Quote of the Day: Atul Gawande on the misalignment of money in medicine
"We can give up an antiquated set of priorities and shift our focus from rescue medicine to lifelong incremental care. Or we can leave millions of people to suffer and die from conditions that, increasingly, can be predicted and managed. This isn’t a bloodless policy choice; it’s a medical emergency.”
In his latest New Yorker piece, Gawande takes sharp aim at US medicine’s tendency to pour vast resources into episodic interventions, instead of investing in the plodding, incremental care that could save loads of money and lives.
Gawande says Republican plans to repeal the Affordable Care Act will exacerbate this fundamental problem. But the real fight, he says, should be over deeper inequities in how we prioritize and pay for care: “As an American surgeon, I have a battalion of people and millions of dollars of equipment on hand when I arrive in my operating room. Incrementalists are lucky if they can hire a nurse.”
From On Call’s inbox: A fiery response to RFK Jr.'s quote on vaccine safety
You responded vehemently to RFK Jr.’s comment last week that he would be leading a vaccine safety panel for Donald Trump because "there is a complete lack of other credible leaders on this particular issue.”
You were split on the need for a new body to examine the issue (we already have a similar committee
). You were, however, united in arguing that RFK Jr. is not the one to lead it. Here is a selection of your responses, edited for clarity and space:
Dr. Jack Shapiro:
RFK is a well known tort lawyer with absolutely no background in medicine or science. Putting him on a scientific panel to evaluate vaccines is absurd.
Dr. John Patrick:
Immunization programs have a critical place in the rubric of public health; they have saved millions of lives worldwide. Decisions regarding vaccine use are critically important, and should be in the hands of objective, reasoned decision makers. Mr. Kennedy is welcome to his opinions, but the hubris, lack of perspective and judgment displayed in his quote should alone disqualify him as an appropriate adjudicator of vaccine usage.
The fringe beliefs of RFK, Jr. do NOT belong in in ANY government agency! If President-elect Trump is interested in health issues, he should be appointing a surgeon general — a well known, respected, licensed medical doctor.
Cleveland Clinic CEO: This is why we use unconventional therapies
Dr. Toby Cosgrove is defending
alternative therapies offered by Cleveland Clinic’s Wellness Institute as a justified response to the nation’s epidemic of chronic disease. “The old way of combatting chronic disease hasn’t worked,” Cosgrove posted on the hospital’s web site. He added that alternative therapies such as acupuncture and Chinese herbal medicine have scientific backing and high demand from patients.
Cosgrove wrote the article in defense of the Wellness Institute, which faced scrutiny after its medical director, Dr. Daniel Neides, wrote a column that pushed the discredited link between vaccines and autism. Cosgrove has repeatedly disavowed Neides’ arguments, but says criticism of the institute was unwarranted.
On Twitter, the column got dozens of likes and retweets. And spawned debate:
A civil war is brewing over prescribing opioids
Two years ago, a record 27,000 people died in the US of opioid overdoses, prompting a crackdown by insurers and regulators on prescription painkillers such as Vicodin and OxyContin. Now a fierce struggle is emerging among physicians who are pushing down on both sides of that seesaw — on one side, limiting access to opioids could prevent addiction, but on the other, limiting access could hurt pain patients who need the relief in order to function.
STAT’s Bob Tedeschi spent some time recently in the middle of the fight, reporting on a lack of nuance and evidence in a debate that is nonetheless raging at top volume. Caught in the crossfire, of course, are desperate patients in need of effective care.