For the purposes of this article, the "ugly" are developments of the last decade that are mixed blessings; that is, depending on your point of view, you may see them as good or bad. They are not black and white. They are shades of gray.
At the root of the ugly is money, and the fact that all healthcare is tainted by money. In the United States we have a profit driven health system. It's not about health or care; it's about sickness and money.
Health insurance and the cost of care in general has become so expensive over the last decade that even middle-income Americans are hard-pressed to afford it. At the close of the decade, more than 47 million Americans have no way to pay for their healthcare, and as a result, emergency rooms are bursting at the seams, due to EMTALA (the anti-dumping law that says hospitals may not turn emergency patients away.)
The too-high costs of care have led to rationing of care, a new development in this decade. Patients are denied the tests and treatments their providers choose for them by the payers who must foot the bill. But the problem of rationing is a reaction to the fact that providers are reimbursed through fee for service, and that they feel they must cover themselves (defensive medicine) in case of lawsuits -- so they order too many tests and provide too much treatment.
In general the real problems of getting the right kind of diagnosis and care is a function of this profit driven medical system that does not allow patients and doctors enough time with each other. Communications have broken down in a big way, and smart patients know they must develop skills to over come drive-by doctoring.
We've looked at the downsides to a profit-driven healthcare system, those that have become more prominent during this decade, but there are plusses a money-focused system creates, too. Pharmaceutical companies, device companies, health insurers -- with profits as their goals, they develop products and services that are bigger and better than ever. In fact, the manufacturers and researchers they employ are responsible for developing some of the best advances of this decade - from drugs to machines and treatments that extend life. Without that possibility of profit, those companies would not invest in these improvements. It will be profit that compels the development of the personalized medicine that began this series of articles.
More mixed blessings come in the form of some of those new "miracle" treatments or preventions that are still unproven. Because profit is at the heart of their development, we don't know what their eventual outcomes will be because they are taken so quickly to market. Many of these forms of treatment were introduced during the past decade, but it will take another decade to know for sure what their long-term effects will be.
Lifestyle drugs, in particular, are examples of the "ugly." En masse, millions try to erase wrinkles with Botox or have better sex with Viagra, but we don't know that any of these drugs won't turn out to have consequences over the long term. Vioxx, which came to market at the turn of the millennium, was touted as THE answer for pain relief. Instead it turned out to be a killer for people with heart disease. Gardasil was introduced for young girls (and now boys) to prevent acquisition of the HPV virus, and in turn, to prevent one cause of cervical cancer. But many believe it's fast and furious rollout may have unintended consequences, too. Time will tell.
Empowered patients know to keep their ears and eyes open, and to be cautious about adoption of new drugs and treatments.
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A Decade of Patient Empowerment 2000 - 2009
