First Things First

servicesImage  Someone asked me today why I thought Europe seemed to be showing stronger gains in healthcare on several fronts — patient centeredness, infection prevention, antimicrobial stewardship, better surgical protocols. Perhaps it is the more centralized payment and regulatory structures in Europe that allow a focus on quality and patient outcomes? Less obsession with the need for multi-million dollar innovation? A desire to use what they have better versus constant innovation for something new?  It’s something to ponder.  In the U.S. we seem doomed to repeat missed opportunities for truly transformative health care.  Just two examples recently come to mind, but they are significant.

First, a JAMA article by esteemed bioethicists posits that a modern mental health system ought to employ 19th century approaches. I’m sure I’m not the only one shocked at the proposition. Perhaps they were, as one notable advocate pointed out, merely trying to provoke long-overdue dialogue about what needs to be fixed in the mental health “care” system. Asylum or Warehouse? « Linda’s Corner Office.  Perhaps. Or maybe the article was a reflection of the greater tendency to want to avoid the difficult cases — chronic debilitating illness, mental health and substance abuse, dementia, autism…  We are challenged at this moment to authentically address and solve some of the problems that cause such a drain on our health care system.  Doing so with panacea solutions and last-century thinking is the wrong jumping off point. Such discussion requires a deep reservoir of compassion, of caring for the individual experiences of people dealing with such conditions, and the capacity to focus on dignity and the possibility for independence and recovery first and foremost.

Second, was the announcement of President Obama’s proposed budget in which a disproportionately high $650 million is proposed for NIH and BARDA research for development of drugs and diagnostics to combat antibiotic-resistant organisms. In contrast, a fraction ($280 million) is bestowed on the CDC, dedicated to the consistent and vigilant surveillance of resistance and stewardship of the antibiotics we have available. It’s not that health care providers and patients won’t benefit from a new arsenal of drugs or diagnostic tools to combat real and here-today pathogens for which there is no treatment. It’s that once again, we are missing the opportunity to prioritize a higher level of resources on improving our methods of preventing the spread of resistance and optimizing the use of already available tools. Without significant investment in the latter, we will release a set of new and powerful tools into an inconsistent delivery and management system. Here’s hoping the ultimate budget strikes a better balance.

In both instances, better policy requires clearer thinking about what will benefit patients most. For mental health, it’s access to care that supports their life in the community. For individuals with antibiotic resistant infections (or in settings where such infections are prevalent), its how best to prevent the spread of such infections in the first place.  With all due respect to the efforts of researchers, drug and device makers and hospitals everywhere, let’s spend time and money on those efforts first. The dividend could be truly transformative.


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