Hospital Ads, The Media, and Hospital Hype

Did you ever wonder why hospitals run those radio ads?  In the U.S., hospitals are always trawling for well-heeled, well-insured patients—and the doctors who bring those patients through the door.  And now, the Columbia Journalism Review reveals, some TV stations and newspapers have taken the hype one step further, by forming “Unhealthy Alliances” with individual hospitals.

But first consider the larger picture.

In the U.S. hospital advertising began in the 1970s, when the money really began streaming into the health care industry.  Meanwhile, other countries did not allow medical centers to peddle their services to the public. 

Indeed, in the U.K. the National Health Service decreed that hospitals could promote  themselves “direct-to-consumers” just a few months ago, bringing an end to what had been a fairly acrimonious debate.  Dr Laurence Buckman, a leading member of the British Medical Association’s (BMA’s) General Practitioners’ committee, was an early critic of the idea: "Patients want money to be spent on their healthcare, not spent on advertising to doctors so the hospital makes more money. The health service is not about making money, it is about delivering care for patients."

Dr Jonathan Fielden, chairman of the BMA's consultants' committee, told the BBC: "It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care…in order to save money."

Medical Tourism: The Big Picture

You’ve probably heard about “medical tourism,” the traveling of patients to foreign countries in order to receive care. But what you may not know is just how popular medical tourism has become: according to Deloitte LLP, an international consulting firm, an estimated 750,000 Americans traveled abroad for medical care in 2007. Aggressive projections put this number somewhere around 6 million by 2010.

As interest in medical tourism increases it’s important to understand the nuts and bolts behind its allure, and the risks that it poses—both for patients and health care systems at home and abroad.

Saving Money

Over the past few years insurers and employers have warmed up to medical tourism as a way to save money: its cheaper for insurance plans to help fund patients’ trips to foreign doctors who charge much less for procedures than their U.S. counterparts.

The price differentials  are stunning. According to a recent Deloitte report, Thailand, the world’s leading medical tourism hub, saw 1.2 million medical tourists from around the world in 2006. On average, medical procedures in Thailand cost a mere 30 percent of American prices. India, another destination that sees more than 400,000 medical tourists each year, charges just an average of just 20 percent as much as the U.S. Thousands of Americans also flock to Mexico and South America every year for cosmetic and dental surgery, where procedures cost anywhere from 75 to 50 percent less than they do in the U.S.

Surgeons and Surgical Nurses: The Husband of a Patient Offers His Perspective

Commenting on “Surgeons and Other Physicians: A Cultural Divide,” a reader who recently found himself in an OR with his wife offers his perspective.  This is not meant as a rebuttal to Dr. Cohn’s post. I think that the two perspectives are both equally true—and that OR cultures may vary widely, from one hospital to another.  I would also like to hear some surgical nurses weigh in.

“jd” writes:

“The domination exhibited by physicians, particularly surgeons, is about far more than verbal abuse and yelling. I don't doubt those defending their experience who say that they haven't seen many angry tantrums by surgeons. But I think we're getting distracted by the most extreme displays so that we miss the very real and dangerous power dynamics here.

“I happen to have just been in the OR a couple of weeks ago with my wife, who was undergoing an emergency C-section. It was performed by obstetricians, as most are. There was one attending and one (I'm guessing) resident who was being trained during the operation. Their tone of voice and demeanor was perfectly pleasant throughout.

A Surgeon’s Response to “The Cultural Divide”

Dr.  Kenneth Cohn, a surgeon and blogger, offered a particularly thoughtful response to my post “Surgeons and Other Physicians: The Cultural Divide.” First, let me introduce him.

On his blog, Cohn describes himself as a “board-certified general surgeon currently splitting time between providing locum tenens surgical coverage in New Hampshire and Vermont and working as a consultant at Cambridge Management Group, which specializes in physician-physician and physician-administrator communication issues. I am a recovering academic surgeon who is passionate about helping physicians, nurses, hospital leaders, and board members work together.”

Let me add that I’m impressed by his blog, Collaborative Confession, and that we’re adding it to our blogroll.

In his comment here on Health Beat, Cohn explained that his training was very different from the surgical training I described in the post:

Review of "The Predator State"

Over at TPM Café (www.tpmcafe.com) I’ve posted a review of James Galbraith’s witty, insightful book, The Predator State, which some readers may find of interest.

What is delightful about James Galbraith's The Predator State is that he says things that are, at once, outrageous-- and completely true. Because he shows so little concern for what one "can" and one "cannot" say in a polite capitalist society, one might call him an idealist. But Galbraith is not tilting at windmills; he is simply toppling the conventional wisdom of the past 28 years.

Begin with "the market." When you come down to it, Galbraith explains, "the market" is a fiction. In theory, "it is the broker, the means of detached and dispassionate interaction between parties with opposed interests...Buyers want a low price, sellers wants a high price. The market works out the price that exactly balances these desires, a price that is fair because it is the market price." Even liberals believe in this mythical "market"--a higher intelligence that hovers over transactions ensuring that, as long as you let "the market" work its magic, everything will work out for the best...

To read the whole review, click here.

The Geriatrician Shortage

In a 2006 New York Times article, Dr. Amit Shah, a physician at Johns Hopkins, recalled how other doctors looked down on him during his residency because of his chosen field. “The most memorable discouragement came during his residency, from a pulmonologist,” notes the Times. ‘When I passed him in the hall, [the pulmonologist] would shake his head and mutter, ‘waste of a mind,’” Shah said.

Dr. Shah’s sin? He had chosen to become a geriatrician.

You’d think that Shah would be applauded by his colleagues for choosing geriatrics, given that the U.S. is in the throes of a major geriatrician shortage: Since 2000, the number of geriatricians in the U.S. has fallen by a whopping 22 percent to a mere 7,100. According to a May Institutes of Medicine report, the outlook for the future isn’t much better: by 2030, there will be just 8,000 geriatricians, despite the fact that the U.S. will need about 36,000 to cover the workload as the number of Americans 65 years and older mushrooms.

Clearly, the U.S. needs more geriatricians. Yet the reason we don’t have more stems from the mindset of the pulmonolgist that scoffed at Dr. Shah: both our health care system and our medical schools devalue the kind of care that geriatricians provide.

Geriatricians are family or internal medicine physicians who have taken extra training in the area of aging and the special needs of seniors. In the words of Cheryl Phillips MD, a Sacramento geriatrician, “the particular focus of geriatrics training is the care of frail elders—where understanding how to assess and determine the individual’s ability to function is oftentimes every bit as important as understanding their diseases.” Thus geriatrics deals with coordinating long-term care for chronic conditions or helping seniors to manage their day-to-day life. Geriatricians tackle issues like confusion, dementia, incontinence, falls, depression, and the special effects that medications can have on the elderly. As the New York Times explains, “caring for frail older people is about managing, not curing, a collection of overlapping chronic conditions, like osteoporosis, diabetes and dementia. It is about balancing the risks and benefits of multiple medications, which often cause more problems than they solve. And it is about trying non-medical solutions, like timed trips to the bathroom to improve bladder control.”

Surgeons and Other Physicians: A Cultural Divide

Are there intrinsic differences between how surgeons and physicians who are not surgeons see the medical world?  A pediatrician who reads this blog thinks so, and he e-mailed me to suggest that “The distinction matters because the dichotomy between doctors who perform procedures and those who practice ‘cognitive medicine’ [listening to and talking to the patient] is a major culprit in driving up the cost of American medicine.”

His grandfather was a physician and his father was a surgeon, which puts him in a unique position to muse over “the cultural divide between surgeons and non-surgeons.” I’ll call him Dr. Y

A Whole New Level of Junk Science

It’s no secret that the pharmaceutical industry trades in junk science. We’ve talked about how prescription drug companies distort research many times here on Health Beat, focusing on how companies fudge measures of drug effectiveness and generally control our knowledge of what works in medication. Big Pharma’s track record of shady science is a serious problem, especially considering the fact that recent discussions about creating a Comparative-Effectiveness Research Institute currently hold a place for prescription drug companies on the organization’s board.

The obvious problem is that, to the pharmaceutical industry, “research” is just a code-word for “smart-sounding marketing.” If you really want a sense of how deep this deception runs, consider the fact that the prescription drug industry relies on so-called “research” not just to shill its drugs, but also to argue that it has a vital role to play in shaping the doctor-patient relationship for the better.

This dubious claim comes in the June 2008 issue of PharmaVoice where Meaghan Onofrey from CommonHealth, a pharma marketing consulting firm, pens a piece arguing that coaching from the prescription drug industry can make sure that “physicians and patients speak the same language” so that “everyone wins.” According to Onofrey, “one case study illustrates [how marketers can help physicians improve their communication]: by videotaping primary-care physicians, who were struggling to assess migraine prevention candidacy with their migraine patients.” According to Onofrey, it turned out that the doctors were actually asking the wrong questions of their patients. In working with key opinion leaders and advocacy groups, a simple solution was formulated to address the issue. These same physicians were taught to ask a single question to help them more simply and clearly identify the patients’ candidacy for migraine prevention.”

Should More Hospital CEOs Be Physicians?

In 1970,  a Fortune magazine cover story warned the nation: “Much of U.S. medical care, particularly the everyday business of  preventing and treating routine illnesses , is inferior in quality, wastefully dispensed, and inequitably financed.” That year, a Fortune editorial declared: “The time has come for radical change…The management of medical care is too important to leave to doctors who are, after all, not managers to begin with.”

This was the beginning of the revolution Paul Starr described in his Pulitzer-prize -winning 1982 book,  The Social Transformation of American Medicine.  In his final chapter, “The Coming of the Corporation,” Starr expressed his concern that “those who talked about ‘health care planning’ in the 1970s now talk about ‘health care marketing. Everywhere one sees the growth of a kind of marketing mentality in health care. And, indeed, business school graduates are displacing graduates of public health schools, hospital administrators and even doctors in the top echelons of medical care organizations.

“The organizational culture of medicine used to be dominated by the ideals of professionalism and voluntarism which softened the underlying acquisitive activity,” Starr wrote. “The restraints exercised by those ideals now grows weaker. The ‘health center’ of one era is the  ‘profit center’ of the next.”
In this brave new world of the 1980s, corporate executives would become both the  wealthiest and the most powerful actors on the new cultural stage.  Hospital CEOs would haul home salaries that made neurosurgeons look like pikers.  In health care, as in other industries, CEOs, not physicians, make the decisions, and their goal, Starr suggested, would no longer be better health, but rather, “the rate of return on investments.”

Senators Baucus and Kent Introduce Bill to Create a Comparative Effectiveness Institute

The Kaiser Daily Health Policy Report below announces that the Chairs of the Senate Finance and Senate Budget Committees have introduced a bill to create a Comparative Effectiveness Institute.

The question: Would its decisions guide Medicare’s decisions about what it covers?  Clearly Congressional Budget Office Director Peter Orszag thinks the Institute would have some real power: He estimates it “could save up to $700 billion annually in health care spending by identifying treatments that do not produce the best medical outcomes.”

That’s the $1 out of $3 health care dollars that we now waste on unnecessary, unproven, ineffective and often over-priced treatments.

Of course, we wouldn’t save anything close to that amount at the beginning. It will take years to wring the waste out of the system. But putting U.S. healthcare on an evidence-based footing would be a giant step toward the national health reform we need.

I am also encouraged by the fact that the 18 members of the Institute’s panel would be appointed by the Comptroller General. The Comptroller General appoints the members of the Medicare Payment Advisory Commission (MedPac), and they have been producing extremely intelligent reports. They are also widely perceived as apolitical.