Improvement of Health Care

By Edward J. Klein

Research has shown that the immense cost of disease care could be significantly reduced by proper preventive health care

Another cause of reduced life expectancy in the U.S. has recently been discovered. Statistics show that the U.S. ranks 25th in the world in life expectancy, while Japan ranks number one. Correlated with those statistics is the fact that Japan has the least gap between rich and poor, while the U.S. has the widest gulf in the developed world, statistically about twice as bad as that of India. Researchers for the AMERICAN JOURNAL OF PUBLIC HEALTH recently examined the records of 282 of America's 283 urban areas, and found a direct relation between income inequities and shortened life expectancy, both for the rich as well as for the poor. Huge inequities produce a breakdown of social cohesion that leads to poor health, as well as to the worst crime rate in the developed world. Dr. Klein proposes intelligent changes in the tax code that would lead to a more humanitarian and healthy society. These changes are explained in position paper number one.

Safety of medication is another important issue for Americans. In 1998, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION estimated that 106,000 Americans die per year from the side effects of properly prescribed medication. Those adverse drug reactions, then are the fifth leading cause of death in the United States. This is in addition to the 44-98,000 who die from errors and malpractice. In the past two years, four drugs and one immunization have beeen withdrawn from the market because they were killing people. How did these unsafe products get released? In 1997, FDA approval standards were cut in half by the "Food and Drug Modernization Act" (FDAMA), a law written and heavily pushed by the drug industry. This law reduced safety standards to unacceptable levels, and needs to be repealed, so that we return to the standards that had evolved over decades for proper drug regulation. Our present standards are so low that Ralph Nader's PUBLIC CITIZEN HEALTH RESEARCH GROUP recommends that no one take a drug for the first five years it is on the market, unless it shows marked superiority to everthing else on the market for that ailment.

Another signifiacant health care problem is the advertising of presciption drugs directly to the public. This is clearly not in the public interest. The drugs that are advertised are not those that are most effective, but those that are most profitable. For example, the most-prescribed blood pressure medication is a calcium channel blocker. Although it costs 100 times more than competing medications, it has no published studies demonstrating that it reduces the risk of heart attack. It is prescribed over other less-profitable and more effective medications, simply because it is so heavily advertised. Polls of patients have indicated that 15% of patients are willing to change doctors if the doctor refused to prescribe the medication the patient requests. Such a system can easily lead to improper medication. We propose prohibiting drug companies from advertising directly to the public. This would also result in significant reduction in drug prices due to the savings of advertising costs, estimated to be $2 billion per year.