PEOPLE AND HEALTH CARE USA
By Corwin McIntyreAuthorHouse
Copyright © 2009 Corwin McIntyre RPh
All right reserved.ISBN: 978-1-4389-9926-5Contents
ACKNOWLEDGMENTS.............................................viiPREFACE.....................................................ixCHAPTER ONE: HISTORY........................................1CHAPTER TWO: GREED..........................................7CHAPTER THREE: ETHICS.......................................13CHAPTER FOUR: ACTION AND REACTION...........................33CHAPTER FIVE: FACING REALITY................................41CHAPTER SIX: HEALTH CARE....................................47CHAPTER SEVEN: POLITICAL INVOLVEMENT........................55CHAPTER EIGHT: NOW..........................................69CHAPTER NINE: "WHAT IF".....................................89CHAPTER TEN: WHAT'S IT ALL ABOUT............................97CHAPTER ELEVEN: WHAT IF AGAIN...............................119CHAPTER TWELVE: MONEY TALKS.................................127MEDICAL EXPOS: EPILOG......................................141CHAPTER FOURTEEN: TIME MARCHES ON...........................143CHAPTER FIFTEEN: NATIONAL MEDICAL TRUST.....................149CHAPTER SIXTEEN: PEOPLE AND TAXES...........................157CHAPTER SEVENTEEN: PEOPLE AND HOW...........................161THE EPILOG II...............................................165
Chapter One
HISTORY
ONCE UPON A TIME. Remember that phrase we related to our fairy tales of yesteryear.
It should be emphasized this book is not a fairy tale. It will be an eye opener for many readers.
In today's market, people are chagrined at the high cost of prescriptions. To address this situation, a look at the history of pharmacy is necessary. An excerpt from a book entitled "Medicine: An Illustrated History".
"Pharmacy has been a part of medical practice throughout the centuries. The physician frequently compounded and dispensed medications in addition to practicing medicine and the apothecary often engaged in medical practice as well as compounding and dispensing. Rivalry between the two groups, which was intense in the seventeenth century continued into the nineteen century. The respective roles of the physician and the apothecary or pharmacist gradually became clearer, but in some countries, notably the United States in the 19th century, the physician continued to prepare and sell medications out of economic necessity. The social position of the pharmacist in most places was high, and educational requirements after the seventeenth century became more and more rigorous, especially in Italy. In France the new standards grew to include a university education, special training internships, and even specialized certifications. In Germany, where the pharmacist seems virtually always to have occupied a high social and professional position, the apprenticeship system evolved into an elaborate progression of examination leading to stratification by educational accomplishments."
Medicine has endured a tremendously tumultuous time throughout the ages. This is exemplified by another excerpt from "Medicine: An Illustrated History".
"PUBLIC HEALTH"
"In the eighteenth century only the very wealthy could be assured of the services of a qualified doctor of medicine, and this of course forced the general public in the hands of mountebanks, quacks, and others poorly prepared to offer rational treatment. Dispensaries were scarce, hospitals had no organized clinics, and even people not actually impoverished had no place to turn for help. As a result, apothecaries gradually began to fill the void by responding to obvious needs of the public, thus destroying the monopoly of the physician. The situation led to eventual acceptance of the apothecaries as general practitioners within the medical community, but this uneasy alliance raised many questions of medical ethics. The principal statement in this field was made by Thomas Percival (1740-1804), who adopted a somewhat patronizing attitude toward apothecaries, but in his own conduct and in his book stressed those principles of professional conduct which are still valid today."
History sometimes gives one an appreciation for what we have today! Interesting to note that at one time barbers were equated to doctors. In the eighteenth century the apothecaries came into existence also with a lot of turbulence as illustrated again with excerpts from "Medicine: An Illustrated History".
"In England, besides the Royal Society, of which physicians made up the largest group, there was an entirely separate College of Physicians, whose functions included policing the profession, controlling quackery, regulating competition from other medical groups such as apothecaries, overseeing fees, and limiting personal feuds between physicians. There was an extraordinary openness with respect to research and medical information in the society, and its Philosophical Transactions was circulating at a time when special remedies and medical techniques were often kept secret. An interesting overview of the medical profession in the seventeenth century may be obtained by noting the conflicts between apothecaries and physicians in London. By 1617, apothecaries had dissociated themselves from grocers and formed their own society. Originally apothecaries were restricted to filling prescriptions exactly as physicians ordered, but they could perform bleeding. While physicians wished to maintain the status quo, the apothecaries sought to liberalize the restrictions. By the end of the seventeenth century the apothecaries had overcome the opposition and were permitted to practice medicine-without a physician's license. But the battle was bitter and stormy."
Currently the relationship between physicians and pharmacists today is a cordial one with mutual respect. The field of medicine has grown so large, the transition from apothecary to pharmacist is a subject other's can delve into. In some countries the practitioner is still called an apothecary., checking for compliance.
The dispensing doctor was forced to diagnose needs of the patient by whatever stock was on hand. The situation today has grown increasingly more complicated with the advent of more powerful medications as well as a much wider range of effectiveness. New ones replace old ones and researchers continually develop newer medications for patient care. Today, the physician has such a wide choice for his patient. This is done by just writing a prescription, and it is up to the pharmacist to supply. This creates a problem for the pharmacist to have the medication on hand for dispensing to the patient. There are so many medications on the market today. It behooves physicians and pharmacists alike to keep abreast of medication available for so many different ailments being presented by patients.
This is accomplished through various means of continuing education in the different fields of medicine. The physician has a tremendous choice and will develop a formulary of medications that he or she thinks are the best and use for the patient.
This prompts a comment about the passing out of samples by physicians. Most people will disagree on this subject, but looking at the bottom line, this is one factor that contributes to the high cost of pharmaceuticals overall. Granted, it is wonderful for the recipient of the samples. Something we all want to see is lower cost of pharmaceuticals that have contributed tremendously to longevity. Here again is posed the problem of a physician to maintain a sample room and adapt to the needs of the patient that he or she has a sample on hand.
Let us leave this chapter with the fact that much needs to be accomplished for our health care in America while appreciating what we now have.
Chapter Two
GREED
From the previous chapter it should be evident there is still some controversy to overcome in our society.
Let us look at a comparable situation like the stock market. There has been some controversy within the market in the last several years. Many of us have been victimized. Why? A lot has to be laid at the doorstep of GREED. In the process of "cooking the books" by corporations such as ENRON, TYCO and others and the falsifying of acquisitions plus financial statements, the goal was money and GREED. In the New Testament of the Bible is "The love of money is the root of all evil" surely stands out in our minds. Do you think it will ever change? The Securities and Exchange Commission is certainly bearing down on the situation to restore public confidence in the stock market and we wish them well.
THE BASIC CONCEPT IS ETHICS VERSUS GREED: This concept is evident within various professions.
First, take up the profession of doctors or physicians, an honorable and respected profession. Yet, as with a bushel of apples you will always find a bad apple. Some of those have occurred within my profession as a pharmacist. On one occasion a doctor diagnosed the majority of his patients as having gout and never have figured out why. Soon, however, he was discovered and ostracized by fellow professionals, and he left town. Another incident brought to my attention was a doctor giving a medication contraindicated intravenously according to patient diagnosis. This doctor was also ostracized by the profession and left the state.
It is beyond my knowledge as to what happened to these doctors after they relocated.
These two incidents of wrong doing by doctors brings up a question: How do the state boards of health police from state to state and follow up on these doctors? Perhaps this will create some thinking within the governing body charged with administration of the principles and ethics of the health related profession.
We have visited the area of bad apples. Let us now look into the tremendous area of quality doctors in the profession. My association with them throughout the years is all good and it goes beyond the scope of this book to enumerate them. Broadly speaking, the medical accomplishments made during my tenure as pharmacist are phenomenal. These accomplishments have contributed tremendously to the longevity of the general public.
How can this happen in the five decades of my tenure as pharmacist? One has only to associate with different colleges teaching medicine and experience the effort put forth by students and teachers alike. I have. The research and teaching are essential to these advances as well as the dedication of those involved. I will not endeavor to go into all of the advances accomplished as most of us are well aware of them.
Secondly, the nursing profession. This will be the shortest dissertation of professions mentioned. Why? In all of my dealings throughout the years the compatibility and association with nurses has been the best. The nursing profession ranks high in the echelon of public opinion polls. Why would any person want to be a nurse? Working at all hours of the day and night plus the great responsibilities involved. Compensation and unrealized rewards will not be addressed here due to the criticism for this book that might follow. Very seldom will you hear of any wrong doing within the nursing profession. GOD BLESS THEM!
Thirdly, pharmacy and pharmacist. Again this will be a short dissertation as more will be addressed in later chapters. This profession is probably the most closely regulated of all professions. Public opinion ranks pharmacy as the most trusted of all professions. The incident in 2002 of the pharmacist in Kansas City diluting cancer medication for profit, GREED is atrocious and unbelievable. Within the profession there is much consternation plus sentiment and hope that he is down deep in a dungeon someplace. The exact penalty is not known at this time. It should be mentioned that the crime perpetrated would be very hard to detect given the stringent laws and inspections pharmacists are subjected to. Someone would have to stand side by side to watch movements to catch the act. I assume pharmacy boards by now have devised a plan of quality control to prohibit this from ever happening again.
This is somewhat like 9-11. Who could ever dream something like this would ever happen? As mentioned before, there can be bad apples in any barrel but the secret here is to close the gap between perpetration and discovery. This has been accomplished a lot in the five decades of my tenure. One need only to see the list of disciplines handed out every month in pharmacy newsletters. Most relate to minor infractions of pharmacy laws such as not displaying license or shingle properly. These rules are administered by the boards of pharmacy within the state, and reported to the board from inspectors as well as board members themselves.
Fourth, the accounting profession. It relates back to the original topic of stock market and is the reason it is addressed here. At one time within the evolution of computers it became evident the computer people would take over the operation of one's business. This was evidenced at one time when the computer people were caught representing pharmacy. In the organizations or departments of government there is always a power struggle. Why, it will probably never be determined. This power struggle is evidenced here. The computer department was trying to take over the pharmacy department of Veterans Administration. It did not register very well so a phone call was made and they were asked to speak to the pharmacist! The reply was they were "representing pharmacy". Through their knowledge they could, through the use of codes, have the key to one's business through their know-how. Management would have to stand by and let them do their thing. The advent of "user friendly" software brought about an abrupt change that enabled the user to adapt without using all kinds of codes, etc. "User friendly" with computer users brought about an evolution of business and services within the computer field.
Now we bring up an analogous situation with the accounting profession and CPA's. In their GREED, the past manipulation of the stock market can, to a large degree, lie on the doorstep of accounting profession for not policing its own. Every profession should police themselves in a manner embodying ETHICS and elimination of GREED.
Fifth and last for this chapter: The law profession. At one time the ethics of law profession prohibited a lawyer from advertising. It can be recalled that, due to inadvisability of lawyers to advertise, the name given to some lawyers was "ambulance chasing lawyer"! This was a method devised by some lawyers to get clients to represent and of course to make some money. Some people in recent years have predicted that lawyers would probably take control over the United States. How many lawyers are there in Congress? As time has evolved it has been predicted that insurance companies will dominate over the United States. How many insurance companies are run by lawyers or influenced by them? This is being addressed here in this chapter because of the ambiguous malpractice suits and preposterous doctor malpractice insurance.
Do we want lawyers to face us in the operating room with a scalpel in their hand?
It is sincerely hoped this chapter has created some thinking along the lines of ETHICS and GREED and the need for each profession to police their own ethically.
Chapter Three
ETHICS
The exact opposite of GREED is illustrated in this chapter.
Back in the thirties there was a famous doctor by the name of ARTHUR E. HERTZLER. 1869-1946. He wrote a book entitled "THE HORSE AND BUGGY DOCTOR". In this book were his experiences, the growth and changes of the medical profession during the time of the depression and dust storms in Kansas.
The hospital he organized and put into operation was in HALSTEAD, KANSAS and this is where he came into my life as my mother went to his hospital dying of cancer in the late thirties.
The book is out of print but possibly can still be located in its entirety. Check the yellow pages for professional book finders is another way to acquire the book. The following are some excerpts. The sections used were included to emphasize the scope of this book. My intention is to stimulate thinking on the part of the reader and to appreciate what we have today.
"Watching that mother, I was learning then, though I did not know it, that it is not the dying but the living who suffer."
"In my early practice a family history usually revealed that some member had died of one of the infectious diseases of childhood, of which diphtheria was the chief."
(Continues...)
Excerpted from PEOPLE AND HEALTH CARE USAby Corwin McIntyre Copyright © 2009 by Corwin McIntyre RPh. Excerpted by permission.
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