Supposedly the Chinese used to pay their Doctor when they were well; and stop when ill. Interesting to see how that might work in the West!

An observation I have yet to hear anyone discuss:

According to Kaiser (or is it RWJ?), roughly 20,000 deaths a year can be attributed to lack of insurance. According to IOM's outdated (and highly conservative) report, 50,000-100,000 die each year from preventable medical errors. . .and that does not count drug interactions that occur outside hosiptals. And some even put the number of iatrogenic deaths much higher.

So medicine itself directly contribues to at least 5x as many deaths pure year as lack of insurance to pay for medicine?

The medical profession in this country is very very sick indeed. I am still trying to figure out how the hell 20 million prescriptions were written for a drug which is marginally more effective than alleve (Vioxx) and which obviously had a higher cost in $$$ and health? Who wrote these prescriptions? Who is writing all the Zyprexa prescriptions for 0-5 year-olds?

Why do we give these people government sanctioned monopolies? So they can just do whatever a sales rep tells them? I can do that?

Autopsy studies show that doctors get the diagnosis wrong in 2 out of 5 terminal patients (1 in 3 of these would have been expected to live if the misdiagnosis was caught). Bad enough. But here is the kicker: THIS HAS NOT IMPROVED SINCE 1938!

Now. . .I know that medicine is difficult due to the unfathomable variability of the human body and its response to diseases and treatments, etc. but for the love of god, NO IMPROVEMENT over almost 7 decades?

Utter . . . systemic . . .professional . . .failure.

With all due respect, I would not say "drugs and lifestyle" or "lifestyle and drugs". I would say "diet and lifestyle", drawing from my having spent over 40 years doing experimental research on diet and health/disease and over 50 years doing experimental and other kinds of research--mostly at Cornell University--that was published in the very best scientific, peer-reviewed journals. I also have spent about 20 years on expert panels doing national and international diet and health policy.

I hope that this does not come across as arrogant. Coming from a farming background and believing in the good ol' American system, I learned from the experimental research that I did with my many wonderful students and other colleagues, that our medical system has drawn from the wrong paradigm. I do not say that drugs have no value, only that they should be relegated to a very low priority. I am convinced, not just from my own work, but from the 'proof of concept' clinical experiences of a growing number of clinical (MD) colleagues and their thousands of patients, that diet and lifestyle alone, IF DONE RIGHT, would be capable of eliminating at least 90% of all illnesses. The evidence from the experiences of my clinical colleagues and from my own formal experimental research is entirely consistent. It is exciting indeed. My views are summarized in a book that I wrote with my son, Tom, called "The China Study. Startling Implications for Diet, Weight Loss and Long-Term Heatlh", that is now a national best seller.

I commend you on bringing such an important topic up for public discussion.

Merrill- Thanks for agreeing on the need for prevention. Even head of U.S. NIH Elias Zerhouni said our current treatment based "disease care" system is NOT economically sustainable. He is correct! I'd like to see more prevention/health promotion in HR 676 too.

Dr. Rick Lippin

Morris--

You question the integrity of doctors and the authority and power of the AMA--very good points.

Currently, it seems there is a large focus on wrongdoing by pharmaceutical corporations--from training reps to promote off-label, to hiding known clinical-trial findings that impact negatively on a drug, to the "purchase" of leaders in colleges, med schools, advocacy groups, prestigious journals, to wrongful deaths caused by harmful drugs, etc.

Perhaps, if the collective "hands" of Big Pharma get slapped severely enough, we might expect some change--at least we can hope. Should--and I recognize that is a very big SHOULD--that happen, perhaps the atmosphere will be ripe for shining a very bright light on the medical profession, and individuals doctors. As long as they can shift the blame elsewhere they have a convenient measure of deniability. If pharma--by means of the pocketbook--is FORCED to clean up its act, who can be charged for mis-prescribing?

Years ago, doctors were "educated" by Big Pharma that rDNA insulin was "just like the human body makes." They did not demand scientific studies that compared the new rDNA material to the old standard natural insulins. The medical profession (individuals doctors within this specialty) had the power--but not the will--to demand (1) safety studies more intensely focused than those provided to the FDA by Lilly; and (2) retention of natural insulins as long as a NEED remained. They chose to do neither . . . to accept the pharma jargon as gospel. The current off-label prescribing of Zyprexa represents the same type of shoddy "doctoring." Accountability will come--just not quickly.

With the current medical crisis (addressed in Merrill's piece as well as the cogent comments here), the best we can hope for is the answer to the rhetorical question: "How does an ant eat an elephant?" [Answer: one bite at a time.]