COMMENTARY

Is Healthcare Shaped by Industry? Of Course It Is

Disclosures

February 14, 2014

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Hello and welcome. I am Dr. George Lundberg and this is At Large at Medscape. How are providers or the healthcare system shaped by industry? As today's providers, we confront that question daily.

A better question might be, "Is there any way that American medicine is not shaped by industry?" Let me count the ways that it is.

The word "industry" has many dictionary definitions. One that I like is: "Industry is a manufacturing or technically productive enterprise in any field." Such as the gigantic hospital industry, which employs facility construction companies and, obviously, health insurance companies and medical equipment manufacturers.

Pharmaceutical companies are the prototype. Medical schools manufacture physicians. The biomedical research enterprise produces research results. The information technology industry creates hardware and software.

How about the knee arthroscopy industry? Billions per year. Or the industry that manufactures and places coronary stents for asymptomatic stable atherosclerosis? Many billions. Don't forget medical publishing, which both thrives on and shapes biomedical research and practices.

All of this is done in the rubric of "better patient care." A lot of these industries are sincere, like the for-profit companies I work with, CollabRx and WebMD. We truly believe that we are contributing to improved patient care and to the health of the public.

But pull back the curtain, and behind every statement from every other group named above you will find one message: Keep the money coming. They/we are all at the oh-so-still-full American healthcare money trough.

Uncontrolled, this whole medical industrial complex is a slashing tyrant, voracious in its eagerness to consume the economies of this and other countries. Rationally controlled, it could be a finely tuned instrument that efficiently delivers health and even a modicum of happiness.

Uncontrolled, or even poorly controlled, it delivers disease-mongering, such as the current "low T "debacle, making lots of money, helping few, and potentially hurting many. Or Prostate Cancer Awareness Week, raking in the dough by screening fearful old men with PSAs (prostate-specific antigen tests), hurting far more than it helps. Or fancy color photos in national magazines of beautiful, diverse doctors driving those surgical robots that cost more and may or may not deliver care as well as experienced hands. Or big expensive ads proclaiming, "My hospital is better than the institution across the street," merely competing for local market share and wasting your money doing so.

But back to the beginning, about industry. The old-prototype physician would not even have his little black bag with a thermometer and a sphygmomanometer if it had not been for industry being interested in medicine and manufacturing devices and drugs that would be useful, even essential, in medical practice.

We are stuck with much medical industry. Let's hope that the big players try to behave more like a part of the learned professionalism they service rather than as pure capitalists.

That's my opinion. I am Dr. George Lundberg, at large for Medscape.

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