This week, in the course of my usual perusal of all things newsworthy, I couldn’t help noticing that this has been a big week for science. Two planets, one colder than the human body and one that is made completely out of diamonds, were discovered by astronomers. A study estimated that there are roughly 8.8 million species of organism on the planet, with only 25% having been discovered thus far. Finally, and unfortunately, most every television we turn on right now has at least one oceanographic map showing the path of Hurricane Irene, showing us meteorology in more immediate terms.
In contrast, a majority of the news that came out of the health care sector this week revolved not around medical discoveries, but finance, and not in a good way. My inbox was seasoned with stories of hospital layoffs and mergers between facilities due to financial necessity. This past Tuesday, CMS released yet another payment initiative, this time dealing with bundled payments for facilities and physicians for hospital cases based on conditions treated, with the payments being generous or penurious depending on outcomes and applications of previously agreed-upon standards of care.
I am struck by the appearance of the rest of the scientific world moving forward while the medical community in the United States is focused not on research, discovery or health innovation, but with how to control costs.
There is a cautionary tale in another science story that came forth this week. Perhaps no scientific story will be bigger in 2011 than the end of the Space Shuttle program. In the beginning of the program, the Space Shuttles dealt mostly with the placement of satellites in high Earth orbit. In later years, one of the main tasks of Shuttle missions was delivering supplies to the International Space Station (ISS).
When the final flight of the program concluded earlier this Summer, it was understood that the reason for the demise of the program was its ”extravagant” cost. We were also told that the ISS would be resupplied by ships from the Soyuz program in Russia, as well as Japan and private firms in the United States. We were also told that they could provide the service at a lower cost.
With all of these facts in tow, and seeing what the orthodoxy of getting everything cheaper has done to destroy American businesses in my lifetime, it was with very little surprise that I read the story of the first such post-Shuttle resupply ship being launched in Russia on Wednesday, and subsequently crashing in Siberia. Three tons of food, water and other supplies instantly vanished. Lest anyone think that this is an isolated incident, it’s worth noting that this is the fourth failed launch from the Russian space program in the past nine months.
We find ourselves at a similar crossroads with regard to our health care system. The forces focused on lowering costs are beginning to dominate the argument about what’s best for the system as a whole. Lost in all the hand-wringing about dollars and cents is forgetting about the core mission of the field of medicine, which is healing the sick while doing no harm.
The study and application of the fundamentals of medicine is, at its root, a purely scientific endeavor. It has been a common refrain from our medical community, in the face of nearly 40 years of insurance company battering, that defensive medicine is now the norm. This style of practice is not what they have been trained to apply. We have learned far too often in human history that science must possess, above all other things, precision. When this is sacrificed to save a few dollars, you get results such as the children of thalidomide, E. coli outbreaks from our food and supply rockets crashing in rural Asia.
The study of evolution is in large part a study of adaptation. Our health care system is beginning to adapt to a cheaper model, but more and more I suspect that the evolving organism resulting from cost-cutting orthodoxy may turn out to be one far more lethal than any we have seen before.