A major rave

The takeover of the medical profession by managers and bureaucrats over the last ten year has been quite extraordinary and shows no signs of slowing up. Why?

The takeover was inevitable and it is going to intensify. Why?

The cost of drugs and surgery are skyrocketing - many thousands of dollars per year per patient for some treatments.

Customer demand is intense. They want the latest and best. They believe in magic bullets.

Doctors are also susceptible to the latest and the best. They need to be able to do something!!

When third parties are paying the bills, the customers don't care and neither do the doctors, someone has to reign in the spend fest.

The third party payers know that zillions of customers are not benefiting much or are being harmed by many treatments. They put out information re harms and it is largely ignored. They are of course suspected of penny pinching.

Doctors become attached to their treatments even when they have been shown to be harmful. They all too often can not or won't let go or change.

Individual doctors can not keep up with the total knowledge and skills base - even specialists have difficulty in their own field.

The knowledge base is highly polluted. Vested interests, bias, egos, unwillingness to speak out, fraud and spun research fool both doctors and customers.

The ability to assess information is not easy and is extraordinarily time consuming. Evidence based medicine has its problems. The more one knows the more grey things become. Neither customers nor doctors like grey. Each person and organisation comes to the party with their particular bias.

The drug and medical technology companies have a duty to their share holders. Benefits are exaggerated and harms put aside. They have huge resources to influence. They have billions of dollars at stake. They do not have your interests at heart.

Many of the guideline bodies have medical advisers who benefit from handsome handouts from the drug and technology companies. They claim these payouts do not influence them.

The major medical journals make their living from drug company adverts and reprints. They, well some of them, admit this is a problem.

More and more research is drug and technology company funded. University departments are all too often dependent on these companies for their survival.

Those that do systematic reviews have their biases and blind spots. Even professional critical appraisers of information can not avoid bias.

The profession has to a large extent lost the right to call itself a profession. There is just too much evidence that doctors do not have patient interests before there own. Medicine has become a business a very expensive one at that - exponentially growing in cost.

Those that pay the fiddler must feel driven to do something about the above scenarios.

A growing number of potential customers who cannot participate in the latest and greatest bring political pressure to spread the 'benefits'. Yet another reason for external controls.

The result - doctors have become or are becoming pawns of government departments, insurance companies, those they work for and the suppliers of drugs and medical technology.

As guidelines and protocols become rules to be followed one has to ask do the protocol and guideline manufacturers have the patients best interest at heart. To what extent do the above companies influence and control what goes on? As individuals they probably care but they too are subject to external forces and interests. They too may fear stepping out of line.

In the end it seems to me that the doors are now wide open for the drug and technology companies to have their way. Government bodies may do their best to reduce costs and obtain maximum effectiveness but when one looks at the whole statin thing and how this is promoted and its use endlessly extended, it seems we are on a slippery slope and your doctor isn't going to be able to help.

As bad as things may have been when doctors were free to operate from their own assessment of information I see no light the way things are going. When your doctor is a corporal in the medical machinery there's not much he can do. If he or she is top brass there still isn't much they can do. They are caught up in it all.

The end result of where we are going is disempowered patients and doctors with third party payers thinking they are in control whilst being manipulated by the drug and technology companies. What's the solution? I have no idea. It's all too big for anyone to sort out. So things will bumble on until things fall apart and yet another system is promoted.

America performs huge numbers of heart operations for coronary artery disease - billions and billions of dollars are spent - patients know they have benefitted and the demand grows. Yet the stats show they actually obtain little benefit - there are exceptions of course - their results keep the whole thing going. The evidence for benefit is unimpressive. Some people are harmed. Yet both doctors and patients are keen!

Anyone got any solutions??