Saturday, October 25, 2008

The health care gap and the poor

My years in a medical library have left me with a bias and love for medical literature. I'm pretty much down to reading JAMA regularly (love the poetry, essays, editorials and book reviews), but I also visit a lot of web pages and have bcome dependent on googling the terms that confuse me (many). I have a growing concern alarm about the amount of money circulating to support research on research (i.e. the value and distribution of information) and/or research on social/political issues or conditions. When you look at the huge dollar amounts from NIH, corporations, pharmaceuticals or foundations or even various philanthropic runs or walks for the disease of the week, you see that so much of it never finds its way into the lab or the clinic. It never touches the virus, bug or neoplasm. It gets sifted and sorted and distributed to various versions of the medical community organizer--ACORN in a lab coat--for lack of a better term.

For example, let's just look at this simple phrase in a review of Metabolic syndrome and psychiatic illness by Scott D. Mendelson (2008) which appeared in JAMA, Oct. 15, p. 1824.
    Patients with chronic mental illnesses may not have access to regular medical care and may lead unhealthy lifestyles, and their physical conditions are often not diagnosed or treated in a timely fashion.
I can guarantee you there will be millions and millions of grant dollars heading out the door to chase "access" and "timely fashion," and not enough toward diagnosis and treatment. Further, there will be more millions wasted on "unhealthy lifestyles," primarily in the form of education, information, and hand wringing with endless lectures by the nearest relative--especially the mother! At the risk of sounding like a cold hearted wingnut as some of my readers call me (not realizing I'm a reformed humanist), I call that "peace and justice medicine." Science isn't advanced, people aren't healed, but liberals get a warm glow, a sense of doing something and a good salary.

Before you buy into peace and justice medicine, just look around at your own family or friends. Especially someone with very serious health concerns. You probably won't find lack of access or timely treatment (unless you're on a government plan, but that's another topic). You'll see that person's genes and jeans. What they inherited from the generations who came before them, and what they are doing with it now: eating too much, exercising too little, driving too fast, chasing too many rainbows, drinking too much, smoking or chewing tobacco, sleeping around, shooting up or sniffing, and hanging out with bad people. That about covers it.

There may be an insurance gap, gender gap or access gap for the mentally ill, but that isn't what made them ill. There may be some people who need cholesterol or high blood pressure medicine and don't get it because they bought groceries instead, but that's not what caused their high cholesterol. There may be men going to bath houses who don't know there is a drug out there for the disease they are about to plant inside the anus or mouth of another man, but it isn't ignorance or poverty that is causing their behavior.

More later. Time for the coffee shop and reading more book reviews in this excellent issue. I'm going to write P. Murali Doraiswamy, MD and tell him/her that was really an excellent review.

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