You seem to be writing expansively on a subject for which you have incomplete insight and express views that do not hold up against root cause analysis. Medicine in the United States is not a monolithic monopoly. People have a broad range of choices as to how they choose to manage their health. Fortunately, Government or Guilds provide some guidance in choosing paths which can lead to continued life and seek to avoid death and seek to minimize fraud. At its core, maintaining ones health is an art which can be guided by science or imagination in trying to determine what is effective. Acceptance of all medical treatment by those considered of sound mind is a personal choice.
We in the US can choose from Conventional Medicine (Western Medicine); Complementary and Alternative Medicine (CAM); Integrative Medicine; Homeopathy; Naturopathy among others. In 2023 Americans spent ~$45 billion or more on health supplements. Many of these are at best a placebo. Unfortunately access to any of these depends on ones economic status.
As you note, conventional medicine in the United States doesn't uniformly provide positive health outcomes, but that is a purposeful political choice. For example, maternal deaths and mortality rates by state per 100,000 live births range from 10-40 with a mean of 23. Tennessee where you now reside has the highest maternal death rate. For heart disease take a look at https://www.cdc.gov/nchs/pressroom/sosmap/heart_disease_mortality/heart_disease.htm
Statistically the leading causes of death in the US are currently: Heart Disease; Cancer; Unintentional Injuries; Stroke; Chronic Lower Respiratory Diseases; COVID-19; Alzheimer's Disease; Diabetes; Chronic Liver Disease and Cirrhosis; Kidney Disease. You can look at the rate of all of these by state.
And you end by asserting: If your doctor is permitted to kill you.... which is inflammatory but incorrect.
10 U.S. states and the District of Columbia now have laws that allow for medical aid in dying, also termed End of Life Option. No single physician is able to provide the chemicals and the decision remains with the individual to choose and they must be capable of ingesting themselves.
Thanks again for the extensive pushback! I'll try to correct a few misapprehensions about what I'm saying.
Am I writing on a topic for which I have incomplete insight? I expect so! I pretty much begin with the assumption that everyone has an incomplete insight on all topics, which is why discourse is so valuable. 🙂
On health care, my perspective may be of especial interest to people in the US since I lived most of my life in the UK, which has a radically different health care system, within which my wife worked as a nurse for most of her life. Indeed, she has worked as a nurse in both the US and the UK. This has given us both a very different perspective on both approaches, which have both common and distinct flaws.
(My wife's views do not entirely align with mine, incidentally - I really value our discussions over our disagreements in this regard! But we do agree about a lot of the core problems).
"Medicine in the United States is not a monolithic monopoly."
Aye, it is more of a oligopoly. Health insurance firms maintain high prices for so-called health care providers, who have no reason to object even though it leads to worse health outcomes. I have a whole side-line on this, but I'll save you from it for now. 😁
"As you note, conventional medicine in the United States doesn't uniformly provide positive health outcomes, but that is a purposeful political choice."
A fascinating perspective! What evidence do you have that individual political factors cause more health problems than iatrogenesis? Given the lack of interest in tracking data on iatrogenic harm in the United States how could we hope to resolve our disagreement here...?
I will certainly look for evidence of this alternative explanation now you've brought it to my attention. It would be hard-pressed to overcome the iatrogenic harms already evident, though.
"And you end by asserting: If your doctor is permitted to kill you.... which is inflammatory but incorrect."
I understand your objection - you think this piece is talking solely about the United States. I can see why what I wrote causes this miscomprehension. However, I mean to talk about global medicalised healthcare - the United States is only mentioned in the scope of a specific example (you can see this if you look back over my wording).
In Canada, Belgium, Portugal, Spain, Luxembourg, the Netherlands, Columbia, Ecuador, Australia, and New Zealand, physician-administrated euthanasia is legal. It is in the light of this significant change in medical practice that the final sentence is rendered.
Many thanks for your pushback! Always appreciated.
Thanks for this piece, Chris. Some fun observations here. I've often wondered if we didn't throw the baby out with the bathwater when we completely abandoned humours theory. Like all paradigms, there was some kernel of truth there, as much as there is to our present obsession with symptom suppression... which is rapidly falling by the wayside as we enter the deranged age of the asymptomatic and preventative medicine--with acceptable collateral injury and death. There's a primitivism that persists in modern medicine. Witch doctors are likely more honest. What's going on now is snake oil vending in the town square with impressive marketing and political skullduggery. I think I may have pointed out before that there's an episode of Star Trek in which Bones exclaims that he's a doctor dammit, not a scientist. So attitudes have changed.
Attitudes certainly have changed! I think we tend to be oblivious to just how drastically everything has changed in this regard.
"Witch doctors are likely more honest."
This is a provocative claim! I wonder if anyone is in a position to comment on this...? There must be some anthropologists who've walked this road...
Also interesting to hear some defence of the 'four humours'. I am neutral on these sort of things (the past frequently having important lessons for the present, after all), but most people have strong feelings of heresy, of course. I also think that the medicine one has been inculcated into tends to look like nonsense when viewed from the outside - I tried Chinese Traditional Medicine once, and was most interested about what it showed me about my own attitudes to medicine. It made me rethink a lot of things, and not because my health benefited from their approach.
"What's going on now is snake oil vending in the town square with impressive marketing and political skullduggery."
Aye, I cannot disagree. As such, I'd very much like to open the question of whether medical licensure isn't just a guild system propping up economic interests. If it isn't producing the outcomes claimed (and it's not) perhaps it's time for trying other approaches.
For me, the ultimate question is: why are placebo's not available for everything? They allegedly work for all ailments! 😁
Fortunately for all of us, most of our biology has evolved to be fault tolerant and self healing. We can continue to function with significant impairment. So the question always is are any health actions helping or hindering health status.
Perhaps you know about The Program in Placebo Studies and the Therapeutic Encounter (PiPS) , a Harvard-wide program that studies placebos.
So let me tell you a story told to me during a Red Sox game by Johnny Hoffman, Abbey Hoffman's father who ran a Medical Supply store in Worcester Mass.
A women came into his store looking to fill a prescription and save some money. The women left happily with the prescription. When she left, the clerk said to the pharmacist, how could you charge her so much for a Placebo. The Pharmacist said, "if I gave it to her for free, it wouldn't work...."
Yes, Witch Doctor's had their place in tribal societies but like in so many areas, humankind has made some progress....
On licensing. I appreciate the problem of creating a monopoly. But it's not like people didn't suffer or die from patent medicines and quack doctoring. Lack of regulation doesn't seem to create a panacea.
The issue of regulation is extremely pertinent here, because the failure of regulators (the MHRA in the UK renamed itself as a "facilitator" at one ill-advised point) is a part of the story. Since in most countries there is little to no legitimate regulatory process being practiced at the moment, this would seem to be a further mark against the status quo.
But as to your wider point: eliminating the state-endorsed monopoly on healers (such that all attempts at healing must be attempted by medical doctors) need not involve withdrawing regulation. You can still regulate which treatments are permitted, if this is what the citizens desire. Alternatively, you could buff up access to legal remedy, and achieve regulation tangentially through the threat of the courts (I don't favour this solution, but it is an option, especially in the US where class-action suits lower the barrier to access to legal remedy).
We have built an entirely imagined edifice on top of the actual practice of medical doctors, hospitals, as well as the numerous mega-industries surrounding and manipulating them. Until we're willing to look at this aspect of civil life honestly, we will continue to get further and further from healthy living. Sooner or later, something has to give! I think this a good time to be having discussions about our options.
Chris,
You seem to be writing expansively on a subject for which you have incomplete insight and express views that do not hold up against root cause analysis. Medicine in the United States is not a monolithic monopoly. People have a broad range of choices as to how they choose to manage their health. Fortunately, Government or Guilds provide some guidance in choosing paths which can lead to continued life and seek to avoid death and seek to minimize fraud. At its core, maintaining ones health is an art which can be guided by science or imagination in trying to determine what is effective. Acceptance of all medical treatment by those considered of sound mind is a personal choice.
We in the US can choose from Conventional Medicine (Western Medicine); Complementary and Alternative Medicine (CAM); Integrative Medicine; Homeopathy; Naturopathy among others. In 2023 Americans spent ~$45 billion or more on health supplements. Many of these are at best a placebo. Unfortunately access to any of these depends on ones economic status.
As you note, conventional medicine in the United States doesn't uniformly provide positive health outcomes, but that is a purposeful political choice. For example, maternal deaths and mortality rates by state per 100,000 live births range from 10-40 with a mean of 23. Tennessee where you now reside has the highest maternal death rate. For heart disease take a look at https://www.cdc.gov/nchs/pressroom/sosmap/heart_disease_mortality/heart_disease.htm
Statistically the leading causes of death in the US are currently: Heart Disease; Cancer; Unintentional Injuries; Stroke; Chronic Lower Respiratory Diseases; COVID-19; Alzheimer's Disease; Diabetes; Chronic Liver Disease and Cirrhosis; Kidney Disease. You can look at the rate of all of these by state.
https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm
And you end by asserting: If your doctor is permitted to kill you.... which is inflammatory but incorrect.
10 U.S. states and the District of Columbia now have laws that allow for medical aid in dying, also termed End of Life Option. No single physician is able to provide the chemicals and the decision remains with the individual to choose and they must be capable of ingesting themselves.
https://endoflifechoicesca.org/
https://compassionandchoices.org/resource/end-of-life-options-for-care-and-choice/
https://www.uclahealth.org/patient-resources/support-information/patient-education/california-end-life-option-act-eoloa
May you continue to provide stimulating perspectives in good health.
Hi Bob,
Thanks again for the extensive pushback! I'll try to correct a few misapprehensions about what I'm saying.
Am I writing on a topic for which I have incomplete insight? I expect so! I pretty much begin with the assumption that everyone has an incomplete insight on all topics, which is why discourse is so valuable. 🙂
On health care, my perspective may be of especial interest to people in the US since I lived most of my life in the UK, which has a radically different health care system, within which my wife worked as a nurse for most of her life. Indeed, she has worked as a nurse in both the US and the UK. This has given us both a very different perspective on both approaches, which have both common and distinct flaws.
(My wife's views do not entirely align with mine, incidentally - I really value our discussions over our disagreements in this regard! But we do agree about a lot of the core problems).
"Medicine in the United States is not a monolithic monopoly."
Aye, it is more of a oligopoly. Health insurance firms maintain high prices for so-called health care providers, who have no reason to object even though it leads to worse health outcomes. I have a whole side-line on this, but I'll save you from it for now. 😁
"As you note, conventional medicine in the United States doesn't uniformly provide positive health outcomes, but that is a purposeful political choice."
A fascinating perspective! What evidence do you have that individual political factors cause more health problems than iatrogenesis? Given the lack of interest in tracking data on iatrogenic harm in the United States how could we hope to resolve our disagreement here...?
I will certainly look for evidence of this alternative explanation now you've brought it to my attention. It would be hard-pressed to overcome the iatrogenic harms already evident, though.
"And you end by asserting: If your doctor is permitted to kill you.... which is inflammatory but incorrect."
I understand your objection - you think this piece is talking solely about the United States. I can see why what I wrote causes this miscomprehension. However, I mean to talk about global medicalised healthcare - the United States is only mentioned in the scope of a specific example (you can see this if you look back over my wording).
In Canada, Belgium, Portugal, Spain, Luxembourg, the Netherlands, Columbia, Ecuador, Australia, and New Zealand, physician-administrated euthanasia is legal. It is in the light of this significant change in medical practice that the final sentence is rendered.
Many thanks for your pushback! Always appreciated.
Chris.
Thanks for this piece, Chris. Some fun observations here. I've often wondered if we didn't throw the baby out with the bathwater when we completely abandoned humours theory. Like all paradigms, there was some kernel of truth there, as much as there is to our present obsession with symptom suppression... which is rapidly falling by the wayside as we enter the deranged age of the asymptomatic and preventative medicine--with acceptable collateral injury and death. There's a primitivism that persists in modern medicine. Witch doctors are likely more honest. What's going on now is snake oil vending in the town square with impressive marketing and political skullduggery. I think I may have pointed out before that there's an episode of Star Trek in which Bones exclaims that he's a doctor dammit, not a scientist. So attitudes have changed.
Hi Asa!
Attitudes certainly have changed! I think we tend to be oblivious to just how drastically everything has changed in this regard.
"Witch doctors are likely more honest."
This is a provocative claim! I wonder if anyone is in a position to comment on this...? There must be some anthropologists who've walked this road...
Also interesting to hear some defence of the 'four humours'. I am neutral on these sort of things (the past frequently having important lessons for the present, after all), but most people have strong feelings of heresy, of course. I also think that the medicine one has been inculcated into tends to look like nonsense when viewed from the outside - I tried Chinese Traditional Medicine once, and was most interested about what it showed me about my own attitudes to medicine. It made me rethink a lot of things, and not because my health benefited from their approach.
"What's going on now is snake oil vending in the town square with impressive marketing and political skullduggery."
Aye, I cannot disagree. As such, I'd very much like to open the question of whether medical licensure isn't just a guild system propping up economic interests. If it isn't producing the outcomes claimed (and it's not) perhaps it's time for trying other approaches.
For me, the ultimate question is: why are placebo's not available for everything? They allegedly work for all ailments! 😁
With unlimited love,
Chris.
Fortunately for all of us, most of our biology has evolved to be fault tolerant and self healing. We can continue to function with significant impairment. So the question always is are any health actions helping or hindering health status.
Perhaps you know about The Program in Placebo Studies and the Therapeutic Encounter (PiPS) , a Harvard-wide program that studies placebos.
https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect
So let me tell you a story told to me during a Red Sox game by Johnny Hoffman, Abbey Hoffman's father who ran a Medical Supply store in Worcester Mass.
A women came into his store looking to fill a prescription and save some money. The women left happily with the prescription. When she left, the clerk said to the pharmacist, how could you charge her so much for a Placebo. The Pharmacist said, "if I gave it to her for free, it wouldn't work...."
Yes, Witch Doctor's had their place in tribal societies but like in so many areas, humankind has made some progress....
On licensing. I appreciate the problem of creating a monopoly. But it's not like people didn't suffer or die from patent medicines and quack doctoring. Lack of regulation doesn't seem to create a panacea.
Hi Matt,
The issue of regulation is extremely pertinent here, because the failure of regulators (the MHRA in the UK renamed itself as a "facilitator" at one ill-advised point) is a part of the story. Since in most countries there is little to no legitimate regulatory process being practiced at the moment, this would seem to be a further mark against the status quo.
But as to your wider point: eliminating the state-endorsed monopoly on healers (such that all attempts at healing must be attempted by medical doctors) need not involve withdrawing regulation. You can still regulate which treatments are permitted, if this is what the citizens desire. Alternatively, you could buff up access to legal remedy, and achieve regulation tangentially through the threat of the courts (I don't favour this solution, but it is an option, especially in the US where class-action suits lower the barrier to access to legal remedy).
We have built an entirely imagined edifice on top of the actual practice of medical doctors, hospitals, as well as the numerous mega-industries surrounding and manipulating them. Until we're willing to look at this aspect of civil life honestly, we will continue to get further and further from healthy living. Sooner or later, something has to give! I think this a good time to be having discussions about our options.
Many thanks for commenting - appreciated!
Chris.