Lamentations

Innovation does not run smoothly. It is a jumpy, lurching kind of activity. What is more, success, continuously sought, is often the enemy. Let me see if I can demonstrate what I am saying.

Over the past couple of decades, great changes have occurred in surgical cataract correction. These changes have resulted in considerable improvement in outcomes. As a result, other options are not considered. If there are other reasonable means of stabilizing or reversing cataracts, they are not means that are attractive to eye surgeons.

An eye surgeon is not going to get wealthier by telling us that we should pay more attention to what we eat and drink, that more of what we drink should be water and less should be alcohol.

I am told that most of us are seriously sleep deprived, often getting hours less than we need. Sleep “medications” are ubiquitous, both over the counter and by prescription. Then, when we awaken, we use stimulants like coffee, tea, and energizing chemicals to get us through the day.

Even our children are in the same sort of mess. They are very often drugged for attention deficit and hyperactivity, or labeled autistic and put into special education programs. What are some of the results? We now have a whole class of new “patients.” The children who were given Ritalin (a cocaine-like stimulant) to help them behaviorally in school, have become ADHD adults, and the “medication” continues.

But let us return to the subject of eyes. About four decades ago, I invented a useful device to discover monocular visual behavior in young children in groups. In other words, you could screen a lot of children all at the same time. This seemed to me to be the most useful feature of the device.

Yet, when I presented it to a variety of optometrists, it was this element which was most troubling to them. They were set up in business to deal with one patient at a time. Of the several optometrists that I demonstrated the device to, none was enthusiastic about changing their niche of dealing with only one patient at a time.

As an inventor, I was mystified by this negative reaction, and eventually disgusted by the optometrists, at least by those I talked to. Of course, one can’t judge an entire profession by the responses of a random handful. Even so, they were exhibiting a very self-serving perspective.

The point is, the device worked very well. No one denied that. The problem was that no one was interested in screening groups of children. And of course other existing equipment was already on hand in the doctor’s office which could identify monocular traits one on one. And that is how the business of medicine has always been set up.

Problems with the outrageous costs of medical care, or services simply being unavailable for vast numbers of people, is not just confined to the United States. And it is not just the fault of the doctors. They just benefit much more visibly than the other complicit components in the system; hospitals, insurance companies and the pharmaceutical industry.

Maybe you are one of the many who feel that the health industry is honest and above-board. Perhaps you missed the story in the news just this past week , in which Bristol-Myers Squibb (a Fortune 500 company) was fined five hundred and fifteen million dollars for their misdeeds. More than a half BILLION dollars. As far as I can tell, none of this money is going back to any of the consumers who were damaged by the practices of the company. It is very hard to track what state and federal authorities are going to get this money and in what amounts, but the total amount that they have paid or agreed to pay in the past few years is actually more than 1.25 billion dollars. Surely some of that total amount has been restitution to stockholders and class action settlements. But a lot of this penalty had to do with unlawful marketing and pricing practices. Marketing practices in which large numbers of physicians played an active role, profiting substantially in a variety of ways.

It has been suggested that I have it in for doctors. Not true. But the conditioned reflexes that we have been programmed with; that we must go for a regular check-up every year, and that by the time we are fifty, we should have a doctor jam a camera up our rectum to see if everything is all right. Or that by the time women are fifty, they should already have had a couple of mammograms and several cervical smears. There is no argument. Lives are saved by these diagnostic procedures.

There is also no argument that lives are lost because these procedures are, one way or another, far more expensive than they need to be, making them financially impossible for many people who could benefit.

I went to a Health Fair a number of years ago. One of the services they provided was a comprehensive blood analysis for $10. Since I had not been to the doctor for two decades, I thought that was a good idea. I got the blood work. And although nothing was wrong, I was glad that I did it. But if I had gone to a private physician and been tested in the same fashion, the bill would have exceeded ten times that figure. What made the difference? Economies of scale and mass production techniques, and the fact that the Health Fair was designed to reach people who could not afford or were otherwise resistant to the extreme expense of conventional medical services.

Now, because my eyesight is going downhill, I have taken an interest in cataracts. Depending on whose figures you want to believe, the typical surgical intervention to deal with a cataract costs $3500 to $5000.

Now contrast this with the work of Dr. Sandik Ruit, an ophthalmologist from Nepal. A few years ago he went to North Korea and in the course of less than two weeks, performed in excess of a thousand cataract operations. He did it with a very small staff of helpers and trained some North Korean doctors while he was at it. The net cost for these operations even when the prorated cost of his portable medical equipment is taken into account, was well under $40 per eye. Now Dr. Ruit practices in the high countries like Nepal and Tibet and charges a sliding scale of $10 to $100 for the operation, depending on ability to pay. The point is, the actual cost for the operation and all materials needed is actually very, very low.

Okay, now compare: I went to an optometrist in Texas. He charged me and my insurance something in excess of two hundred dollars for his half hour of testing. Then I went to an ophthalmologist, whose staff did some additional testing. Her office workers took about forty minutes with me, screwing up a bit along the way. Then the ophthalmologist popped in and had a quick look, ignored some important details on my intake form, and scheduled me for cataract surgery.

The total cost for this one hour of services? Something over $400. And the operation itself? That will be another $3500+. Now I suspect that I would ultimately get a better lens, perhaps slightly better matched to my individual needs than those that the Korean patients got, but really, there is no way to check that. I will get the result that I get. I have about 19 chances out of 20 to have better eyesight without too many complications. But that means I have 1 chance in 20 of being blinder than I was, or even totally blind in that eye.

Meanwhile, the prevailing opinion among the ophthalmologists is that these odds are very good. I am inclined to agree, unless I am the one in twenty for whom things don’t work out.

It is claimed almost universally that only surgery can deal with cataracts. For me, the jury is still out on that. From my perspective, ophthalmologists have too much to gain and too little to lose, to consider the less invasive options. These would include changes in nutrition, changes in eye behavior (exercises), changes in hydration, changes in the amount of sleep we get, and other lifestyle considerations. From the physicians perspective, the patient can not really be trusted to do much to help himself. Otherwise he would have already done it.

We have only to look around us to find evidence that this is so. Obesity is of epidemic proportions. Alcohol and drug use is widespread. Tobacco addiction is not as universal as it once was, but it is still a very serious problem. Our food supply is far from healthful.

Just this week, an American meat packer recalled 22 million pounds of ground meat patties, then promptly went out of business. There were not enough assets to pay for the recall. So who pays? And what is the ultimate fate of over twenty million pounds of (possibly) tainted meat? It seems like only a month or so since there was a nationwide recall of American spinach greens.

Many of us have taken losses because of the Chinese adulteration of pet foods with a poisonous substance added to increase the protein content. Other Chinese products, like toothpaste adulterated with antifreeze, children’s toys painted with lead-based paint, cribs that have killed babies because of design and assembly defects, are probably the tip of the iceberg.

So what could possibly have caused this mess, in which we have somehow become so dependent on Chinese labor and products that we cannot do without them? In the course of my lifetime, we have gone from total isolationism, fear and hatred on both sides, to mutual economic exploitation in trade. But the fear and hatred are still right under the surface. At the moment, we are probably one of China’s biggest customers. This reverse in policy took only a few decades. Few of us even noticed it happening. All those years we were castigating the Chinese for rampant human rights abuses, we were consuming the cheap products that those abuses produced. With each passing year, we become more entangled in this international trade with partners we cannot trust, but can no longer do without.

We are really in the same situation with our medical-pharmaceutical-insurance industries as well, aren’t we? They are plundering us and have been for so long that most of us cannot even see that it is happenning. What is the solution? Perhaps there isn't a perfect solution. But perhaps it would be a start if we each took a whole lot more responsibility for understanding how our bodies work, and took a whole lot more responsibility for dealing with our own ailments, rather than putting ourselves so entirely in the hands of this group of self-proclaimed experts.