Later On

A blog written for those whose interests more or less match mine.

Best medical system in the world? Really?

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Donald McNeil, Jr., reports in the NY Times:

For months, a simple generic drug has been saving lives on America’s battlefields by slowing the bleeding of even gravely wounded soldiers.

Even better, it is cheap. But its very inexpensiveness has slowed its entry into American emergency rooms, where it might save the lives of bleeding victims of car crashes, shootings and stabbings — up to 4,000 Americans a year, according to a recent study.

Because there is so little profit in it, the companies that make it do not champion it.

However, the drug is edging slowly closer to adoption as hospitals in New York and other major cities debate adding it to their pharmacies. The drug, tranexamic acid, has long been sold over the counter in Britain and Japan for heavy menstrual flow. After a groundbreaking 2010 trial on 20,000 hemorrhaging trauma patients in 40 countries showed that it saved lives, the British and American Armies adopted it. The World Health Organization added it to its essential drugs list last year, and British ambulances now carry it.

But outside Britain, it is used in very few civilian hospitals, though almost six million people around the world die each year of trauma — 400,000 of them in hospitals. A studypublished March 1 in BMC Emergency Medicine estimated that the drug could save up to 128,000 of those lives a year, 4,000 of them in the United States.

The slowness of American hospitals is due to . . .

Continue reading. The author quotes one doctor as saying the problem is “inertia,” which begs the question: that’s not an answer, it’s just a different word for saying that hospitals are not moving to adopt it. But why not? Reason: In the US medical treatment is a profit-oriented business, and like all such businesses, the constant drive of the institutions and businesses is to grow profits. As noted many times, a modern corporation is legally obligated to put profit considerations first (or face shareholder lawsuits for abdication of fiduciary responsibility). Unfortunately, profit considerations don’t always work well for every situation, and here we see a drug that could save lives by the millions being rejected—or at least not adopted—because the profit potential is so low. So you die? So what? The hospital must make a profit or it will not be able to function, so let that be your consolation.

But maybe—just maybe—the profit model is not the only model to use?

But even then one must face the pig-headed obstinacy of the stupid—Dr. Holcomb, for example, who rejects findings of clinical trials because… well, because he can, I guess. So what if patients die? Not his problem.

UPDATE: It occurs to me that Dr. Holcomb offers an excellent example of how ideology overrides evidence for some people: a study of 20,000 people shows no side effect, but Dr. Holcomb rejects the study out of hand (and, presumably, without so much as a glance at the data) because he has his convictions and those he will keep even if he must ignore conflicting evidence. Much easier for him.

Written by LeisureGuy

21 March 2012 at 2:39 pm

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