Progress, Potential, and Possibilities https://www.youtube.com/watch?v=Y2AwJ7_ci3A discussion of Free to Choose Medicine (FTCM) http://www.freetochoosemedicine.com.
Highlights:
05:00 Gold standard of randomized control trials versus gold standard of systems thinking
15:00 2019 Science article critical of FTCM and Madden’s reply in Econ Journal Watch https://econjwatch.org/articles/science-on-fda-liberalization-a-response-to-the-status-quo-process-for-medical-treatments
19:00 FDA culture: good people in a dysfunctional process
20:00 Way of looking at the problem
21:30 Dynamic system
24:00 Big data analytics and subgroups
28:00 PatientsLikeMe.com https://www.patientslikeme.com/ and MyTomorrows.com https://mytomorrows.com/en
31:00 Frank and Abigail Burroughs
34:00 Venture capital funding
36:00 Bipartisan FTCM legislation in 2021.
Related: Diane Abbitt (Left) https://www.huffpost.com/author/diane-abbitt and Bart Madden (Right) http://www.learningwhatworks.com share common ground and coauthor an op-ed, “Seniors Suffer the Most from an Antiquated FDA Approval Process” https://thehill.com/opinion/healthcare/515145-seniors-suffer-the-most-from-antiquated-fda-approval-process.
Madden at Rockford University, 2018, speaking on his Value Creation work.
(Another perspective)
The medical loop: the State healthcare’s autoimmune disease
The unforeseen consequence of state healthcare
In 2009, the buzzword in the USA was healthcare or Obamacare. Back at that time, I was clearly on the side of national healthcare as we have in France. Here is a personal example of its usefulness. My wife and I were about to make a road trip on Quebec’s roads, but then I had a health issue. Without French healthcare, the cost of all the examinations I had to go through would have had canceled our road-trip project. It was not as serious as expected, and we enjoyed three marvelous weeks in Canada. My example still stands, but people must be aware of a deeply hidden consequence of state healthcare. It might be corrected but even if it’s the case, I fear that it will cost too much, and the solution might be simply to stop the state healthcare and go for local, non-state, help. I believe state healthcare is a good but dead-end idea. It has all the appearance of a fine concept to help people, but in the end, it decreases significantly the quality of healthcare. How come?
The medical loop disaster
The term ‘medical loop’ I will use describes a system in which the patient is no more the focus but the system itself. The evaluation of the quality of service shifts from the resolution of the patient’s problem to the efficiency of the system to treat everyone. Healthcare is considered optimum if everyone is in the system, not if the doctors have found the solution to your problem. Being in the system means you will be cured. The patient enters a medical loop, in which it will travel from one specialist to another until it gets better. In many mild cases, people are just fed up to go to the doctor and despite their problem not being solved, they drop out of the medical loop, while the system congratulates itself on the patient’s healing.
How did this happen?
When a state is in charge of the healthcare system, by the theoretical definition it defends the people. However, it is also a system, which is so powerful that the other actors have no other choice to become systems themselves. In the end, the doctor system, the insurance system (private), the lawyers, and the state, speak together. Systems care only about systems. When the state takes over healthcare, all other systems are subordinate to it because as a state, it makes laws to which all other systems are bound. It also has control over the money, like taxes. The other systems will fight for their lives, and the patients will be sacrificed. There is another reason, which is mechanical. Any system tends to optimize itself and as a rule starts to be unable to take all the particularities of individuals who constitute the system, aka the patients. Doctors see no more a patient but an ‘agent’ that needs to fit into the system. The return of information from the patient to the doctor will no more be relevant, only the feedback between systems.
What consequences does it have?
The quality and effectiveness of the healthcare system will slowly decrease. The skills and level of knowledge of practitioners will follow the same trend. They are trapped in a feedback loop as I have explained in the chapter ‘Thinking in systems’, the drift to low performance produced by the evaluation based on previous performances. The real evaluation which is given by the patient’s health status is no more taken into consideration, only the evaluation of the system by the number of patients it can handle.
There are also side effects. The first is accountability. The second is trust. If the patient stops being the point of reference by which the medical workers evaluate the quality of their work, to whom are they accountable? The answer is, to the system and themselves. The system doesn’t care much about what they do to the patient if the system still runs, and they will certainly not accuse themselves of any wrongdoing. The result is no accountability, whatsoever. The second side effect is that trust between doctors and patients is damaged. Doctors know full well about the consequences of a trust issue with patients, regarding the diagnosis and treatment. It is simple. To treat the patient you need to make the right diagnostic and to be able to do that you need reliable information from patients, which is possible only if trust exists. Moreover, most doctors, in a bizarre way, think that they still help people, while, in reality, they are only helping themselves. By ‘bizarre way’, I mean, they twisted reality to avoid to face what is happening and what they are taking part in. They prefer to protect themselves by surrendering to their new master, which leads to psychological and sometimes physical mistreatments of patients if the patient rebel against the medical loop. An unsatisfied patient is not someone whose health is not going better, but an aggressive person which the system needs to take care of, it follows the criminalization of any opposition to the medical loop.