Just as yesterday's longread looked at what the U.S. healthcare system can learn from an unlikely source -- chain restaurants -- today's longread examines what the vaunted U.S. system might learn from oft-maligned third world health systems. As this article argues, too often U.S. health care providers try to "reinvent the wheel" rather than taking small steps to advance individual and community health.
An interesting example that comes up in the article is people remembering to take their medications. Even in cancer treatment, this can be a real issue. One type of leukemia, CML, is typically very effectively treated with a drug called Gleevec. However, some patients relapse after initial positive response, and the most common cause is "poor adherence" -- a fancy way of saying people not taking their meds. Especially given the costs of prescriptions, many patients try to stretch medications by skipping doses or cutting pills in half. In other cases, people just forget. Whatever the reason, it is important to remember that no matter how much we spend on mapping genomes and conducting advanced drug development, it only matters if people do the seemingly simple things like take their pills.
This isn't to say that reminding people to take their pills will solve the problems of our healthcare system. But it is an indication that we may not always need massive reforms and overhauls to make significant improvements in the quality, efficiency, and costs of care in the U.S.
"What We Can Learn From Third-World Health Care" by Pauline Chen
Published in the New York Times, July 26, 2012
http://well.blogs.nytimes.com/2012/07/26/what-we-can-learn-from-third-world-health-care/
Note: Information on poor adherence for CML comes from the National Cancer Institute website, http://www.cancer.gov/cancertopics/pdq/treatment/childAML/HealthProfessional/page11
Eric
In the U.S., is there money put towards simplifying medicine and methods of recovery for the patient?
ReplyDeleteOr is the focus more on newest technology and research?
There is money that is spent toward those things. The government funds primary care health services in underserved communities and for underserved populations. There are also a number of different types of patient education programs and things of that nature. But a great deal is also spent on finding big technological breakthroughs or new drugs. Obviously, some of this is driven by financial imperatives -- profit is more easily obtained for a pharmaceutical company, for example, to pursue a big new research breakthrough so that they can patent a new drug.
ReplyDeleteEric
In other words, it's more about the proportion of the money spent and the priorities of the budget in health care.
DeleteIf you had 5 million dollars (is that even enough these days for research/dev in medicine?) to spend on something in medicine where would you put it after reading this article?
ReplyDelete$5M is way, way too little for most R&D. For example, in FY2010, the National Cancer Institute (NCI) spent over $2B just out research grants. That is only government money and only for cancer. It also doesn't include a great deal of research conducted at NCI (almost $1B) or through other R&D contracts and funding mechanisms (over $1B combined). So we're talking about tremendous sums that go into R&D. A lot of these are high-risk, high-reward research projects.
ReplyDeleteAs such, $5M would fall short before it had a chance to see a project through. That kind of amount would probably be much better served providing resources to existing health clinics that provide preventative care services (vaccinations, pap tests, etc.) and primary care, especially to people who are uninsured or under-insured.
All that said, I am totally unqualified to really answer this question. I just think it might be helpful to think outside the box by thinking about how smaller sums or smaller actions might be able to have significant returns without requiring major R&D breakthroughs or overhauls of the entire health care system.
Eric
Note: NCI funding info comes from here: http://www.cancer.gov/aboutnci/servingpeople/nci-budget-information/snapshot