The Healthcare Crisis, Part One

February 26, 2009
Ravi Kulkarni

There is a big crisis in the health care system (some would like to call it sick care system). The prices are going up by 10-15% every year, and correspondingly the insurance premiums. There is a tuberculosis epidemic that is threatening to breakout anytime, even in the developed countries. The chronic diseases, such as cancer, diabetes, hypertension continue to plague us with no solution in sight. The pharmaceutical companies and the medical community have managed to find palliative measures that keep a patient alive for a long time, but there is no true cure for many health problems. Every new drug invented, every new procedure developed is costlier than the one before, but with few exceptions, most of them do not cure the patient. Instead they keep him or her dependent on the system for a long time, with attendant expenses and unwanted side effects. Even antibiotics which saved so many lives in the 20th century have become ineffective against increasingly virulent and resistant bugs.

Every spoke in the wheel of health has had its own role to play in creating the mess we find ourselves today. Let's start with the health care professionals. General physicians seldom get to spend enough time to understand an individual patient, his or her lifestyle or diet. More than 50% feel they are overworked. More often than not, it is a quick enumeration of symptoms and some lab tests and a prescription. Physicians are happy to prescribe antibiotics and other strong medications even when they are not strictly called for. The pediatricians are the worst offenders of overprescribing antibiotics. Majority of the cases do not even need them because the infections are viral. This not only creates super bugs, but also weakens the immunity of a child. My reasoning is simple – if you give a crutch to the body, the body stops making an effort to heal itself and comes to rely on the crutch. See this article on antibiotics. Specialists such as dentists and orthopedics doctors are even more culpable. Often they tend to treat individuals like mechanics treat your cars – the more repairs the better – for them. This is not to say that there are no ethical, sincere and loving doctors around. But often they become unwitting part of an establishment that is too hard to navigate and change.

Next come the insurance companies. They show no interest in ensuring that an individual gets proper health care. For them every medical expense is another expense and it is their stated goal to reduce this expense. For example, most insurance policies do not cover preventive measures such as multi vitamins or supplementation. Most policies won't cover the membership of a health club or give discounts if you are an active member. Most often they are not interested because the employers who provide the biggest chunk of insurance policies, keep changing the insurance companies frequently. Thus insurance companies have zero incentive in keeping an individual healthy.

Then come the pharmaceutical companies. While they have done some wonderful work in the past in developing life saving drugs, now they are in a rat race. Their credibility lies in tatters due to recent scandals. Peddling drugs that are of dubious efficacy, suppressing research that shows negative aspects of their drugs, bribing doctors to prescribe more medicines, encourage doctors to use the drugs off label, you name a perversion, they have indulged in it. The scandal goes on and on and with no end in sight. What is worse, there is hardly any liability for the individuals who consciously swindle the society. At the most they get a slap on their wrists.

This brings us to the fourth spoke – the regulator – FDA in America. For all practical purposes they do the bidding of the pharma companies. It is a revolving door at the FDA, often professors and researchers with deep connections to pharma industry head the FDA. While there is a process to certify and monitor drugs, FDA uses its big stick to beat back any attempt by alternative medicines to address a market need. In the States, no supplement or food producer can make a claim that his ware can cure anything. There are many such instances where a traditional (really traditional like an Ayurvedic preparation) can and does alleviate a certain condition, but they are not allowed by FDA to make that claim or at least FDA won't certify them. According to FDA, something is a drug only if it has gone through certified clinical study. No matter that these clinical studies are conducted by the interested parties, and that the traditional medicines have gone through millennia long trials. A lot of the funding for FDA comes from the pharma industry itself.

The final spoke is the consumer. This is where the biggest blame lies in the whole system. People tend to believe that a doctor knows everything. We are ultimately responsible for our own health – failure to recognize this simple truth often results in fatal consequences. People go to doctors with their mundane problems and accept prescriptions which are often not necessary. Doctors have become very defensive because of the ever hanging threat of malpractice lawsuits. So they will choose the strongest measure even when a wait and watch method will work just as well. We are too lazy to choose a careful diet that's suitable for our lifestyle, genes and body. We do not exercise enough. We eat and drink a lot of junk food. In the end is it any surprise that we are at the mercy of harsh chemicals and - at best - indifferent professionals?

In the second part of this article I will write about some of the methods we have adapted to ensure a healthy lifestyle.

Ravi is an IT professional with a penchant for philosophy, numbers, science fiction, chess, economics, hindustani classical music and... you get the picture. He has much to say, but not enough words to do it. He welcomes any criticism, sincere or otherwise, and will not take anything personally.
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Ravi Kulkarni
February 26, 2009
08:35 AM

Dear Aaman/Editors,

This article is on healthcare crisis as it applies mostly to the USA. I didn't intend it as Indian healthcare Crisis, though many of the same arguments probably apply there as well. I am not as current about Indian healthcare. Please should take "Indian" out of the title.



February 26, 2009
08:41 AM

Corrected, in future, please move to pending when ready and remember to first publish to Desicritics

Ashoka Chakra
February 26, 2009
06:50 PM

Well, Ravi and editors, I am in a fix. I wrote a series of articles for DC titled America's Health Care Crisis - and it is in part I, II, III, and IV. Should I submit or let it go? Some things are similar to what Ravi has written, but some are different.

Regarding the FDA, Ravi, I disagree with you. Being in the pharmaceutical industry, I can attest that they (the FDA) are fair and very tough. You have no idea how many drugs they have turned down - you only hear about the few high flying ones that get by. You are also wrong about alternative medicines - they are in fact encouraging me in one of my inventions that is based on alternative medicine (ayurvedic) by allowing me not to undertake any preliminary tests. You are also wrong about FDA funding - the PDUFA was enacted to increase the FDA budget so as to enable the FDA to hire more people to assess the drugs coming in, and it is a small part of their overall budget ($628 million out of $2.4 billion, or 25%).

In any case, editors, let me know if you want me to send my series.

Dan D.
February 26, 2009
07:05 PM

If the $634 Billion is any indication of Obama's health care plan, Obama is planning a radical change in the health care system. The plan has not yet been laid out and already Obama is earmarking more than half a trillion for it and explaining that it will just be the beginning of what will be necessary.

One of the reasons that health care seems to be so expensive (among many others) is the cost of research and development in order to procure new treatments and drugs.

At the moment the health care industry has a significant incentive to pour money into research and development because of the possibility of making money. What will happen when this incentive is marginalized when the government has taken over the health care system? Will our advancements slow down or even cease?


Ravi Kulkarni
February 27, 2009
06:12 AM

Dear Ashok Chakra,

I am not an editor at DC, but I don't see any harm in have two people expressing opinions on the same topic. So by all means...

Clearly, I do not have any inside information about how FDA works. My views are formed from observing how they behave from outside. Perhaps they are just inefficient. But from any of their actions it appears that they would rather take the side of the pharma companies rather than a consumer. See this latest news (http://www.washingtonpost.com/wp-dyn/content/article/2009/02/25/AR2009022501541.html) According to this news, they have not released the names of the drugs that are affected, thus leaving the public in the dark. They claim even though the company (Ranbaxy) falsified data, the drugs are safe. This action does not inspire the confidence that FDA is on my side.

I am glad that FDA is helping you in your case. All the best with your inventions.



Ravi Kulkarni
February 27, 2009
06:54 AM

Dear Dan,

"One of the reasons that health care seems to be so expensive (among many others) is the cost of research and development in order to procure new treatments and drugs."

I think the primary reason why health care is so expensive is that we do not do enough to prevent the illness from happening in the first place. The old adage "An ounce of prevention..." is really true. The consumerist society encourages us to eat and drink more, while the pharma industry will keep inventing toxic cocktails that are only palliative in nature. A pharma company is driven by profit motive just like everyone else. They will always try to maximize their profits. This has the following consequences:

- There is no incentive to promote medicines that are not patentable (such as turmeric a powerful ant inflammatory herb).

- There is no incentive to find cures.

- There is enough incentives to cut corners where possible.

Health care is a humanitarian concern. As the number of sick people increases, the burden on the society also increases. We need to find ways to provide universal health care that is affordable and effective. Private sector can not do it on its own. In my opinion, the govt can play a constructive role in the following:

- Educating the public about preventive measures (diet, exercise, lifestyle)

- Funding research into natural remedies that already exist in various systems (ayurveda, unani, homeopathy etc).

- Clinical trials for all new drugs

I know the last one is likely to be controversial. But there is not other way, because the private sector simply can't be trusted anymore.


Ravi Kulkarni

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