Health Care Industry

1. Health Care Industry • Medical-industrial complex • The industry that supplies healthcare for a profit • Response to the opportunity to make large profits from the ill health of others • 600 billion dollar industry in US alone (2009)

2. Medicine • Is medicine a business or a profession? • Make money and is organized around fees for service business model (indemnified) • Makes new products and services only if profit is possible • Markets and Media blitzes • AND provides health and medical care

3. Industry • Began as a cottage industry of offices with little horizontal or vertical integration • Hospitals allowed for organization and integration • Insurers and payers gained control and increased profit motive activity • Now vertical and horizontal integration

4. Technology • Makes the cost higher—DOES NOT NECESSARILY IMPROVE OUTCOMES • Forgotten art of examination and history taking • More scientific precision and more trust in result • Complicates the Doctor-patient relationship

5. Industry of Medicine • Commercialization • Market-orientation • Competition • Threat to Moral Professional power base • threat to social contract—patient gives power to doctor to diagnose and treat and doctor agrees to care and be altruistic

6. Do No Harm—A Moral Obligation • Hippocratic oath • Mission statements • Malpractice law as check on obligation • If we have no contract to care, then less trust—poor morale of doctors and harm more likely

7. Specialization of care • Based on technology • Example of heart centers and other centers of excellence • Market oriented • More money • CCUs and ICUs cost more and have shiny technology—do they improve outcomes?

8. Special care units • Borne of the research that was designed to improve outcome • Little objective research of effectiveness • Is it ethical to do a blinded study and sort LIVES into experimental groups when lives are what is at stake?

9. Technology and ethics • Must control the technology not let it control us • Personal autonomy depends on full information and consent • Requires physician to be ethicist and doctor • Requires the patient to be competent and knowledgeable

10. Do we need the technology? • Simple measures most effective • Old drugs less costly and more effective • Prevention and health augmentation • Public health • Chronic disease and longevity

11. End of life issues • Technology can continue mechanistic “life” almost indefinitely • What is life? • What is quality of life? • Why quantity over quality—issue of uncertainty

12. Autonomy • At end of life requires preplanning and commitment to thought and action in specific ways • Requires knowledge (Foucault) • Power is Knowledge

13. Marx and technology • Unlikely that Marx intended the technology of medicine to be fitted to his ideas on stratification • Is the tech available without regard to social status? • Is money important to acquisition of healthcare?

14. Industry • Are we headed to a more comprehensive health support system? • Does this endanger outcomes and medical power structures? • How much is too much integration?

15. Pharmaceutical Industry • Life cycle of medication goes from • Research, Clinical trials to Regulatory approval • Marketing, Prescription and use • New indications, side effects and limitations • Panacea and safe, or harmful and removed

16. Pharmaceutical Industry • Drug as a social phenomena • Changing the potential of human kind with psycho-acute drugs • Lobbying efforts—patents and control on distribution • Who suffers in all of this?

17. Physician relationship to drug companies • New rules of ethics in relation to drug representatives • Can you take food and pens and be objective and use the best/most effective and cheapest treatment?

18. Examples • AIDS drugs and patent infringement • Foreign prescriptions and safety • OTC drugs • Vaccines and older drugs