While listening to a Minnesota Public Radio discussion today on anti-bacterial drugs (no link available, but it was the Kerri Miller show) (the bad news: new antibiotics are not under development) (the badder news: antibiotics of last resort are becoming ineffective against drug-resistant bugs), it occurred to me that the invasion of private sector practices into the health sector has somewhat twisted the purpose of the health sector.
To an extent, it’s inevitable, because the health sector has a dependency on two elements: process, the procedures used by medical personnel to diagnose and treat patients; and things, such as drugs, surgical tools, and the like. The latter class could be supplied by entities entirely within the health sector, but they are not. This is a mixed bag: entities not subject to market forces are not forced to develop efficient procedures with respect, and for those talented individuals motivated by wealth might not choose to provide their talents to such an entity, to the communal loss of the patients. But the impingement and, perhaps more accurately, dominance of private sector practices with respect to the development and delivery of medicine has its well known deleterious effects: the sudden hiking of the price for Daraprim, and the lack of interest in developing new antibiotics are two of the most obvious problems; less salient, yet perhaps more important, is the perception of a sizable portion of non-medical personnel that the medical community really only exists to parasitize the citizenry while the citizens are blind to a cornucopia of simple cures for all sorts of problems, from carrot juice to acupuncture. This latter point induces ill persons to waste critical time on homeopathy and other failed approaches, all the while convinced the people most able to help them really only wish to relieve them of their cash. Such is the bane of a culture dominated by the superstition and ignorance.
But there is worse news descending from this dilution of the medical sector’s operationalities: the marketing of drugs to the general citizenry, the suggestion that drugs are necessary even for minor ailments, is exerting an evolutionary pressure on the pathogens, and they are responding by becoming immune to the drugs of the day – and, as noted, because it’s not profitable to develop antibiotics, we do not have a new generation in the pipeline.
Because we are a social species (or so I’m told), communicable illness doesn’t affect just the guy across town, or the kid in Altoona – but all of us, potentially. We’re not islands, nor can we control the communications medium of pathogens all that easily in many cases – and even those we think we have under control can prove slippery. But the activities of the private sector ignore or even contradict these realities of the medical sector – each person’s individuality is sought out, their separateness from others, and their capacity to spend the fruits of their labors on the things produced by the private sector.
In contexts where these assumptions are true, the private sector does an admirable job of fulfilling its function. But when it dominates an area where these assumptions are not true, then we see tension. Pollution control is a common example; the examples from the medical sector are not as familiar, to which we may need to adjust – perhaps by rescinding the FDA decision permitting direct to consumer advertising (DTCA)1 by drug companies. No doubt more compromises and/or approaches will be necessary, as we explore how to make these two sectors work together to efficiently treat the citizens’ health.
Because, without recognizing these differences, we will continue to see the supply of drugs become uneven and, possibly, dangerous to our very health. Private sector advocates will claim the demand for these drugs will result in their supply, yet the reality contradicts them; nor are they simply widgets to be built, but the results of research (which reminds me of yet another tension, wherein business people want reliable schedules, while folks who are actively researching, whether it be biomedical or, in my case, just developing new software, can find it difficult to hit a schedule while maintaining quality). Yet, this is not to advocate that the medical industry take over development of drugs and devices on some sort of non-profit basis. It’s not clear to me how to crack this nut.
1 See this publication from Milbank Quarterly for a scholarly look at the issue. The suggestion of a difference between patients and consumers highlight the problems of using a sector’s terminology in another sector, as it brings expectations that are not necessarily appropriate. A similar discussion of the difference between students and consumers has been on my mind of late.
