Thursday, September 6, 2012

KNOW-HOW AND KNOW-WHY


A new procedure, bronchial thermoplasty, is becoming available to people who suffer severe asthma. It consists of introducing a tube called a bronchoscope into the airway and then heating the lungs, lobe by lobe, to 149 degrees Fahrenheit. This apparently reverses the smooth muscle swelling characteristic of asthma. Post-treatment studies indicate fewer attacks and fewer hospital visits. It costs around twenty thousand dollars.

Understandably, insurers are reluctant to cover it, their rationale being that it’s still “experimental.” So some—or maybe most—asthma sufferers will go without bronchial thermoplasty. This seems a shame, say many, since the multiple hospital visits and treatments that the procedure might obviate will cost far more than twenty thousand dollars.

This exemplifies healthcare’s predicament. New and possibly effective technologies are constantly coming down the pike. What they have in common is breathtaking cost: high-tech is inarguably expensive. Someone needs to pay for it, and it will inevitably be end-users, either through taxes or higher insurance premiums. The more optimistic view is that high cost in a single treatment is possibly cheaper than dozens of hospitalizations. I find it hard to take sides on that, but it makes me recall the observation a friend from Mumbai offered me: “You Americans have a lot of know-how; what you seem to lack is know-why.”

That is, we could ask ourselves why there’s so much asthma these days. In our little rural county, asthma incidence has increased along with constant rise in ozone, a known cause. Now one of every six of our kids is asthmatic. Our ozone isn't created here, but drifts here from population centers, where it’s generated by internal combustion exhaust.

We treat asthma—and a host of other preventable illnesses—only after it’s gotten to the emergency department level. We could choose to prevent much of it by providing ourselves cleaner air. By the same token, we could prevent much of cancer by questioning the presence of thousands of chemicals added to our foods and other products, and much of cardiovascular disease with personal habit changes. 

But our political system is gridlocked, and our healthcare system limits its jurisdiction to flagrant disease. Insisting on overt disease development instead of sensible prevention, we’ll be faced with dilemmas such as the efficacy versus cost of high-tech procedures like bronchial thermoplasty. A genuine “breakthrough” in American healthcare will be to address illness far earlier in its development. That would require a sharp increase in personal responsibility and civic participation. Are you willing?

2 comments:

  1. When I started reading this post I wasn't sure where you were going with it. No surprise, your viewpoint and mine are as one :-)

    When will we have the courage to address the roots of the problems rather than continuing to clip the leaves off the tree?

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  2. Hear! Hear!, Dr. J!

    No one with any compassion will say to people whose lifestyles have wrecked their hearts, "No, you can't have a new one." We'll do the transplant.

    But let's also intervene earlier, before damage. Not to do so is to enable behavior we know to be self-destructive. Is that helping the patient to be healthier or actually unhealthier?

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