Plus ça change....

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Pardon my French, but there's no better cliché to describe a special issue of Harper's magazine dated October 1960, starting with the cover headline: "The Crisis in American Medicine."

A powerful case of déjà vu begins with the editors' foreword: If American medicine is really the best in the world, why are millions of people dissatisfied with the care they receive? Why are our hospitals on the verge of bankruptcy? “The ever-more expensive technology of the healing arts has convinced both political parties that government action is called for,” yet powerful groups still “fight to the last ditch against changes that have been adopted long ago in virtually every other civilized country.”

The second article reports that “the doctor-patient relationship is at a low ebb,” with docs providing “hasty, superficial, and impersonal treatment.” The high cost of care is another source of complaint. (After all, a complete physical now costs $40!) “Medicine, in truth, faces…a breakdown in communication between doctors and patients,” made worse by the fact that as patients grow more sophisticated they show alarming signs of thinking for themselves.

The litany of '60s problems goes on:
Medical errors: instruments improperly sterilized, antibiotics indiscriminately prescribed, emotional problems neglected.

Shift in medical care to clinics and hospitals where “the patient is often a total stranger.”

Specialization and sub-specialization. “Without a personal physician to ride herd on the specialists you cannot have good medical care,” and “in focusing on his [sic] particular field of interest one specialist might miss a manifestation of serious illness in the preserve of another.” Suggested solutions: training more family practitioners and (some things do change) group practice.

Loss of respect for medical profession, due to the change from personal service to the “highly intellectualized approach demanded by the sophistication of modern biological theory.” The result: more malpractice suits. This organized medicine insider sees potential disaster for the profession in “identification with the ultra-conservative” politics.

Environmental forces with effects on health: diets rich in meat and fat, lung cancer due to smoking and air pollution, and lack of activity, and “the likelihood of contact with new microbial agents.” (Turned out to be viruses.)

There were also some hopeful trends: the recent development of open heart surgery, the arrival of foreign medical graduates offsetting the “doctor shortage,” and the “ability to manipulate the gene.”

Though some things did change—think Medicare and widespread bans on smoking —the same basic problems still persist. So perhaps the authors and editors were wrong to conclude that the problems they identified in 1960 represented a crisis. From today's perspective they look more like the beginning of long-term trends—trends that are more likely to accelerate than to go away. There is a lesson in that: systemic problems will not be cured by piecemeal solutions. And that lesson applies not only to medical problems but to the related ones faced by pharma marketers: the first step in developing proper defensive strategies is an accurate diagnosis.  

Warren Ross is MM&M's editor at large

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