Posted by: drwbortz | January 31, 2011

State of the Nation’s Health: January, 2011

  1. I am  energized to blog again, after Obama’s State of the Union address. I guess that re-energizing the people is the purpose of this message.
  2. In my case, at least, it worked. On the 26th of January 2011, I was nestled in the satisfaction that the recent publication of my seventh book, Next Medicine: The Science and Civics of Health, was accomplished.  I’m very proud of it. In my view, it is my effort to “capture the moment”, to “carpe the diem”.
  3. As a devoted participant and observer of my profession for many decades, I feel that it is my solemn duty to address what I and most others identify as a huge problem in its ranks, I acknowledge fully my part in its problems. After all, it happened on my watch. But I relish the opportunity to pay back, hopefully in full measure, by proposing what I see as “A,” if not “The” solution.
  4. First, in my book I list the symptoms of current Sick Medicine: cost, injustice, danger, corruption, inefficiency, inconsistency, and finally irrelevancy. The first six of these problems are huge in and of themselves, and are interconnected with the others.  In many of these domains the practices of Current Medicine are clearly perverse.  The cost of health care insurance is the largest cause of personal bankruptcy.
  5. But it is the last symptom, irrelevancy, that is central to all the others. What I mean by irrelevancy derives from my nominated Mission Statement of Medicine: “the assertion and assurance of the human potential.”  If we can agree on the truth of this job description it is immediately apparent that Current Medicine is not congruent with the latter part of this mission, “the assurance of the human potential.” It is a square peg for a round hole.
  6. In Next Medicine. I address the centuries’ long events which led medicine to its current operational format. Until Louis Pasteur of just 150 years ago, medicine was the province of scripture and shamans. Pasteur changed all of that. He showed that metaphysical objects were not the cause of mankind’s big assaults. Instead a bug was.
  7. Rapidly medicine achieved a robust legitimacy for genuine human good.  Medical science was born. It achieved subsequent great success in addressing the acute infections which dominated our death certificates till recently.
  8. This success led to a changed landscape. In less than a century, no longer did we linger and die from acute infections, but from chronic illnesses of diverse origins and courses. Further, the new Riders of the Apocalypse are not the ones where current medicine was appropriate. The twin tools in medicine’s black bag.
  9. Surgery and pharmacy, the legacy of an earlier era, are irrelevant to the behavioral origins of today’s killers. We are therefore faced with a huge anachronism, facing today’s problems with yesterday’s treatments. The current killers are not curable. Heart attacks, strokes, diabetes, arthritis, much cancer are palliated, but not cured. Yet Current Medicine has become addicted to the great financial rewards, which are inherent in the old paradigm.
  10. Zimmerman’s Law says “nobody notices when things go right.”  Health, although invaluable, doesn’t pay.  Or at least the way Current Medicine is practiced.  Health promotion and disease prevention are not billable items.

Therefore we need a new direction, a drastic cure, we need a system transplant.  We need a total reconceptualization of our system with different personnel, from subspecialists to expanded primary care providers at different levels, we need different personnel training, recognizing that the intensive care in the hospital should not be the primary locus of M.D. training. The home and community should be. The payment for medical care should not be fee-for-service, but pre-paid. We should reformulate so that health is the product we are selling rather than disease. We need a health care, not a disease care system.

This is the message of Next Medicine.


  1. Totally agree on all fronts. I’ve been recently with a sick relative attempting to navigate through the SYSTEM and the cost, the unnecessary testing and over subscriptions of drugs was very upsetting. It only made the patient worse and more frightened.

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