|By Dr. B. M. Hegde, India [ Published Date: August 15, 2006 ]|
Dr. B. M. Hegde MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS, is presently the Chairman of State Health Society, Govt. of Bihar, India, Visiting Prof. Cardiology at The Middlesex Hospital Medical School - University of London, Affiliate Prof. of Human Health - Northern Colorado University, Visiting Prof. Indian Institute of Advanced Studies - Shimla, Retd. Vice Chancellor, MAHE University - Manipal. Prof Hedge regularly gives talks on AIR, Doordarshan, BBC and Zee TV, London.
"What we really mean by originality is the modification of ideas." -- Zora Louis Stevenson.
This is a neologism like democracy, plutocracy, aristocracy, monarchy, and other isms like communism, capitalism, socialism et cetera. Corporatocracy is a close cousin of aristocracy. In all the above cracies the essential ingredient, humanocracy-the good of the people at large- is missing. All of those systems have failed us but each one had the Gee phase when everyone got on to its bandwagon soon followed by the realisation that all is not well with the system and the whole thing was condemned like poison. May be much later it flattens a bit and people start analysing the good and the bad of the system. India is passing through the Gee phase of corporatocracy. The government is bending over backwards to please the corporate sharks. The media goes to town even if one of them coughs. They easily get nominated for the "Man of the Year" award. In India the opinion making "intellectuals" praise the system. The bad news is that some of those corporate giants are now eyeing the so called "health care" system to invest their excess wealth to make large profits that probably do not accrue in any other sector of the economy.
In fact, what they are viewing is the "health scare system" where human health is the first casualty. For huge profits the system tries to medicalise human life by inventing new diseases in apparently healthy individuals, scaring the public, to net more and more people into the system. This results in a very rich harvest. Hospitals have become a menace to the common man in the west. A couple of them in the US had recently been closed by the FBI for overdoing cardiac interventions to the tune of 84% unnecessary bypass surgeries! Cardiac interventions today are the biggest till-movers in the corporate hospitals and for good reasons. When they have invested, say, fifty crores to set up a modern surgical and medical cardiac lab. they expect at least the interest on it to come back with all the expenses added. This works out to at least four "bakras" every day to intervene. So very one with enough means who walks in there looks like an ideal patient for intervention.
Today's so called "health care" system that cares for everything except your health, therefore, is good business. Business is for profit. Corporate hospitals set targets for their doctors to achieve. That also pushes more and more individuals as deserving patients for intervention. A man/woman who sees a doctor in this setting becomes a patient; rarely ever, if ever, to become a healthy man/woman again. I could let a secret out to the corporate hospitals that if they bought a Total Body Scanner for their hospital they could be assured of a constant supply of patients. Everyone that goes through this machine will be declared abnormal needing some intervention or the other. Nothing could beat that for making money as the whole world population of six billion could be potential patients! India, with its hype on "health" tourism would be the biggest beneficiary! Are the Finance and Tourism Ministries listening? This news would make their day.
In this system the doctors do get financial incentives in addition. Referring family doctors also get their share of the booty. So every one is happy with the system as it is except the hapless patient who does not know what he/she is in for in the system. This system is called the industrial age medicine, where doctors practice paternalism. In the west it is slowly changing to a new system called information age medicine, where doctors and patients are equal partners in medical care. This has come about after repeated audits showed medical interventions and adverse drug reactions to be first cause of death in the US followed by cancer and heart attacks in that order.
There is an editorial asking for more generalists in the UK system in this week's British Medical Journal. Latest issue of Texas Heart Journal, a leading American heart journal, has two editorials on similar topics. The first one, hyposkillia, is lamenting on the lack of bedside skills in American specialists resulting in higher mortality and morbidity due to unnecessary interventions, and the second one on The stethoscope song written in the last Century by the great American doctor and novelist Oliver Wendell Holmes Sr. urging cardiologists to rely more on their stethoscopes to make bedside diagnoses in the midst of the array of scopes, scanners and angiograms! In a recent meeting of the American College of Cardiology, the key note talk, by a great teacher of teachers at the Morgan State University, Proctor Harvey, was on how to auscultate the heart, a lesson normally taught to first year students in the Med. School.
We Indians are a wise lot. We want to learn everything by committing our own mistakes. We do not want to be wiser to learn from other's mistakes as life is too short to make all the mistakes and learn from them. Until and unless the lowest of the low get the bare minimum needs of existence there is no meaning in talking about equitable health care. In fact, the present gulf between the rich and the poor even in the US is the largest in the history of that country. More than two thirds of the world population, nearly four billion people, gets an average of less than $200 per year. The poor all over the world pay for their poverty with their lives; poverty is the mother of all illnesses. Oppression, suppression and denial breed criminals and terrorists in addition, a health risk for the rich!
It is the equal opportunity, the real level playing ground that is lacking. "The most important difference between laissez faire and non- linear economics is that laissez faire assures us of a stable and benign economic equilibrium. If that balance is slightly tilted it would come back to its original form eventually. By contrast, non-linear economics shows that the equilibrium could be unstable," wrote Kenneth Freidman in his classic The Myths of Free Market. The rich-poor gap might grow exponentially and bring on catastrophic results at the end! Health care depends on equal opportunities and trying to bridge the gap between the rich and the poor. Even the recent World Bank report showed that both in Cambodia and Gujarat, in India, the poor got a better deal thanks to NGOs. The governmental efforts or the efforts of corporate medicine had nothing to do with the improved lot of the poor in both those instances!
Indian masses in the villages and city slums are under nourished. The sanitary levels are so bad that a recent survey in India showed that 70% of Indian kids had only less than 50% hemoglobin, thanks to the ubiquitous hookworms. There are enough vaccines to prevent some of the childhood killer diseases. If a child has such bad nutrition how could we expect that child to produce enough anti-bodies to get protected from any illness, vaccination notwithstanding? Again our efforts in that direction only help the multinational vaccine manufacturers and not the recipients. The Patents Bill, recently passed by the Indian Parliament, to get a pat from the WTO, will, I hope, not make matters worse for the poor. Essential drugs will be beyond their reach.
To get at the bottom of the problem and get at the truth one has to read the following book. The New York Times book review section puts this book on their best seller list. The blurb tells the reader that it is CONFESSIONS OF AN ECONOMIC HIT MAN (John Perkins), a former employee of an International consulting firm, published by Barrett- Koehler. John talks about the corporatocracy. The book gives the reader an insider's view of the "business" of the rich and the powerful. It also shows the real face of poverty and illnesses. Japan, with most number of generalists and very few specialists in addition to having the lowest doctor patient ration among the fourteen developed countries audited recently had the highest longevity and best health status for their people while United States with the highest number of specialists and very few family practitioners was last but one at the 13th place with Germany at the bottom.
This should teach India a lesson for the future and should discourage well meaning (if there is any) corporate giants to keep away from hospital business. Hippocrates wrote in the first Century BC that "one should not try to make money in the sick room." How true? Corporatocracy is a new addition to the list human woes. Long live human kind on this planet bereft of all cracies except humanocracy (economic humanism). The world still is round with less than five percent of the population sitting on the top holding 95% of the wealth and the rest hanging on without knowing where their next meal comes from. The Mathew Law still works in this world. "He who hath shall be given". While the rich sit on the top, the poorest of the poor regularly drop down from below to the bottomless pit to perish for ever due to hunger, malnourishment and disease. Even Nature seems to be cruel to the poor. Tsunamis, Katrinas, Wilmas, earthquakes and floods seem to love the poor. "The meaning of good and bad, of better or worse, is simply helping or hurting."
"Whosoever would be a man must be a non-conformist." -- Ralph Waldo Emerson.