Why is American health care so expensive?

In 1971, as medical science was wrestling with the observation that elevation of cholesterol levels was associated with heart attacks, a Japanese chemist named Akira Endo discovered a substance that inhibited the enzyme HMG CoA reductase and thus lowered cholesterol levels. His original chemical was never introduced due to significant muscle toxicity and the fact that it caused tumors, but not long after, a less toxic version was introduced under the brand name Mevacor (Lovastatin.) This drug was significantly more powerful in lowering cholesterol levels than the unpleasant and relatively ineffective drugs that came before. These are still used today, but are difficult to take, including ones that taste like sand and absorb cholesterol from the gut as well as high dose niacin which causes itching, flushing, worsens diabetes and exacerbates gout.  Lovastatin could be dosed once daily, was an innocuous capsule, and lowered cholesterol strikingly. Since that time, many more HMG CoA ...

Reading through the Internal Medicine News today was surprisingly uplifting. This is a large format free journal that highlights studies presented in journals or in meetings around the world.  This time the most interesting articles were about prevention of disease. Deborah Barnes and her associates calculated, using recent reviews on the subject, that improvement in various health and lifestyle conditions could potentially avert millions of cases of Alzheimer's disease.  These conditions, in order of importance, are physical inactivity, depression, smoking, hypertension, obesity, low educational attainment and diabetes. She calculates that half of the more than 36 million cases worldwide are at least partially due to these risk factors. This information is especially nice since all of these conditions are independently important and strongly impact a person's health and happiness in other ways. Sudden death is usually due to a heart attack, though pulmonary embolus, ruptu...

Today in the Journal of the American Medical Association David Jenkins MD and colleagues from Toronto, Ontario reported that certain dietary interventions really do help reduce cholesterol levels. Most patients believe, because we have told them, that improving their diets by eating less fat will significantly lower their cholesterol levels. According to a really well done study published in 1998, that is not true. Combining such a diet with exercise is helpful in reducing cholesterol, and probably also reduces many other bad health outcomes, such as diabetes, obesity and death. In Dr. Jenkins' study, however, patients were not told just to eat less fat, they were also instructed in what foods to add to their diets to reduce cholesterol. The study participants were instructed to eat a vegetarian diet and to add plant sterol containing margarine, soluble fiber (such as psyllium, oats or barley), soy protein products such as tofu and soy milk and peanuts or tree nuts. Simply being na...

Since Alexander Fleming first discovered penicillin in 1928 and the first sulfonamide antibiotic was introduced in 1932, medical science has created countless chemicals that inhibit the growth of disease causing microbes. Dirty wounds that would have resulted in certain death prior to antibiotic therapy were treatable and curable. It must have been a very exciting time to be a doctor. In my lifetime, the number of antibiotics available to use to treat infections has grown to the extent that, even with constant vigilance, I can't keep track of them all. Antibiotics are more often prescribed not for life threatening infections, but for treatment of symptoms such as sore throats, stuffy noses and inflamed bug bites for which those antibiotics are undoubtedly not effective, symptoms which if left untreated would resolve on their own. These prescribed antibiotics kill bacteria anywhere in the human body where the blood delivers them, hitting complex bacterial communities much as a bo...

Care of the dying is one of the most important jobs that a physician or nurse can have. Death, like birth, is a momentous and sacred transition, and good care can give peace and comfort to the patient as well as to his or her family and friends. The dying process is often painful and frightening and good, knowledgeable support can alleviate suffering for all involved. Hospice care has evolved since its inception in the 1400s to embrace support of the dying both in designated facilities and in patients' own homes. Once a patient and his or her doctor have come to accept that a disease is terminal and that death is imminent (usually 6 months of expected life left) hospice care can usually be arranged to allow a patients last days or months to be as pain and anxiety free as possible, providing caregivers with the help and support they need. Hospice services usually include home visits by nurses and nurse's aids, medications for symptoms control, social worker visits, grief couns...