To change something, build a new model that makes the existing model obsolete.
-R. Buckminster Fuller
For years government agencies and others have come up with plans to manage our food supply and what we eat in order to make us healthy. The result is obesity and the diabetes and heart, joint and other problems that result from it.
Along the way one of the things that seemed worth doing was giving citizens some information. Restaurant chains over a certain size were required to print on menus how many calories were in the meals. The behavior of customers in response now has been monitored. When customers can read the calories contained, on average they order about 50 calories less. For the average customer that will come out to between 3 and 7 pounds less weight gain per year. For easy math call it an average of 5 pounds per year. In 20 years that is 100 pounds.
For many 20-year-olds that is enough to mean they will not be obese when they are 60 like nearly every 60-year-old woman I know today is. And all it took was giving people the information necessary to make smart decisions.
Why do we not have such information about medicine?
Most of the time it is because no one knows. No one keeps track for us. If one surgeon in a hospital routinely injures patients with a certain procedure, there is no record of it anywhere, least of all in the records created by the surgeon, unless enough patients sue. Only one in some thousands of injured patients manage to get a lawyer. So it would be a rare situation for the problem to be discovered. And when it was discovered, the last thing anyone in medicine would do is warn future patients.
We can tell patients that most diagnoses are wrong, but no one knows which doctors are always wrong about certain problems and which are usually right. No one monitors it.
How often people are sickened or die from tainted drugs? No government agency tracks cases unless they’re linked to a major outbreak among hospital patients. So no one knows. No one is monitoring the outcomes for patients.
Patients are supposed to trust medicine to know what is best for them when medicine doesn’t even know what is worst.
Patients need to know. To protect its own interests, medicine needs not to know. When things go wrong in medicine, it almost never gets in the record. The worse the problem, the more likely it is to be covered up (see Medical Record Keeping). And medicine is resolutely in denial of what injured patients routinely find when they get their records.
The medical community will never be a good source for the information patients need to be safe. Fortunately, it has become possible for the patient community to monitor itself and overcome that.
The Problem
Nothing can make second parties with vested interests good governors of first parties, who have no ability to determine the odds of success or the price, while third parties decide whether and how much to pay for it.
(We are not talking about the 20% of medicine that is emergency medicine. That is the part of medicine that is like having a military or a coast guard. This is about the other 80%, the lion’s share that if handled properly also can reduce the size of what currently consumes 20%).
The only box in which anyone thinks about this problem is the one that imagines that there is no choice but to work inside the box in which first parties have no ability to determine the odds of success or the price, which is worse than trying to order in a restaurant without being able to determine the calories of the choices. In a century and half enforcement, education, micromanagement and all the other changing fashions in thought haven’t managed to result even in having providers wash their hands enough. It never will. It’s the wrong approach. It doesn’t address the fundamental problem.
A better focus would be to make it possible for the patient community to know what and where such problems are. If patients know where the problems are they can avoid them and let the problem areas in medicine respond by fixing themselves in order to get patients to come back, the way it is in other parts of our economy.
This can be done by gathering the information necessary to know what treatments are worthless, where the infectious death traps are, what bankrupts the most patients, which physicians cannot be trusted, etc.
This is information that cannot be collected by anyone in medicine. People with vested interests being the only source of the data never will be a good idea. The data must be collected from the outside by watching the patient community and how it fares depending on where patients have been.
In 20 years of millions of patients around the world being given metal on metal hip replacements, no one noticed the results of the toxic levels of cobalt patients got from them in their bloodstreams until a doctor became one of the victims. One of the mantras in medicine is “Don’t go looking for problems” and they don’t. The patient community needs to be able to expect the opposite from an entity with no conflicts of interest.
This is not “big data.” This is small counting – something no one in medicine ever will be objective enough to do, which is the hardest thing for anyone inside or outside of medicine to understand. And it is the first thing that must be understood to make patients safe. Government cannot do it either. Just look at how state medical boards handle the problems caused for patients in medicine (see osmb). Medicine votes and lobbies and protects its reputation. The patient community needs to be monitored by someone sharing their interests and doing that same thing for them, and making the results intelligible and providing it to them them so they can make safe decisions for themselves – the equivalent of providing which menu items have too many calories. Which facilities have too many bankruptcies or infections or post-surgical blood clot fatalities or overdoses or tainted drugs or patient complaints of sexual misconduct or records providing no evidence of obvious injuries? Currently, not only does no one keep track in your community. They cover it up. What goes wrong in medicine almost never gets in the record (see medical reporting) and it is the most important thing to know to be safe.
A more complete attempt at explaining this can be seen at Patient Agency link and myriad other pages on this site.
Solutions ……….|………. Problems
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……………………. | ………… Myth #1
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Patient Agency… | …………………….
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Nequamitis ……. | ……………………
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……………………. | Conflict/Interest
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……………………. | ………… Loyalty
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……………………. | ..Wall of Silence
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……………… …… | …….Blacklisting
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…………………… | ….Psych of Care
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…………………… | … Transparency
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…………………… | .. Charles Cullen
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…………………… | Orville L Majors
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…………………… | ……… Kayshyap
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…………………… | ………….. OSMB
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…………………… | ….. Semmelweis
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…………………… | . Benjamin Rush
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…………………… | …. Government
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Patients Boards. | ……………………
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Campaign … | ………………
“If we can get just 10% of people to be smart patients, it will change the system.” – Mehmet Oz, surgery professor.
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With regard to the institution of the medical industry, I suggest that we do what was done by Hippocrates, the founding father of medicine. It can be done only from an objective position outside of medicine. Otherwise we have done nothing but allow medicine to coopt the effort until it is only another pretense.
What Hippocrates did was get to know everything about his patients – the water supply at the patient’s residence, which direction the patient’s residence faced, which way the prevailing winds blew, the patient’s diet, family, blood, tears, sweat, etc. With data science we can do that again and look for what patients with similar conditions have in common. Like if in the last year, within the group of, say, 50,000 patients that you are monitoring, 6 are declining with symptoms that include dementia, blindness and heart failure and the one thing they have in common is metal on metal hip replacements.
Eat, think and be wary
How can patients be wary, or give informed consent, when they cannot even learn that the treatment being recommended has a history of poisoning patients?
For 20 years millions of patients around the world received metal on metal hip replacements that poisoned them with levels of cobalt that were toxic beyond what would be tolerated in industry. There were treatment providers who knew about the toxic levels in the blood, but who decided it would be all right. Decisions and policies in medicine frequently are based on nothing more that kind of than self-interest.
That is why no one monitors outcomes – self-interest. So no one checked to see if it actually was all right. It wasn’t. But for 20 years no one in medicine gave any of their patients information about that to help them make their “informed” decisions.
It is time that we began monitoring outcomes from outside of medicine so that they are not monitored by people who think that toxic levels of cobalt probably will be all right for patients.