of a long life, we might do well to spend our time and energy trying to help more persons lead happier lives. As it stands, our current system is hardly egalitarian but rather stacked in favor of a privileged minority.

  2. Jaina Lee says:

    One thing that is not taught in medical school is social interaction. They’ve had a greater push towards having students take sociology classes, etc. However, it’s clear that being able to diagnose a disease is one thing, but it’s another to come up with a treatment plan that best suites their own life style and culture. There was a study done that showed that disparities in minority health care is largely due to the fact that many doctors give a very objective treatment plan that not all people of all cultures can adapt well to. Cultural insensitivity can bring about a lack of trust towards doctors. This problem lies more within the subject of discrimination and racism but I do believe we are one of the most objective countries when it comes to treating diseases.
    There was another thing that I read that religion plays an interesting role in rate of recovery. It doesn’t matter what religion, just as long as the patient believes in it. When doctors allowed religious practices in the patient’s room (whether it be bringing in a priest, etc) the patient seemed to recover faster.
    Anthropology is also a growing field in medicine specifically (I also might be biased). By understanding a population’s culture, we can understand their political limitations and in turn, their social limitations (like healthcare). These are all things that the U.S. does not focus on (although there is a growing awareness of it).
    America likes to throw money at its problems and think that if they throw enough money on it the problem will disappear. Instead of trying to solve the core issues to the problem (like making sure children in inner city aren’t in a food desert), we spend millions and millions of dollars attacking the disease. Preventative care is not only cheaper in the long run, but really would save more lives.

    • I’m glad you found this post interesting. There’s no denying that modern Western medicine can do some remarkable things. Even someone as cranky and contrarian as Greenberg is perfectly willing to admit that, and argue no one would want to go back to a world without it. Still, what modern medicine has achieved it has achieved through developing an extremely reduced view of how the world functions – in terms of simple and direct causes – and how we should act within it. This extreme narrowing of focus has lead to a neglect of broader and more complex issues of social relations, lifestyles, and systems of meaning, all of which non-Western medicine take quite seriously. Even if diseases do function on a microscopic as Western medicine suggests, the persons sufferings from these diseases are not microscopic, and things they do, think, and feel on a macroscopic level have very real physiological effects. At this point, any curious and responsible medical practitioner will want to take these factors into consideration when treating a patient.

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