Friday, April 18, 2014

Commoditization of MEDICINE

It dawned upon me, the importance of a name. Unlike Shakespeare who deemed that a “Rose by any other name would smell as sweet,” I beg to differ, not about the smell but about our perception of the rose, if we called it, say a “skunk.”
There is more to a name than meets the eye.

Doctors have long been called “doctors” because they were in Latin considered Church fathers, educators, advisers and scholars. Hmm sounds like a lot of hats to wear, doesn't it? But think about that for a while and you will find truth in it. Doctors do, advise, they are learned in the arts and science of medicine, they educate against unhealthy behaviors. Similarly the word “Physician” in Latin holds court as the natural science and art of healing, something more in line with being a doctor.

But recently the word in the politically correct world does not smell as sweet; it is “Provider!” Now why would anyone shy away from the word, doctor or physician that has been in use since the days of Hippocrates and Osler to this one coined by the elite? There must be something to it. For what’s in a name, you might ask?  Ah! But there is power in it. It (the name “doctor”) has long been immortalized in prose and poetry, in annals and tomes, in sickness and in health, in life and death and in any form of ritual or ceremony. Oh yes the word “doctor” has a significance that none other have. It is not the station or the pulpit but the knowledge and the critical thinking that goes with the art and science of medicine. That art, my dear friends cannot be replicated in the IBM Watson or the Star Trek Holographic guiding image of the future.

So then, why did the elite change the term doctor into provider?

To answer that question, we have to look at the word, “Commodity.” Commodity is a marketable item. It satisfies the “needs” and the “wants,” or “demands” if you will, of the populace. Since the commoditized product is not differentiated enough, the demand is great and the margins (or profits) are low. Hence the commodities that people cannot do without are bandied about in the market in greater supply to meet the demands. These commodities can be “hard” (mined) or “soft” (grown).  Examples of commodities include staples such as milk, wheat, corn, soy beans etc. You get the message.

Why does something become a commodity? Well, if the product differentiation is lost in either its function or functionality and is easily available in the marketplace, that product has been commoditized.  Lo and behold, the word Commodity was first brought into the lexicon by none other than the French, who have a penchant for socialistic ideals.

To commoditize, one has to mass produce the product or has to reduce the value by creating competing products that are less differentiated. Debasement of any product in the market is the first and the unkindest cut of all in a marketplace. Vilify the product, demonize the brand or hurl baseless invective by flooding the airwaves and you change the value proposition of the consumer.

Okay, so those who have followed the trend can easily see where I am going with it. Here are the nine factors in the making of a commodity:

1.       Debase the name. But the long tradition of what the words “doctors” and “physician” represent are difficult to eliminate from the mass memory. So the elite take a swipe and gradually change the title to “Provider.” Ah it is catchy and they use that in various media, oozing slowly into the mindset of the populace. As time goes on the “provider” term starts to take on the nurses and then the home care givers, the technicians, the transporters and the house-keepers. Everyone who might have an iota of influence in being involved in a hospital, private clinic or in a university, is a “provider.” When everyone becomes a provider then everyone in the eyes of the beholder has similar value.  You ask, “who’s my provider?” The answer might surprise you.  And surely as I write this, I find that a certain expert elite named, Ezeke Emanuel, MD of University of Pennsylvania as stated that 80% of all medical care can be provided by Nurses, Physician Assistants, or Nurse Practitioners.  And they are now making noise for equal pay for services they render with less education- so much for cost control here… Huh? Really? Oh but wait, the NPs, PAs and others are rallying behind that cause because they get to be “doctor-providers.” And many wear the white coats and hang their stethoscopes around their necks as they arrive. (And I am not going to make a disclaimer or a politically correct statement here either).

Are they up for the challenge?

2.       Next create guidelines to minimize differentiation in what the “Provider” can do. That reduces the underlying principles of the “Art” in medicine and turns everything into a “soft” science. (And I am being nice here the real word is “pseudoscience”).  So elites and experts now create massive amounts of guidelines in how to treat illnesses. But, and you might have guessed it, they forgot the individual patient. You see no two patients are the same and none ever fit into a category or a cubby-hole. The “Unum” is very much alive in the e-Pluribus Unum. Yet the march to dedifferentiate continues at break-neck speed, maiming all and any defiance.

3.       The third arrow to take flight against the doctor is the new art of “Choosing Wisely.” The concept is so convoluted and does not fit good medical care in the majority of patients that at times it appears that some other element, not being mentioned is the driver behind that program. Everyone falls to their knees and prays to the neon gods and those that don’t are taken to task. And  …

4.       Meanwhile as the commoditization of medicine is in full swing, a constant harping about costs and how the US is far behind other countries in health and survival outcomes is drummed into the spongy brains of non-critical thinking crowds that are busy trying to make ends meet. The graphics are titillating; the charts are colorfully expressing the desires of the experts and the elites, they show; US medicine is subpar and more expensive. But no one, no one looks at the cost drivers.
They seem to hone in on the doctors (here they call them “doctors” and not “providers” to complete the image). Meanwhile the drivers of hospital care and the newly discovered pharmaceutical drugs and the latest innovative devices
and the Administrative Costs remain unmentioned. Only the physician is under the magnified scrutiny!

      On the one hand there is this crush of cost related difficulties and the “fortunes of a great nation is at stake” and the entire fault is laid upon the shoulders of the doctors (er, providers). And as surely as the sun rises, other mandates are drummed up including Electronic Medical Records (EMR). EMRs have created another gulf between the doctor and his or her patient and the value of the doctor through this enforced interaction has further minimized the value of a doctor/physician in the eyes of the patient. However as many have pointed out that EMRs have created larger barriers in medical care and added to the complexity, reduced efficiency and exacerbated the costs (that the experts want to reduce). The drumbeat of progress continues. Oh well!

6.      SIX
      Springing into contention and not wanting to lose out on the revenue stream a hodge-podge of self-appointed experts are making billions of dollars on the plight of the doctors. The costs of the EMRs are astronomical and are never paid in full. But the makers are enriched. Others who benefit are the “data trolls” who glean (mine) and create nuances of “appropriateness of care” and also find means to kill any attempts to expose their deeds by hiding behind software algorithms. For example, Epic Systems had revenues of $1.2 Billion in 2012 from this meaningful enterprise.

     The ongoing onslaught continues in the form of a daily banter about “Bad Doctors” (not providers). There is a daily dose of fraud committed by bad actors in the medical field and some are unfortunately doctors also, but they are demonized in large print to make the point that the nobility in this privileged field is no longer. It makes for good news worthy headlines. It keeps the agenda in full Monty.

     The sound and fury is also enjoyed by the legislature, who in their desire to show the public that they are doing an admirable job in their well-entrenched capacities, want more “heads” on the chopping block. The whips and scorns continue to rain on this once noble profession and nary voice is raised in opposition for fear.  Criminalization of doctors remains in full force and escalates daily. Here are three separate insights. 1.  and 2. and this one for sure: 3. “The Criminalization of Medicine: America's War on Doctors (The Praeger Series on Contemporary Health and Living)” First Edition 2007 [Hardcover] by Ronald Libby

To boot Medicare just completed their first MD Data Dump and lo and behold it is the talk of the town, nay, the country. Anyone can see who was paid what. But the details of what was the profit in all that is not deciphered. The obvious reason it seems is to incite the rage of the public that is a willing accomplice in the class warfare. The lynching continues through every means available to reach the end.

When business, politics and medicine converge there are bound to be deleterious consequences. There are! You might be in the ivory tower making the claims, you might be a nobody who has found a fog horn to exclaim, you might be a self-serving individual bleeding the life out of the noble profession for pecuniary gains, you might be a believer in the commoditization of the doctors and medicine as a whole or you might be an intellectual in pursuit of another paper to serve your own needs, whoever you are, know this, there are unintended and deleterious consequences to these actions.

One cannot take the “Art” away from medicine and one cannot make decisions on the shifting sands of contrived “evidence” and base all decisions on such contrivances. The Art works hand in hand with the Science. Both flourish together and neither survives without the other. For instance Washing hands with soap and water is better than Purell! But someone is making a boatload on selling Purells. These little bottles are ubiquitous, mandated to keep our hands sanitary. No one wants to appear dirty, right? But through it all the most ancient of life (viruses) continues to spread as it will, because it is ancient and it has learned to survive. One day the virus will have mutated to understand the Purell mechanism, and a new "Improved Purell" will be concoted by someone and the inexorable march of one besting will go on...Meanwhile Simmelweis...But I digress...

Does Healthcare need a reform? You bet! We definitely need it!
But what kind? And how to implement it?
Should it be cost driven?
Should it be care driven?
Should it be based on arbitrary "Evidence?"
Should it require input from Physicians, Economists, Politicians, Public at large?
Should it be based on the Economics of Political Science?
Should it be based on the Politics of Economic Science?
Should it be based on Pseudoscience of Correlation?
Should it be based on the Business Model or modeled after a Business? 
Should it be based on Patient care or Care of a Patient?
Should the patient have a stake other than healthcare being free in the care of his or her own health?
Should 3rd Party reimbursements be removed thus removing incentive for physicians?
Should a direct patient-physician relationship remain private and not doled out into the digital realm?
Should Medical care subscribe to the data-mining pseudo-evidence as a surrogate for reality?

I mean I could go on... You decide the right question and the answer to it yourself. You are so armed with information!

Currently Karl Marx is here in spirit and pounding his chest with pride!


  1. Spot on analysis, but few will listen and work to make changes; alas.

  2. What you have described is part of the "Great Plan' of the 'elites' who have decided to hook everyone (Doctors inclusive) onto the 'monetary system', from which there is no escape. With insight comes awareness, but the fundamental question is: How many people are prepared to 'wake up'?