Lest we forget that medicine is also part art, as well as part science, I have included a lengthy passage from Gloria Yu’s (from Hong Kong) paper on Traditional Chinese Medicine (TCM)

 Chinese have a unique system of categorizing illnesses.  The philosophy behind TCM is that man lives between heaven and earth, and comprises a miniature universe in himself.  The material of which living things are made is considered to belong to “Yin,” or female, passive, receding aspect of nature.  The life functions of living things, on the other hand, are considered to belong to “Yang,” or masculine, active, advancing aspect.  The core concept of TCM is based on such organic balance between “Yin” and “Yang.”  In this perspective, human health should be treated as a science of systems that are always changing, but all together-cooperative phenomena.  There is no division of body and mind; they are viewed as a whole.  The passage of the seasons, changes in weather and the environment will have an impact on both the body and the mind at the same time.  Thus, good health results from a balance between Yin and Yang, whereas poor health is a sign of unbalanced Yin and Yang.  Keeping the Yin and Yang in balance, therefore, is a major task of TCM.

 On the other hand, if mood changes within the individual, such as happiness, anger, worry, pensiveness, grief, fear, and surprise are too extreme, they will also harm the health.  In TCM, the external disease-causing factors, interacting with the emotions, form the theoretical foundation of disease pathology.  TCM practitioners use this foundation together with the illness of the patient to analyze the overall physical and psychological loss of balance.  Based on this analysis, the doctor can prescribe a method to correct the imbalance.  Hence, the object of Chinese medicine is the person, not just the illness.  The illness is only one manifestation of an imbalance that exists in the entire person.

 The same principles described above are also applied to assess the patient’s living environment, his life rhythms, the foods he prefers or avoid, his personal relationships, and his language and gestures, as a tool in better understanding his illness, and suggesting improvements in various areas.  Once the imbalances or excesses are pinpointed, they can be adjusted, and physical and mental health and balance restored.  This attainment of equilibrium in the body’s flow of energy [“Jing” (vitality) and “Qi”] is the ultimate balance of “Yin” and “Yang.”

 Recent studies show that the insertion of needles at certain points enables some parts of the brain to release certain chemical substances, which, in turn, inhibit pain sensation.  As a result, the pain is relieved or even disappears.  The released chemical substances have been purified and some of them are mainly the natural substances resembling morphine called enkephalins.  These findings strongly suggest that acupuncture can reduce pain.

Successful research was also done on the Chinese anti-malarial drug “qing hao su.”  In 1971, it was found to have specific antimalarial activity and the active compound artemesin was isolated.  In clinical trials, parasite clearance times are shorter than with chloroquine, symptoms responded more rapidly, and there was no serious toxicity.  Today, artemesin is widely accepted as an effective treatment for malaria.  The WHO calls it the best hope for a malaria cure.  A cocktail combining artemesin with another drug is being produced by Novartis under the name Coartem.

 —    Gloria W.L. Yu,

 Traditional Chinese Medicine –

A Framework for Maximizing Benefits and Minimizing Costs

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Dr. Reinhardt, with tongue firmly in cheek, said that Europeans often comment on the healthcare expectations of U.S. patients, noting that “Americans are the only people who think death is optional.”

 …[C]apitation has fierce opponents.  Perhaps the greatest criticism of primary physician capitation is society’s fear of physicians withholding care from patients in order to better their financial position.  Indeed, the financial incentives on physicians are now reversed.  Instead of the general incentives of fee-for-service medicine to perform more services and procedures, capitated arrangements now exert financial pressure to do less.  These pressures affect every aspect of the doctor-patient relationship: how doctors and patients choose each other, how many patients a doctor accepts, how much time he or she spends with them, what diagnostic tests the doctor orders, what referrals the doctor makes, what procedures to perform, which of several potentially beneficial therapies to administer, which of several potentially effective drugs to prescribe, whether to hospitalize a patient, when to discharge a patient, and when to give up on a patient with severe illness (Stone, 1977).

 “When wealth is lost, nothing is lost; when health is lost, something is lost; when character is lost, all is lost.” (Billy Graham)

— Kevin Gish,

Is Capitation the Answer?

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. . . Medicare, Medicaid and attorney general’s offices had found evidence of abuse of inpatient psychiatric hospitalization as some healthcare systems actually sought out patients who could be gathered up and hospitalized in order to increase revenue (Pierre Rioux, M.D., personal communication, June 22, 2002).

 Nevertheless, since trends in mental health spending show that one of the fastest rising expenses for mental health services has been outpatient prescription drugs, this is the next area of attack by payers despite the fact that the newer psychotropic medications have been the reason that inpatient utilization has decreased (Pierre Rioux, M.D., personal communication, June 22, 2002).

— [LWH1] Kirk Mueller,

Psychotropic Medications and Their Cost

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A study published in the June 2002 issue of The American Journal of Public Health concluded that the tobacco industry youth anti-smoking programs are designed to promote the industry.

 According to the July 1, 2002, Time Magazine, “No state has been quite so brazen in distorting the purpose of the settlement money as tobacco-producing North Carolina, which has directed only 1.2% of tobacco settlement revenues to smoking prevention.”  Incredibly, $400,000 of settlement money is being spent in Rural Nash County for water and sewer engineering to attract a tobacco-processing plant.  “The tobacco settlement money is going full circle here,” says Don Carrington of a state-government watchdog group. 

 In effect, the states negotiated themselves into an inherent conflict of interest: Because the states’ share of the settlement is based on cigarette sales, each time someone kicks the habit, the settlement share goes down.                                                                

 —Wanda Webb,

 Smoke and Mirrors:

A Reflection on the Tobacco Settlement Agreement

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Senator Chuck Hagel (Republican), Nebraska’s senior United States Senator, testified in 1999 before a Senate committee and said, “In most cases, rural hospitals, community health centers, and rural health clinics are the only primary source of health care services for hundreds of miles.  When they are forced to close their doors, the impact on the community they once served can be devastating – not only on the health and well-being of its citizen – but also for the community’s economic growth and prosperity.  Without ready access to quality primary healthcare . . ., these communities will have a difficult time attracting any new businesses or manufacturing, or keeping their young people in the community.”

 Cordes also contends that rural healthcare keeps dollars in the local economy that otherwise are spent in larger communities, depriving the local economy of needed funds.  Communities tend to think of opportunities other than healthcare when it comes to economic development.  A community will roll out the red carpet and make an investment pitch to a new manufacturer, but won’t typically even consider providing the needed resources to recruit a new physician that might “spin off” twenty-two jobs.

— Todd Consbruck,

Critical Access Hospitals – Critical to Nebraska

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 Three years after the arrival of casinos, Atlantic City rose from 50th to 1st in the nation among cities in per capita crime. 

 In Ledyard, Connecticut, home of the nation’s richest casino, rape, robbery, car theft and larceny all increased more than 400% in the three years after Foxwoods opened.

— Ronald Reno, as quoted by Peggy Schram,

The Social Costs of Problem and Pathological Gambling

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 The National Cancer Institute cautions, “The potential benefits of a negative result include a sense of relief and elimination of the need for special preventive checkups, tests or surgeries” (2002, p. 6).  However, a positive result does not guarantee a person will obtain cancer either; it only identifies certain mutated genes passed on from your parents.  USA Today reports, “Scandinavian researchers concluded that genes account for 42% of the risk of prostate cancer, 35% for colorectal cancer, and 27% for breast cancer” Genes cause more, 2002).  Leslie Alexandre, Vice President for Oncormen, Inc., feels, “There is no benefit to the general population.  These are not screening tests and, frankly, are a disservice to families without a history of cancer, given how little we know on what it means to carry a mutation when you don’t have cancer” (American Cancer Society, 1998, p.1).

 A European study completed in June of 2000 showed that 60% of the women who carried the mutated BRCA1 or BRCA2 genes chose to have their ovaries removed.  Of this group who tested positive for the mutated gene, 51% chose to have preventive mastectomies (American Cancer Society, 2000).  This study demonstrates that individuals are willing to undergo significant medical procedures, even though removal does not guarantee that cancer will not develop, in an effort to decrease the possibility of developing cancer.  They based their decisions upon the results of their genetic information and the genetic counseling that they received from their physicians.  The American Civil Liberties Union states, “Most health care providers do not have training in genetics, and many who order genetic tests may not know how to interpret the results” (2002, p. 1.)

 —Dave Pfeifer,

Setting the Boundaries for Genetic Testing

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 It has been estimated that survival after breast cancer increased by four months (whereas) average cost to treat breast cancer rose about $20,000 (Cutler, 2001).

 An Institute of Medicine study (Osterweis, 1951) concluded that lumbar spine surgery is overused and misused in the United States, and the wide use of imaging studies may be the driver of this excess us e(Cutler, 2001).

—    Lawrence Tan Thuan Heng,

The Impact of Medical Technology on Healthcare Today

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Reported Disadvantages of Medical Savings Accounts:

 “Risk comes from not knowing what you’re doing.” (Warren Buffet)

 “If you are healthy or if you make a lot of money, it’s a great plan.  But if things start to go wrong and you don’t have a high income, it’s not.” (Julie Griswold, an MSA enrollee commenting in the July 7, 1998 New York Times on her experience with an MSA after incurring $4,000 in unexpected personal expenses.)

 — Rod Nordeng,

Medical Savings Accounts

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Illegible prescription writing, resulting in the wrong drug or the wrong dose, is the most common cause of the more than one million serious medication errors that occur every year in U.S. hospitals, followed closely by overlooked drug interactions and allergies (Birkmeyer, Birkmeyer, Wennberg & Young).

—Tess Settergren,

Economics and Ethics of Computerized Physician Order Entry

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Birkmeyer et al. (1999) also found that surgical mortality was four-fold higher in lower volume hospitals as in high-volume hospitals (for ten different procedures).

 — Cris Gilb,

Leapfrog: Industry vs. Healthcare

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