There was an interview in yesterday's New York Times with Harvard Business School professor Clayton Christensen. (Not one of your shy and retiring professors, I should add). He's saying that the US healthcare system is terribly inefficient, and proposes (among other things) that some diagnostic tasks be opened up to a larger field of practitioners than just M.D.s. That's a worthy topic of discussion, but for one of the pure med-blogs, I'd say, rather than over here.
What struck me about the interview was something else - the tone of some of the questions. It's part of an "Armchair MBA" series by William J. Holstein, but the interview seems to have been conducted by Elizabeth Olson, so I'm not sure of the source. Here's the part that gave me pause:
Q. An example of what you mean?
A. A hundred years ago, there was a big disease that nobody understood and was often fatal, called consumption. . .what we thought was a single disease was a whole bunch of different diseases. You had tuberculosis there, at least three types, and you had pneumonia. We thought it was all one disease. So the care had to be left with doctors because they were the ones with the training and the judgment, but once you could precisely diagnose the cause of the disease, you could then develop a cure. It was so rules-based that you didn’t need a doctor any longer. Today a technician can diagnose those diseases and a nurse can treat them.
Q. Are you saying doctors rather than the pharmaceutical industry are the root cause of what’s gone wrong?
A. The pharmaceutical industry has been focused on therapy, not diagnosis. The medical profession has simply accepted that many of these diseases are well-diagnosed, when in fact they aren’t. As a consequence, we haven’t moved the health care profession into a world where nurses can provide diagnosis and care. Regulation is keeping the treatment in expensive hospitals when in fact much lower cost-delivery models are available.
Q. Wouldn’t your solution require a dramatically different regulatory environment?
A. It differs state by state. In Massachusetts, nurses cannot write prescriptions. But in Minnesota, nurse practitioners can. So there has emerged in Minnesota a clinic called the MinuteClinic. These clinics operate in Target stores and CVS drugstores. They are staffed only by nurse practitioners. There’s a big sign on the door that says, “We treat these 16 rules-based disorders.” They include strep throat, pink eye, urinary tract infection, earaches and sinus infections.
These are things for which very unambiguous, “go, no-go” tests exist. You’re in and out in 15 minutes or it’s free, and it’s a $39 flat fee. These things are just booming because high-quality health care at that level is defined by convenience and accessibility. That’s a commoditization of the expertise. . .
Q. Aren’t the pharmaceutical companies also profiting?
A. They are. But in general, pharmaceutical breakthroughs that involve a precise diagnosis of a disease and an effective therapy save the system a tremendous amount of money even though the drugs may appear to be high-cost.
Now, I've never found the tone of the NYT's business section particularly warm where drug companies were concerned. But this really seems to be pushing things along. "You mean it isn't all Big Pharma's fault? But your idea would still allow them to make money!" Do I have my gain setting turned up too far, or is this as obvious to other readers as it is to me?