Yesterday I commented on the intriguing health care ‘value chain’, shown above, that Verna Allee’s group has constructed, seen from the perspective of Big Pharma. This perspective assumes that ‘the patient’ is basically helpless, passive, ignorant and uninterested in taking an active role in the management of his/her own health. That’s a very patronizing perspective, though I admit I know many patients who give it credence.
I would argue, however, that this is changing, and changing quickly. What is precipitating this change is:
Last week I contrasted, a bit simplistically, the traditional approach and the emerging ‘Edge’ approach to being healthy:
This emerging approach is entirely consistent with the recommendations of the US National Institute of Medicine’s 2001 Crossing the Quality Chasm report which laid out these ten ‘rules’ to govern effective health care:
So what would a health-care system ‘value network’ look like that honoured these rules? Certainly not like the one above. Here are two charts that show, first, how I think an increasing number of (cynical) patients see the ‘value network’ operating today, and then, below it, what a reformed health-care system ‘value network’ would/could/should look like:
The significant new ‘ingredient’ in the bottom chart, the Health Info ClearingHouse, is an example of what I have called a peer-to-peer information exchange. The ClearingHouse would be largely Internet-based (though also accessible through other media), not-for-profit, and not owned or controlled by anyone. It would aggregate and objectively assess health information provided by everyone in the system — customers (patients), doctors and other health-care providers, pharma companies, regulators and other government bodies etc. It would allow us to second-guess the hype we’re getting from for-profit providers and bureaucracies, get second opinions, and form support groups and share information and resources with other customers dealing with the same ailments.
Under this system, as in most countries today other than the US, Big Pharma would no longer be able to ‘push’ its drugs through the mass media (“despite these 147 side-effects, ask your doctor if new overpriced toxic XanthamPlus is right for you!”) nor would it be able to bribe doctors with ‘incentives’ to prescribe its brands.
The other big change would be in the relationship between doctors and other health-care providers and their customers (mere ‘patients’ no longer). The new relationship would be a continuous one, with factual information (data about customers’ health, analysis reports, new medical reports, etc.) being transmitted continuously between the customer and the health-care provider (perhaps even, as in some places in Japan now, automatically and electronically). The three-way information flows between customers, health-care providers and the ClearingHouse would enable the establishment of a co-developed ongoing personal program for every individual that would include (a) activities to prevent illnesses from occurring, (b) activities to self-diagnose illnesses in their very early stages, and (c) activities to treat illnesses when they occur. These would be joint activities with the customer actively engaged in the process.
Such a system is almost a no-brainer: it would generally result in a healthier populace and much lower costs to the system. But its evolution has been, and will continue to be, blocked by the special interests who would lose out in such a system: Big Pharma would find less need and market for its products, and its influence in the system would be drastically reduced. The HMOs, of course, would be out of business. Many of the lawyers who make their living on both sides of patient-health-care-provider litigation would also be out of business, since along with greater control over their own health, customers would also have to accept more responsibility, and not be able to hide behind ignorance and helplessness when suing doctors and drug companies. Doctors with God-complexes would not handle such a system well. Predatory snake-oil and wonder-therapy ‘alternative’ health-care providers would find themselves exposed by the ClearingHouse.
As you can see, then, there are plenty of reasons why the current dysfunctional system continues to squander our money and our health. And this is another complex system, that cannot be fixed by government fiat or by any group acting alone. We need to get to the system in the bottom chart above by evolutionary means. That evolution needs to start with bottom-up awareness, organization and information exchange, probably beginning with both (a) an insistence, when dealing with health-care providers, on complete two-way information exchange, total honesty and active customer involvement in all assessments and decisions, and (b) the establishment of the beginnings of what will eventually be the Health Information ClearingHouse. Instead of opting out of the system in favour of alternative medicine, we need to demand a greater role in our own health management from practitioners, and refuse to take no for an answer. My guess is that many practitioners will welcome rather than resist this change.
In other words, we need to become our own holistic ‘general practitioner’. We cannot expect doctors to know what is happening, and what we are doing, in alternative health-care and in our own lives, unless we tell them. We need to tell everyone we involve in our health what everyone else we involve is doing and saying and prescribing, and what we are doing about it. That means that what our doctor, our physical and/or psychotherapist, our herbalist, our pharmacist, our personal trainer, our dietitian knows, they all should know, and we should know not only what they have told us to do, but why, and what else they considered and ruled out.
And there, of course, is the rub. This requires more candour than a lot of us are willing to exhibit, and an investment in time and energy and learning that is more than many of us areprepared to make.
But until we do, the system will remain dysfunctional and insolvent. And we’ll keep getting needlessly ill.
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