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Where Has Exceptionalism Gone in U.S. Healthcare?

Posted December 3, 2013

As American households celebrate Thanksgiving it remains a good time to express our gratitude to live in a terrific country. America is a beautiful place. We have amazing heroes, charitable hearts to serve others, families and folks full of kindness with a great spirit to persevere through adversity. Americans are willing to work hard yet their independence breeds ingenuity and invention. We remain in awe of our forefathers’ courage and the brilliance of the plan they created to fashion a land of liberty and justice for all.

That magnificent system of government and law breeds a political landscape that can be full of messy discord. Vested interests have led to wasteful spending and the corruption of those who seek money and power. Yet, many Americans remain hopeful that our leaders seek the common good. Is the same true of American medicine?

The current political discourse about the recent changes in healthcare legislation has set the stage for many Americans to consider their present healthcare. Americans spend more money on healthcare than any other country on the planet. While we do not live the longest or have the best quality of life, our technology is astounding. Leaders from other countries travel to our hospitals for their care. We educate talented physicians, nurses, and many other healthcare providers.

The same melting pot of many immigrants whose interests unite has created a vibrant system of complementary and alternative medicine. Books that include 1491 and 1493 chronicle the rich cultural tradition of innovation and integrative care that predates the discovery and settlement of the Americas and continues even today. The integrative scene of traditional allopathic medicine, traditional Chinese medicine, homeopathy, naturopathy, energy medicine, body work, medical herbalism, and Ayurvedic medicine indicate eclectic medicine is alive and well even today in the U.S.

Yet, many of us wonder why in the land of liberty, innovation, and ingenuity many aspects of medicine have failed to change despite the passage of decades. Recently a physician friend hospitalized for a surgical procedure bemoaned the 1 am vital signs, the 5 am venipuncture, the institutional food, nurses’ call button cords that ensnare patients. He was amazed that medicine has done the same things for 40 years since he completed his residency.

Hospital-acquired infections occur over 2 million times a year killing as many as 106000 every year. Yet, American medical researchers as well as those from other countries have amassed an amazing look at the balance of good to bad bacteria that populate every portion of the human body. Countries with far less resources than the US have made far more improvement containing hospital-acquired infections than this country. Handwashing and the prudent use of antibiotics and antiseptic washes appears to be often ignored in American hospitals.

The nutritional literature doubles every year. The medical research doubles every five years. Yet, many a hospital continues to serve processed macaroni and cheese to cardiac patients and fail to question fast-food restaurants on hospital property. And oncology centers proudly have a full bowl of candy on hand for patients. Most physicians have little focus on their patients’ diet and the potential of nutritional support used preventively and therapeutically. The potential of using nutrition as a preventive tool and therapeutically to adjunct or even avoid more invasive therapies remains unknown among most hospital staffs. Yet many physicians use nutrition and nutritional supplements for their own health and that of their family.

The research documenting the myriad of beneficial effects of regular activity has prompted all too few healthcare providers to write out an exercise prescription for their patients. Yet, activity has documented benefits for cancer patients, heart patients, and diabetics, those with cognitive dysfunction far too often never brought to the patient’s attention. Activity can make a difference for patients with Parkinson’ disease as well as help patients age well.

The rate of medical errors stunned both healthcare professionals and consumers alike revealed through the 1999 study by Harvard researcher Dr. Lucian Leape. It was published in 1994 in the Journal of the American Association under the title Error in Medicine. Yet, few have followed the model of the VA hospitals to acknowledge and provide restitution for every medical error whether it was perceived or not by the patient. That simple step cut the rate of medical errors in VA hospitals and reduced malpractice rates long-term and was pioneered at the VA Hospita in Lexington, KY.

Many a medical wag has joked that medicine changes during the time it takes to educate a physician, the length of his/her career, and then their death. In other words, physicians become financially invested in what they mastered and practiced and fail to adopt innovation because, for example, a large investment has been made in the dated techniques/technology. Hospitals deter physicians from using simple yet medically researched techniques of magnesium to ease asthmatic attacks, vitamin C used intravenously to boost the immune response to viral infections poorly treated by conventional medicines, and nutrients like d,ribose, coenyzyme Q10, and l,carnitine that can reduce repeated hospitalizations for congestive heart failure. Medical boards viciously attack physicians who innovate charging them with using therapies outside the standard of care for the practice of medicine. Yet, in case after case, the standard of care may not be the best for that patient’s needs. The lack of openness to taking a more integrated approach to preventing and even treating disease is often driven by this restrictive close-mindedness.

Recently, compounding pharmacies who offer healthcare providers and their patients tailored approaches to therapeutic compounds have come under attack. It is yet another example of rules and regulation strangling innovation in healthcare.

Many of us raised our eyebrows to read the headlines “Hospital Profits Rise When Surgical Complicatons Occur” in a recent Wall Street Journal article. How could the system of American exceptional healthcare actually award complications that imperil patient’s well-being as well as costs patients and their insurance carriers far more? The average revenue per patient was $18900. The average revenue per patient with complications was $49400. Click here to read further http://online.wsj.com/article/PR-CO-20130416-912453.html

Americans now face the intrusion of government bureaucracy into their healthcare. Those of us who have reveled in the exceptionalism of American healthcare find this a sobering change. The system was not perfect and much work needed to be done. Americans who voted with their pocketbook to use lifestyle based healthcare and healthcare providers who embraced and offered complementary and alternative therapies view with skepticism the government-run boards who will determine the one-size fits all approach to American healthcare in the coming years. Eliminating the most important driver of healthcare, the patient, is not a good thing. Patient responsibility and patient choice are integral parts of a system of American healthcare that functions well.

It makes me want to eat well, supplement wisely, get regular activity, and balance the stresses in my life. Staying well is my family’s approach to the healthcare of the future.