“Finance dictates the activity” – Our Corrupt Disease Care System

Dartmouth InstituteDoctors Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of a study entitled “Higher Integrity Health Care: Evidence-Based Shared Decision Making” published in the journal Circulation: Cardiovascular Quality and Outcomes.

We do not know when healthcare decisions are guided by sound interpretations of the evidence and whether patients are engaged in the process,… Rather we observe that in the United States, one of the most highly developed healthcare systems, consumer demand for healthcare is manufactured and manipulated, driving up cost, waste and harm.

In their study, they highlight five problem areas in the health care disease care system where they see “obvious corruption”

Elwyn and Fisher’s research found is that, like in many other areas of the economy, the game is rigged against consumers and for the pharmaceutical industry and corporations.

You need to have a subscription to the journal to read the article, but here are some highlights from a press release from The Dartmouth Institute.

The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say.  The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious  predictions.

Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.

According to the authors,

The problems of greatest concern to patients are often left uninvestigated, with emphasis given to research that expands market share

Here are the five areas of concern they identified and some possible solutions:

  1. Weak Research Foundation – Measure outcomes that matter to patients; and have a registry that requires publication of all trial protocols. Also, research outputs should have prominent warnings when the trial design, management and analysis were not done independently of a company who stood to profit by the outcomes.
  2. Low-Quality Evidence Synthesis – Conflicts of interests must be made transparent and minimized where possible.\
  3. Evidence Remains Inaccessible to Those Who Need It – Redesign research results so they can be understood by patients and clinicians, allowing them to review the harms and benefits in order to make better decisions about treatment.
  4. Ineffective Performance Measurement and Accountability – Measuring volumes while not paying attention to quality leaves patients vulnerable.
  5. Manufacturing Consumer Demand – The public and the media need to be more skeptical of industry claims and be wary of hype that over promises.

Like me, the authors are wary of changes happening anytime soon.

Solutions to these problems are visible but will be difficult to introduce unless there is a much wider recognition that healthcare has become less about well-founded, trusted relationships between healthcare professionals and patients, rather it looks more like a profit-driven service industry, where commercial interests have influenced the value chain.

The profit incentive is too great for Big Pharma and the disease care industrial complex to change. Why promote healthy diets, when money can be made selling statins or medical centers building huge coronary care units and cancer clinics.

I applaud these researchers for being so blunt about the issues affecting this system. I wish/hope more people will listen and demand change.

This Farmers’ Market Space is Enchanting – and Functional

Rotterdam Farmers Market

This new Market Hall in Rotterdam is a feast for the eyes.

It was built to provide a local, healthy food to the city’s center, but the architects did much more. They created this beautiful functional space for 100+ food vendors and surrounded it with apartments and other shops.


And look at that beautiful ceiling


This is the kind of smart design that makes cities flourish and grow.


This was too beautiful not to share. I’d love to see something like this in a city here in the US.


Images via MVRDV