November 2016
On Healthy Societies

The nations that lead the world in health outcomes are not the ones that spend the most money. The U.S. now spends over 18% of its GDP on healthcare, but countries like Japan, Sweden and Switzerland spend about half as much and get better results. The cost of healthcare weighs heavily on the middleclass (i.e. those that do not qualify for Medicaid) and on business. For small business the ever increasing expense of providing health insurance for employees can be crushing. Even large corporations find it burdensome as they compete with foreign business where the state picks up almost all health care costs. Our healthcare system is bankrupt and only the ability of the federal government to borrow and print money masks that reality. We must find a way to spend healthcare dollars as if they are finite and precious - because they are.

A century ago the average life span was about 50 years, and now it is about 80 years. Public sanitation (clean water), vaccines, and antibiotics were and are the key drivers in this success. Rich and poor lost about half their children to disease before World War I. Benjamin Strong, the first chief of the Federal Reserve, lost a child to scarlet fever (a strep infection), and he himself died of tuberculosis. By 1946 there were no more sanitoriums to care for TB patients as all had been cured with antibiotics. Franklin Delano Roosevelt could not walk because of a polio infection; polio was eliminated in the industrialized world by vaccination. Small pox killed an estimated 75% of the Indian population of the New World after Columbus brought the disease from Europe. Small pox now exists only in chemical warfare labs because of vaccination. Cholera epidemics were the scourge of city life in the 19th century, but are now unknown due to sewer and water systems (rediscovered from the ancient Romans). By comparison other highly touted advances in medicine and medical equipment and surgical techniques have had a minimal impact, and some have turned out to be disasters.

When I was in medical school postmenopausal hormone replacement therapy (HRT) was the standard of care, but after we started taking women off of estrogen in 2003 as a result of an NIH study questioning HRT safety, breast cancer rates dropped by more than 15%. So how many women did we kill with HRT? Reversals in medicine have become so commonplace that people have lost faith in medical science, and are even rejecting what works - such as the vaccination of children against the killers of the past. The Caesarian section rate in the U.S. now exceeds 30% as compared to 5% in Europe because of fetal monitoring in combination with litigation. The fetal monitor is high tech, and often wrong; if it worked we would have better maternal mortality and better infant mortality than the Europeans, but the opposite is true. The fetal monitor leads to over diagnosis and over treatment, but the OB/GYNs who do the most C-sections are the least likely to be sued - hence the national tragedy of our C-section rate. In short, our faith in high tech medicine is misplaced. Low tech medicine as practiced in so many other industrialized countries leads to better results and is far less expensive.