Health care is big money. The U.S. Bureau of Labor Statistics says that health care represents America’s largest industry, providing roughly 14 million jobs. The Bureau goes on to mention that seven of the 20 fastest growing occupations are health related. Here at Cornell, medical research is a huge deal, producing shiny new buildings like Weill Hall, and attracting top professors from around the country. And our top students have always been lured towards medicine as an attractive, stable, intellectually stimulating career option.
But question: Jobs and investments aside, is this approach to medicine effective? Does it produce a healthy, productive society in the most efficient way possible?
The argument runs as basic as they come: we’re dealing with human lives here, and only the very best treatments that money can buy will do! A two-year-old MRI machine won’t detect a brain defect quite as early as a 2010 model. Generic aspirin might be OK in socialized Britain, but if you really care about your darling Jimmy’s headache, you’ll buy him Bayer (tm). And any hospital that doesn’t build a new research wing every year or so has clearly not demonstrated a firm commitment to curing cancer.
But an economist knows the costs of this approach run far deeper than hospital bills and construction fees. There is an enormous opportunity cost to this tech-heavy approach to medicine. Income allocated towards expensive, brand-name medication is money that could have been spent on other aspects of general health. And for every new MRI machine, there goes the budget for a bright young post-doc who was interested in an avenue of medical research thus far unexplored.
Historically speaking, shoveling money into a single, homogeneous research industry is the worst way to discover something new and powerful. The biggest breakthroughs occur when least expected, during an experiment that no one thought would yield big results, in a corner of a lab whose primary interests are in a completely unrelated sub-field. From penicillin to the cosmic microwave background, big discoveries come from bizarre places.
But this approach to research can’t support the sort of big profits medical types thirst for. Thousands of researchers aimlessly wandering through academia may lead to a medical revolution, but it won’t guarantee profits for this quarter. So we stick to what works, seeking funding through proposals containing tried and true buzzwords. Millions in private donations and federal research grants come pouring in, and we create our expensive new drugs. If they don’t accomplish anything major, then maybe we’ll divert some of those assets towards a more effective marketing campaign. Whatever sells.
Of 2009’s top 10 highest paid academics, eight specialize in medicine or health. The two exceptions were USC’s football coach and Yale’s Chief Investment officer. Cornell’s own Zev Rosenwaks, down at Weill Medical College in New York, came in fifth. Rosenwaks’s total compensation (from our tuition dollars?) exceeded $3.1 million in 2009 — a full order of magnitude higher than President Skorton’s. Rosenwaks specializes in Reproductive Medicine and Fertility, similar to number 10 on the list, an OB/GYN at NYU. I should just screw physics and go into Obstetrics!
When millions in research grants are on the line, very smart people start to do very dumb things. In 2005, Seoul National University caught a professor falsifying data related to the successful cloning of human stem cells. Hwang Woo-Suk had doctored photographs to turn two successful data sets into 11. According to the BBC, Woo-Suk had recieved $40 million in research grants from The South Korean Ministry of Science and Technology alone.
This case is singular in its magnitude, but Photoshopped data certainly isn’t. Since 2002, when the Journal of Cell Biology first implemented tests for photo manipulation, they found a full 25 percent of all accepted manuscripts had at least one image in violation of the journal’s manipulation guidelines. One in 100 of these cases involved actual, proven fraud.
This ethical erosion does not simply occur at the pinnacle of celebrity scientific research. The American Medical Student Association recently graded medical schools on ethics. Harvard Medical School, the wet dream of premeds across our campus, received an F. The New York Times reported on a professor who served as a consultant for a whopping 10 pharmaceutical companies, including five makers of cholesterol drugs. The professor belittled a student who asked about the side effects of these drugs in his class. And the former dean sat on the board of a pharmaceutical company. Today, a coalition of 200 students and faculty at Harvard are pushing for ethical reforms.
When Cornell premeds go off to med school, they will be faced with myriad choices: Do I want to be a heart surgeon? A podiatrist? An oncologist? A pediatrician? These talented students have worked exceedingly hard to get to this point, and it’s only fair that they expect good compensation for all this effort. It’s thus reasonable that they follow the money. Open heart surgery is glamorous, and pays well: a tough field with high competition. But what America desperately needs right now are primary care physicians. Unfortunately, these low-paid, vanilla positions don’t seem to attract top Ivy League grads quite as much. Capitalism fail.
And about those primary care physicians ... In a recent NPR report, a doctor detailed the skewed education he received in med school. He complained that the advice was always to go for the very best treatments regardless of the costs. Today, after years of experience with low income patients, he knows better. He prescribes pills with double the concentration and instructs his patients to cut them in half, because this approach saves money. He advocates generic drugs and low cost options over expensive surgeries. He wishes med schools would do the same.
I was raised by two parents in medicine. My views on medicine are admittedly low tech. When I had a cold or fever, there were no antibiotic prescriptions or tasty new cherry-flavored gummy drugs. Just water. Lots of water. And Vicks Vapor Rub ... god, I hated that stuff!
There are lots of low tech methods to curb illness in America and prevent many surgeries. If high school teachers just made every student drink two full cups of water and wash their hands three times a day, we’d have fewer flu epidemics and (40 years later) fewer kidney transplants. But this kind of common sense approach to medicine doesn’t sell. Where are the shiny new research buildings? The tenured faculty? The peer-reviewed journals? The pharmaceutical companies? Only Poland Springs wins in the end, and they didn’t spend millions lobbying senators. How unfair!
Down on the Potomac, the health care industry has declared war on the Obama Administration and the majority of Americans who support a public health option. These folks are scared that when the Obama technocrats craft a health care policy, the addition of many cheap, holistic approaches to health care will hurt the billions flowing through their labs and offices. They fear that when the government-run program provides easy-to-digest facts on drugs and medicine, shoppers will begin reaching for CVS-Brand Cough Syrup or Ibuprofen. What’s good for American healthcare is not necessarily the same as what’s good for the American healthcare industry.
Munier Salem is a former Sun Assistant Design Editor and founded the Science section. He is a senior in the College of Engineering. He may be reached at firstname.lastname@example.org. Critical Mass appears alternate Mondays this semester.