When I first started my training in 1982, most of my classmates at the University of Chicago chose to go to medical school because of a personal commitment to help people, we thought of the patient first, and our training focused on the doctor patient relationship.
Over the last 40 years, I have seen the system deteriorate, with the erosion of the quality of health care by powerful corporations that lobbied for laws that served their financial interests instead of the people they were supposed to protect.
In the late 1980s, Managed Care was presented to the legislators as a better way to provide preventive care. The unsuspecting public, misled by their local and state governments, supported these changes- not knowing that they were actually designed to increase their own profits by slashing health care actually given to patients – and that’s what actually happened.
Why the widespread ignorance? Most doctors were already dependent on insurance companies for their income, and had no choice but to agree to contracts that prohibited them from recommending treatments based on their clinical judgement. Since about 1990, doctors could only discuss treatments that were “authorized” by the insurance company. These “gag clauses” as they were called, were later labeled “disclosures” – to soften their nefarious hidden intent.
But you may have noticed that since about 1992, whenever you called a doctor, or went to the ER, you were not asked the familiar questions, “What ails you? or “How soon do you need to see the doctor?” Now the first question is, “What kind of insurance do you have?” because the first priority is to make sure that the insurance company will have total control of what the doctor and hospital are allowed to do for you.
In the early 1990s, the pharmaceutical industry followed the example, in some cases hand in hand with the insurance companies with co-legislation to increase profits by cutting costs. They even lobbied Congress to allow direct advertising to the public on TV, again under the guise of “open public disclosure.” This led to another series of measures that were anything but honest. Patients come to me asking for Monoclonal antibody drugs they have seen advertised on TV, not knowing that those drugs can cause dangerous viral and parasitic infections, leukemia, and even aplastic anemia.
Mergers and acquisitions were another blow to the US healthcare system. Since the disruption of Antitrust laws in the late 1980s, large corporations have grown increasingly more powerful by taking over or “buying out” small companies. When I started hearing about drug company mergers that could lead to escalating drug costs, and loss of safety checks within the industry that were once effective in preventing dangerous drugs from being released by the FDA, I complained, but discovered that the Antitrust Division of the US Dept of Justice had become powerless.
From 1992 – 1998, I was in an FDA “Study Section” for several years, , which means I was on the committee to review testing of new drugs and determine whether they were safe for release. We could recommend additional studies, studies to include older patients with reduced renal function, patients on other common drugs that may interact, etc. One day at a committee meeting in Bethesda, one of the doctors announced that he had received a job offer from Wyeth Pharmaceuticals, which would pay a lot more than his G12 government salary. The question put before the committee was, should he be allowed to remain on the committee, or might this be a conflict of interest? There was a lot of discussion among the 12 members. In my youthful ignorance, I may have actually voted “yes” because I didn’t know any better. Well, that doctor did stay on, and within a few years there were 2 then 4 then 7 -8 – 9 -10 members with private industrial employment or “commissions”, and suddenly I was the only member of the 12 who was NOT in private industry. Needless to say, I was always outvoted, sometimes all 11-1, when I tried to stop a bad drug from being released. By 1998 I resigned from the committee, feeling guilty but powerless.
When I wrote to various Federal “oversight” agencies about dangerous drugs being released by the FDA, which was supposed to be a consumer protection agency, I received no response from the Department of Justice or even the FDA itself, I only received general denials on Drug Company letterhead. The FDA explained to me that the new policy was to “… leave it to the drug companies to respond to such complaints … To avoid any conflict of interest.” I was not convinced, but unfortunately, did not know where else to turn. The FDA was not the only government agency whose objectives were changed by privatization.
I tried one last time in my own home state when AB 487 (Assembly Bill 487) came up before the California State legislature. Drug companies lobbied heavily for this new Business and Professions Code law; in fact, they introduced the bill. The bill was written was to punish doctors who did not prescribe pain medications requested by patients. In effect, this law directed the Medical Board of California to sanction or suspend doctors if they prescribed over the counter or natural remedies for pain instead of Vicodin, Norco, Hydrocodone, Morphine, and other narcotic class pain medications. A small group of doctors and independent pharmacists accompanied me to Sacramento in an effort to oppose this bill, armed with medical articles about the dangers or opiate addiction to the individual and to the community, including permanent mental and physical side effects, unemployment, and homelessness. As expected, we were outshouted (and outspent) by the drug company and insurance company lobbyists, and the bill was passed in 2001. Sales of opiates and narcotics skyrocketed, and through the early 2000’s, the drug companies enjoyed great profits. … at the expense of thousands of lives and unmeasurable harm to the public.
What is really sad, is that doctors, hospitals, pharmacists and other health care providers know all this now, but they didn’t see it coming. Everyone talks about health care in the US approaching third world standards, but nobody is doing anything about it. Most doctors and even large medical groups are too deep under the control of huge corporations that monopolize all stages of health care. When you walk in to your neighborhood clinic, it may look the same, but if the first question is “What kind of insurance do you have?” you know that they can only help you as their parent corporation dictates.
You can browse the Internet now and find more than 10 years of publications with growing alarms predicting such a disaster. There is a huge body of documentation of insurance company decisions causing harm and death to patients who could have survived had they received treatment in other countries, even some third world countries like India, had better outcomes than we did during the CoVid pandemic because they distributed available medications that our FDA prohibited.
The real sadness is that so many people complained and were ignored (or ‘silenced”), that now doctors, patients, and pharmacists are afraid to speak up. Some of my colleagues tell me It’s too late and are simply leaving their jobs. You may have noticed that doctors around you are retiring at a younger age, and new doctors are passive to your concerns or even “invisible” when you try to find them after your programmed 10-minute appointment.
It is now up to the public to change this new status quo, and to a future generation of health care professionals to revive the mission and purpose of our profession.