Do you know that there’s not a pharmaceutical drug on earth that works for more than seventy percent of the population? Not one drug. Pharma companies consider a drug a success if it’s effective in a much smaller proportion of patients.
— Zia Haider Rahman
Thanks to Sanders and Warren, the Democratic debates are highlighting the huge inefficiencies and inequities in the way we pay for medicine in America. Health care in America costs twice as much per capita as other modern, industrialized countries, and our outcomes are worse than all of them [Harvard Gazette]
But even more important than changing the way we pay for medicine is changing the way we practice medicine, and this is a discussion that has been marginalized.
The gold standard for validating a treatment is the placebo-controlled double-blind study. If you practice medicine that is not based on PCDB studies, you can’t get third party payments and you can’t even get malpracctice insurance.
And yet, we know that PCDB studies are effective validation for only about half of a half of medicaal practice. We’re excluding ¾ of what we know to be effective.
“Placebo-controlled” means that we are focused on the body, not the mind. We are deliberately excluding anything that works through the mind from study, treating it as an annoying artifact in our scientific study. Medicine that works with the mind as well as the body can be twice as effective. Yet, medical employers assure that doctors’ calendars are so crowded that they have no time to develop a caring relationship with their patients. We make sure our doctors function only as diagnosticians and prescribers, confining them to the part of job that computer algorithms can actually do better. We forbid them to function as healers, or to bring empathy, intuition, and caring to their practice.
The structure of a PCDB study specifies uniformity. Every subject in the study receives the same treatment. We know that choosing the right treatment for each individual patient is half the story, and yet we are not even studying individualized medicine, let alone practicing it. Genetics, personality, and the microbiome make each patient unique; yet every medical intervention in use today has to be validated in a study that treats patients as if they were the same.
Medicine could be at least four times as effective for the same expense and effort, based on individualized medicine, and considering the mind together with the body. And this is in addition to the low-hanging opportunities to eliminate insurance overhead and administrative costs which are peculiarly American inefficiencies.