We all experience ‘aha’ moments in life. That instant when a concept or solution you’d previously not grasped or fully understood suddenly becomes clear, and you nearly fall over from the realization that you finally understand something in a way that eluded you until then. It’s a great feeling although occasionally a harrowing one. Sometimes the clarity that comes after the moment is followed by a tinge of foolishness from having not seen the truth for so long.
I experienced my ‘aha’ moment about modern medicine a few months ago. I’d been working at the Lown Institute for a few months and thought I had a pretty sophisticated understanding of the way American health care works. After all, I’ve been working in health policy for 15 years—and then a combination of accumulating evidence and one big revelation made me realize something: A lot of modern medicine—yes, a lot of medicine—does things to patients that have little or no benefit, and it does so because someone is making money off it.
This is a startling and disturbing revelation. It’s fair to assume that some of medicine is done for profit. But we assume that most of the health care we receive is based on some combination of rigorous, peer reviewed research and the wise, careful counsel of experienced doctors. But that is simply not true. Most of the medicine we experience is done to us because we have a system that encourages clinicians to do things to us even when there is no clear benefit.
Because like any other business enterprise, the health care system needs to sustain itself. Patients are customers, and they are being sold a service. The system is set up to deliver as much service as the customer will consume. Routine tests, procedures and treatments are ordered because somewhere, perhaps decades ago, a medical company or a specialty society determined that this test, procedure or treatment was BOTH profitable and arguably helpful to the patient. But these are not treated as equal factors. The profitability of the medical intervention must be significant for it to be sustained over time while the helpfulness to the patient can be marginal and is not necessarily reassessed every few years. As long as it is still profitable for someone along the health care food chain, it will likely continue to be used.
The health care system is made up of millions of caring individuals who likely chose medicine as their profession because they care about people. Then they are pulled into a system that purports to use science, evidence and judgment to deliver care but is really built on the same model of service and sales as any car dealership.
My ‘aha’ moment came when I realized that a lot of the health care we are receiving is determined not by evidence and scientific rigor but by the need to perform transactions that keep the health care industry financially viable. And this monumental waste of money and resources is sapping funds from what patients and citizens really need, which are healthy communities—safe neighborhoods with sidewalks conducive to walking; fresh, accessible local produce; improved water and air quality; bike lanes and better public transit. For too long, these elements of what make up a healthy lifestyle have been marginalized.
On March 8-11 in San Diego, California hundreds of doctors, nurses, researchers and health policy experts will gather at the 2015 Lown Institute Conference, The Road to RightCare. Many of them have probably experienced their ‘aha’ moment about modern health care—that’s why they are there! But I expect a few will have a moment where they slap the side of their head and say, “Wow! Now I get it.” Together, we’ll discuss the issues of overuse and underuse facing our nation, and hopefully, we’ll find ways to finally address it.