The state of healthcare in the United States is at a crossroads. We have major systemic problems in multiple areas of medicine. Medical and psychiatric services prioritize treatment of symptoms over preventing disease, illness, and debility. Our medical educational systems emphasize memorized knowledge and feigned certainty over troubleshooting and complex decision-making. The payment process is riddled with confusion and clinical decisions are made by non-clinical entities without patient care experience. The system thrives on chaos and perplexity, with a clinical focus on symptom relief. Good patient care, academic progress, and improving our understanding of disease through high-quality and reproducible research are system afterthoughts. 

Our system is in a dismal state. We spend, per capita, almost twice as much as the next closest country on our healthcare, yet some countries that spend less than a quarter of what we do have longer life expectancies. We have the highest rate of drug overdose deaths in the world, the highest suicide rate and lowest life expectancy of the 10 wealthiest countries, and claim the highest rate of preventable deaths with the lowest number of primary care physicians in the developed world. The vast majority of our graduating physicians go into other fields, where over-treatment and under-delivery are commonplace.

Capitalism is not the enemy, but unfettered capitalism can be toxic to providing good medical care. Multi-level marketing of healthcare touts unproven treatments for non-existent, or over-exaggerated, diseases, contributing to the disintegration of our entire system. New medications and procedures are marketed as “state-of-the-art” and groundbreaking, while older, off-patent ones are deemed outdated and no longer effective. In reality, older meds are many times more effective and safer, with known long-term side effect profiles, but are under-utilized as they don’t drive profit. As medications near the end of their patentability, newer ones spring up to replace them, and a new phase of marketing ensues promoting the latest, greatest, silver bullet for Depression or Anxiety, Diabetes, or Hypertension. Medical, and especially, psychiatric conditions are expanded, and sometimes even created, to convince American healthcare consumers of their need to “get checked out.” Research is done many times for the sole purpose of obtaining FDA approval, as opposed to learning more about disease processes and discover the most effective treatments, and FDA approvals are increasingly requiring less evidence for drugs to get across the finish line.

These factors and others have created a situation where we are being SOLD healthcare similar to the way our kids are sold toys, marketing the latest Remote-Controlled JEEP as THE GREATEST IN THE HISTORY OF THE WORLD, without any way to verify such statements.  Doctors and Scientists' historical role in dictating efficacy and safety of treatments have been replaced by Marketers and Businesspersons, whose role to their companies are to sell more products and make more profits. 

We cannot simply state that the problem is due to unfettered capitalism and the marketing departments of Pfizer, GlaxoSmithKline, or Eli Lilly (though their practices are certainly not conducive to good and reliable scientific practices), but is also shared by regulatory agencies (which appear to be working in conjunction with big pharmaceutical companies), persons in my positions (doctors and other clinicians being unaware of how data and research is manipulated to make treatments appear safe and efficacious), scientific researchers (those on the frontlines of fraudulent studies not sounding the alarm, likely due to the associated consequences), and CONSUMERS (unyielding belief that these companies are operating solely for your benefit and the pursuit of scientific advance).  My hope with this podcast, website/blog, etc. is to continue to raise awareness about this problem.  Please consider sharing this information virtually or verbally, do your own research, ask your own questions and be skeptical of others' motivations, donate to those promoting progress over profit, and report where others can find reliable sources of accurate clinical information.   

WE MUST PROMOTE good, conscientious, and appropriately skeptical physicians and researchers to take back control over what is deemed safe and effective for the American public and beyond!

Get well soon America,

Ethan P. Short, MD