Keryn palmer

Are Advances in Medicine Helping Us?
It is an undeniable fact that throughout time the invention of new technology and the advancement of scientific knowledge have helped to advance the medical world. If one was to look at any period of time it can be seen that advances in science and technology allow the ability to provide healthcare to also advance. Yet, as our ability to use new technology becomes greater and greater, the question of the detrimental effects of such progress begins to appear. It is clear that many of these new additions to our knowledge provide a greater ability to treat the sick, to prolong life, and to allow medical crises to be averted. However, in some instances, these new technologies seem to hurt more than they help. As technology continues to increase, and new medications and technologies become important in the medical field, the relationship between increasing technology and the medical field will continue to become a major issue and because of this is an important issue to be faced by our generation. For anyone who enters a location of medicine in today’s world, it is clear that without technology and scientific discoveries, nothing would work as it does. Every aspect of the modern medical system requires these features. It is also apparent, not only from looking at today but also into the past, that as new technologies appear, they make a great impact on the medical world. This can be seen at the beginning of the twentieth century. At this time great advancements were made in sciences including chemistry, physiology, pharmacology, etc. Such advances allowed great strides in medical discoveries. One of these discoveries, which could be said to have had the greatest impact, was the development of the x-ray. By the 1930’s “The power this technological innovation gave physicians was enormous. The x-ray permitted them to diagnose a wide variety of diseases and injuries accurately” (Blanchard, 10). Such advancement was very important for the medical field as it allowed diagnosis to be a great deal more accurate. As new medications were introduced, the hospital and treatments of patients begin to transform toward the modern day. Through such consideration of the past, it is clear that advances in science and new discoveries have and will continue to cause great changes in the medical world. It is clear that such positive effects are still occurring today and that new pieces of knowledge add tremendously to our healthcare system. However, in today’s world, one begins to question if all these advancements are actually as positive as The new methods of treatment which have become possible through today’s expanding technology bring about not only positive effects but also some which can be harmful. With the ability to use new technologies and medications, comes the question of whether they should actually be used. Because of this, a variety of questions come into debate. As medical technology rapidly advances, “capabilities have also produced great uncertainty as to what is most beneficial or least harmful for the patient” (Blanchard, 41). A key point in the medical field is to do what is considered to be most beneficial to the patient and above all to do no harm. The uncertainty of what will be the most beneficial for the patient causes a judgment to be made by those giving treatment. The fact that technologies are used before there is knowledge they will actually be of benefit to those treated also causes one to wonder if the system in place is actually sound. The United States has an obsession with using the newest technology. However, this obsession brings an inquiry of if this is actually the best idea. Unlike new medications, new technologies must not be proven to have a positive effect before they are put into use. And due to the nature of the American medical system, these new machines, which have not been extensively studied to show their benefit, are used to a high degree. Although it is clear many of these changes are beneficial, some such as artificial spinal disks have not been shown to make any changes, while others have actually been shown to be detrimental. “Physicians were stunned, for example, when clinical trials showed last year that expensive anemia medicines might actually hasten death in kidney and cancer patients” (Berenson). As we move into the future it is clear that more and more new technologies will continue to be introduced, if there is the possibility of each having detrimental effects, it seems as though the system needs to be changed. There have been too many times when it was thought these technologies would do one thing but instead did another, it is evident that studies should be required before such technologies are Further, it is apparent that this same fascination which the American people have with the newest medical technology may be having detrimental effects financially. “Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care” (Berenson). The use of new technology is important and can be of great benefit to the country; however, it is clear that the way in which it has been used is not of great benefit. Because it is not often known if the technologies will be of benefit to the patient, it is generally left to the physician to decide when and how they should be used. This leaves them with a dilemma of trying to decide if it will be of benefit, often without much proof either way. This can be seen in the example of the CT heart scan. This machine allows for a better view than previously possible inside the heart, however, it also exposes the patient to radiation. Many of those who have purchased the scanner are using it to a high degree, and according to some doctors, they are over using it, exposing patients who do not need the scanner to radiation when it is not necessary. In many cases, patients who have shown no symptoms of heart disease have still been scanned, although in some instances this has in fact shown they needed some kind of lifestyle change or a stent put in, in many cases no issues were found. This implies a needless exposure to radiation and an elevated risk of cancer. Such an example brings into question whether these technologies are benefitting the patients in all cases, and if they are not, it makes the It is clear that there are some financial incentives to use such technologies. Once the FDA has approved a new device, it is rare that companies such as Medicare will not cover them. In some instances, such as the example of the CT heart scan, it is clear that when they did not feel they should cover the technology without studies done, they were met with great resistance. “Concerned about the overall proliferation of imaging tests, Medicare said it might require a large-scale study to determine the scans’ value. The plan met with fierce resistance…” (Berenson). Those promoting coverage have claimed that breakthrough technologies need time to prove themselves. Although this can be seen to be true, it also brings into question how many detrimental effects will occur during this time. Medicare eventually dropped pushing such efforts and no studies have been forced to occur. Such an example makes it clear that it is very rare that these new machines will not be covered by insurance due to the push of those promoting it, and so, they can easily be put into use. Further, when doctors use such medications on patients, they charge a substantial fee. Although these machines are expensive to buy in the first place, they more than make up for their costs. A considerable amount of the income of many doctors, especially those within fields of specialty, comes from the use of such new technologies. Because they realize they will make such a profit, it seems quite possible that many of these doctors could overuse new technologies. This use can clearly provide benefits to the patients, the question remains however if the risk and the cost outweigh the benefits and if this technology is truly being used as it should. As technology continues to grow, new discoveries in the uses of medications are also occurring. Because of this, medication is being prescribed much more often than in the past and is often being taken in ways it shouldn’t be. This has caused diseases to mutate and become resistant to drugs. People and animals are on preventative medications, and medications are at times prescribed incorrectly causing detrimental effects upon the patient. As doctors prescribe antibiotics much more commonly than ever before, and people begin to take more and more preventative medications, diseases begin to change. Antibiotic resistance became increasingly common between 1987 and 1994, possibly due to the overuse of the antibiotics prescribed. These drug resistant bacteria had mutated slightly so that penicillin could not break down their cell walls and so the cells could not be harmed, leaving the illness untreatable by the current antibiotics. At this time drug companies thought that no more antibiotics were needed and they had solved this issue, and instead were trying to find other types of medications. This lead to no medications being available for these drug resistant diseases, leading to the deaths of many people (Lewis). Issues such as the overuse of broad-spectrum antibiotics, incorrect diagnosis, unnecessary prescriptions, and improper use of antibiotics by patients have been shown to lead to such mutations which cause antibiotic resistance. It is also thought that the use of antibiotics in livestock used to promote growth and to prevent the possibility of disease may also lead to this resistance. Such types of resistance lead to a The emergence of drug resistance in several diseases, including tuberculosis, HIV/AIDS, malaria, and bacterial infections, began to be recognized as a global threat in the 1990s. In most first world countries, this drug resistance is thought to be caused by the treatment of animals with antibiotics (most feed animals are given prophylactic antibiotics which are often unsystematically applied) as well as failing to complete a course of antibiotics, or the over prescription of antibiotics. In other parts of the world it is thought that drug resistance is also caused by unreliable access to drugs paired with incomplete courses, as well as switching between antibiotics over the course of a treatment (Lewis). There are two types of drug-resistant tuberculosis, multi-drug resistant tuberculosis (MDR TB) and extremely drug resistant tuberculosis (XDR TB). As the name of each implies, the multi-drug resistant strain is resistant to some generally used TB medications and the extremely drug resistant strain is resist to most of the drugs. Extremely drug resistant TB is often found to be untreatable. “The chronic features of tuberculosis in these patients suggest that extensively drug-resistant tuberculosis may be acquired through previous treatments that include second-line drugs” (Keshavjee). It is necessary to treat this disease aggressively in order to help prevent the spread of it as well as to prevent fatality. Multi-drug resistant tuberculosis is also said to occur “when patients do not complete their full course of treatment, when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs, when the supply of drugs is not always available, or when the drugs are of poor quality” (cdc.gov). In looking at this disease, the way in which it is transferred must also be considered. Tuberculosis is very contagious and can be spread by breathing in air droplets of the cough or sneeze of an infected person. Because of this, those who have this disease could easily infect anyone with whom they come into contact. “There was one study that found that a single TB patient can infect 14 other people in the course of a single bus ride.” (Kristof). This emphasizes the point that those carrying this disease pose a major risk even to those who might be in the same room or bus as them. Yet, these people are generally not isolated in any way, but do use public transportation and are able to infect others, without meaning to or knowing they have. Tuberculosis is not often thought about as a major issue by most people in the United States; however, this is something which should put into our consideration. HIV/AIDS was once also not considered something which was going to be a major issue for our country and it has become clear that this was a mistake. Drug-resistant TB is spreading, in a world connected by planes and constant flows of immigrants and tourists. As the world continues to become increasingly connected, we need to consider this issue. If nothing is done, and it continues to be ignored and allowed to spread at its current rate, we run the risk of having our shortsightedness catch up with us, just as it did with HIV and AIDS. Issues such as those highlighted by these two strains of tuberculosis are also a major issue with other drug resistant diseases. As time goes on and people continue to incorrectly treat diseases, self-medicate and over medicate, and ignore the instructions of doctors the issue of drug resistance will continue to spread. This will spread not only due to people spreading to one another, but also due to people having mutations of diseases within their bodies. This is an issue which will need to be considered and resolved in order to prevent such an occurrence. This requires both cooperation from the patient and the healthcare provider. The patient needs to work with the healthcare provider to follow instructions and the healthcare provider needs to correctly diagnose and treat the disease as well as to make sure the patient is completing their treatment. This also means the patient must be able to both access and afford to complete their medications, which is Not only can financial incentives be seen in order to use new technologies but also in the cost of medications. This can be seen by the drug companies as well as by pharmacies. It is clear that drug companies make a large profit on the medications which they produce. It is also evident that when generic versions of their medications become available many people will switch to the generic version in order to save money. Because of this, companies such as that making Lipitor have tried to allow their exclusivity to last as long as possible. It is clear in these situations that they are not concerned about allowing the cost for the patient to be less but instead in their own profits. Lipitor is a cholesterol medication and is the world’s top drug, with $12.7 billion in sales last year. This medication is taken by a large amount of people in the world and is clearly important to the health of these people. “Lipitor’s current price can exceed $3 a day, while a generic version might eventually sell for well below $1” (Saul). This would make a great difference for the vast number of people on this medication. However, an agreement has been made with the company which has made a generic version of the medication to delay its release. This delay will last up to twenty months, until November 2011, making a huge impact on those using this medication. During these months, it is projected that Lipitor will add billions to their profits. Such an agreement can clearly be seen to have financial incentives and is not considering the good of the people. It is also clearly an obstacle for those who find it difficult to afford their medications. When one looks at the amount of money charged at pharmacies such as CVS and Walgreens, it is quite evident that the cost is much higher than is actually necessary for many medications, especially that of generic drugs. Such an issue is often not felt by those who have insurance as it is those companies which will pay for most of the cost of the medication, and these companies are given deals because of the large quantities which they by. However, those who do not have insurance will feel great effects. Often, unfortunately, it is these people who are at the highest risk of not being able to afford these high costs. This can cause people to take their medications incorrectly which in the end can cause major issues. Because of this it has been seen that some people will take less medication daily in order to make it last longer, stop treatment before they should, or switch medications at a point they should not in order to lower the cost. These choices can often be seen to be detrimental to the health of the patient. If one looks at the cost of the generic version of the drug Zocor, a medication taken to help lower cholesterol, the ridiculously high cost of medication, which is seemingly unnecessary, is clearly illustrated. This medication’s patent expired in June 2006 allowing for generic versions to be available. This introduction of generic versions would seemingly imply that a great decrease in price; however, in most instances this is not the case. “At online pharmacy walgreens.com, for instance, the price for 30 tablets of a 20-milligram dose of Merck & Co.'s Zocor is $149.99, compared with $89.99 for simvastatin, the generic version. And last week, the same dose of simvastatin cost $108.99 at CVS's Web site, compared with $154.99 for Zocor.” (Rubenstein). It is clear that the expected lowering of cost did not occur, but instead only a slight drop in price. However, at other pharmacies such as Sam’s Club and Costco, the prices of these same generic medications are vastly different. “Simvastatin costs $6.97 for 30 pills of the 20- milligram dose at a Sam's Club for which the company provided price information.” (Rubenstein). This is clearly an immensely different price from the prices seen at CVS and Walgreens, yet, it is for the same product. Sam’s Club says that they are still making a profit on these medications meaning that these pharmacies are choosing to charge a much higher price than is really necessary. However, these companies claim that they need to charge such high prices. It seems ridiculous that such a difference can exist, and unfortunately it is often the case that people do not act upon these price differences but continue to go to the pharmacy they are used to (which in most cases is charging the higher prices). It is clear that changes need to occur in order to allow for a system which better aids those who are attempting to receive medical care instead of simply being for the economic benefit of those who are supplying the care. There are important gaps which are clearly apparent in the health care system and if they are not repaired, this will continue to become an increasingly large issue. Because of this, I feel that my generation is going to have to reform the system and this will be a major issue we will face. There is a major gap between the US spending on healthcare and the results which are achieved. Second, there is a major gap between the use of new technologies and the proof that these technologies will be of benefit. Third, there is a gap between the risk due to diseases and the education and treatment necessary in order to prevent them. Finally, there is a gap between the cost to the public for treatment and the cost to the companies providing the treatment. If these gaps are not narrowed and these problems are not fixed, there will be major issues. If we are not able to deal with these issues, diseases will not be able to be treated and will continue to spread. The life expectancy could easily begin to lower as people begin to become sicker and sicker and not have possibility of treatment, not only due to drug resistance but due to the cost of medical care which continues to rise. If people are unable to be healthy, they will certainly not be able to deal with other areas of life and we will see major issues in many places. These increasingly sick people will not be able to go to school or work, they will not be able to learn or add to our economy, we will slowly deteriorate as a people. Such ideas seem to be completely ridiculous; however, if we continue to disregard issues which need to be addressed, these issues are clearly possible. The first gap, that between US spending and the results it has achieved is very clear. The United States is spending more on healthcare than any other country and yet it is not finding itself to actually be achieving results proportional to this spending. It is clear that a major reason for this is the excessive use of technology in the American healthcare system. It is clear that unnecessary spending is occurring; yet the actual amount of unnecessary spending remains unknown. However, one study estimated that one-third or more of the care that patients in this country receive could be of little value. (Berenson). It is clear that this is not an acceptable standard for the country and that something needs to be done in order to have our spending allow all patients to receive care which will be of benefit to them. It is clear that the unnecessary spending needs to be discontinued, however, we must first analyze where and when such spending occurs. It is clear that some of this spending is due to the over use of technology and this issue should clearly be worked on. If we close the gap between the evidence something will work and its use, it is clear that some technologies will no longer be used or they will not be used in the situations in which they are. However, it is unlikely that making such regulations will take care of this entire issue. It is also necessary to then find a way to provide care to everyone. By not making sure everyone receives the care they need, not only are those people being hurt, but the society as a whole. As people continue to get sick, they are able to spread their illness, which allows for more and more people, many of which likely will not get the care needed to be ill. Such a cycle needs to discontinue and in order to do this we must narrow and eventually close this gap. The second gap, between technologies and their proof, clearly plays a role in the first as it has been seen to have a great impact on spending. However, this is not the only reason this gap must no longer exist. It is evident that some technologies are actually not doing what they were expected to do and are detrimental to the patients. Although this is not necessarily a common occurrence, such an issue should never be allowed to occur outside of a trial setting. Because of this, it is necessary to begin having regulations for technologies just as we do for new medications. Although this may mean the cutting edge technologies take longer to be released, its impacts will be better for the system. By allowing these technologies to be tested, doctors will know when they should and should not use a technology. This will lead to less overuse of technology as there will now be guidelines for use. This can allow for rules and regulations about the use of these technologies which will also help to solve the issue of overuse. Finally, this will allow less technologies to actually be released meaning there will be less spending on technologies and only those which are truly helpful will be used. It is clear that these changes would be beneficial not only economically but also to the health of the patients as those new technologies which would be detrimental or would simply not be justified because the results do not seem to be any better than older cheaper methods would no The third gap, between the danger of diseases and the public understanding of this danger as well as the efforts to treat these diseases is another major issue. It is clear in many cases that the public as a whole does not have a true understanding of the danger of many diseases which are apparent in today’s world. Although the general public cannot be expected to know about every disease which may be encountered, it is important for them to have an understanding of what is generally around them. Those who are suffering from a disease, especially those which are drug resistant, need to be informed of the consequences of their disease, how they could spread it, and what they should do to prevent this. This type of education will be helpful in order to help people to avoid such diseases and prevent spreading which does not need to occur. Causes of drug resistant bacteria could often be prevented if we make efforts to educate people to stop this from occurring, and it is this type of education which is necessary. In order to close this gap the medical community needs to make great efforts not only to educate but also to work to find ways to stop spreading. It is obvious that diseases which are extremely contagious, such as resistant forms of tuberculosis, need to be prevented from spreading. However, it is clear that currently, this is not being stopped. People with these diseases are clearly able to travel on public transportation in which they could spread the disease. It is also obvious that it would be wrong to tell these people they cannot have lives as they did not chose to get sick, however, something must be done in order to prevent others from being given the illness. Such a problem is difficult to solve and an easy answer does not seem apparent, however, it is clear that something must be done in order to prevent this spread. Education would clearly be a step in the right direction, however it is also clear that education will not be enough to fully solve this problem and because of this more steps will have to be taken in order to close this gap. The final gap, that of cost to the patient vs. cost to companies is another major issue which can be seen to be faced in today’s world. If this gap is allowed to continue to exist, it is clear that people will continue to not take medication or take it in a way that they shouldn’t. If people are unable to afford their medications as they are meant to take them, they are going to try to find ways to solve this problem, unfortunately in many cases people’s solutions are doing more harm than good. It is quite evident that the companies who are making the medications and the pharmacies that are selling them, in most cases, are making a huge profit. They are clearly not considering the patient but considering their own wish for economic advantages. It is also quite obvious that if this gap is not narrowed, the issues which are currently occurring will continue to and because of this, something must be done. Companies such as Sam’s Club and Costco are clearly offering a more affordable situation, however, this is not so well advertised as to allow all of the general public to know the price difference. It is likely that more advertisement would allow these price differences to be of some help in this situation. Walmart is also offering cheaper prices for generic medications; this program is well advertised and is likely to be used by those who need cheaper prices. Such companies are clearly helping with the issue at hand, however, it is clear that this is not enough and more changes need to be made to solve this problem. Unfortunately, this is an issue which is mainly one of greed. It is unlikely that companies will decide to lower their prices just to be nice to those who currently can’t afford medications. However, it is possible for the government to pass laws in order to force lower prices. It is not justifiable for these people to continue to make billions of dollars each year in profits while the people who really need the medications are not able to afford them. Such a law should not cause a lack of profits, however, it should allow for the prices to be lowered, possibly lowering the profits of the drug companies by a small amount, though not so drastically as to be truly detrimental to those working there. This solution is not the simplest choice, and clearly would be met with a great amount of resistance. However, it is clear that such a solution would be of great benefit to many people. The gaps which are apparent in the current healthcare system have the potential for creating major problems in the world as we move into the future. However, if people work to eliminate these gaps, these problems will not occur. Although it is obvious closing the four gaps mentioned will not be an easy nor is it a quick task, every step made to try to solve these problems is one step closer to a better healthcare system. This work requires the efforts not only of the healthcare providers but also of the government and of the general public. Through the efforts of the community as a whole, we will be able to solve such problems and change a future of devastation to one of hope. If everyone is willing to work together to solve these problems, I feel there is potential for great improvement and the possibility of great advances for the future of the medical world. Berenson, Alex, and Reed Abelson. "The Evidence Gap: Weighing the Costs of a CT Scan’s Look Inside the Heart." New York Times 29 June 2008. Blanchard, Susan M., John D. Enderle, and Joseph D. Bronzino. Introduction to Biomedical Engineering. New York: Academic P, 2005. "DTBE Fact Sheet Multidrug-Resistant Tuberculosis." Fact Sheet. 16 Oct. 2008. CDC. 5 Dec. 2008 <http://www.cdc.gov/tb/pubs/tbfactsheets/mdrtb.htm>. Kristof, Nicholas D. "A Killer Without Borders." New York Times 6 Dec. 2008. Lewis, Ricky. "The Rise of Antibiotic-Resistant Infections." FDA Consumer Magazine Rubenstein, Sarah. "Why Generic Doesn't Always Mean Cheap Zocor Case Shows Drugstores May Offer Only Small Savings Over Brand-Name Drug Prices." Wall Street Journal 13 Mar. 2007. Saul, Stephanie. "Release of Generic Lipitor Is Delayed." New York Times 19 June

Source: http://www.faculty.fairfield.edu/faculty/hodgson/Courses/progress/drafts/KerynFinal.pdf