I just listened to a podcast of an interview of Dr. Atul Gawande by Stephen Dubner of Freakonomics fame.(1) The title was “The Most Ambitious Thing Humans Have Ever Attempted.” At no point in the interview was obesity mentioned. But it won’t take much thought for you to realize, nor do I need to point out, all the parallels and contrasts with fat science.
For those of you who haven’t heard of Dr. Atul Gawande, he is a cancer surgeon at Harvard’s Brigham and Women’s Hospital, a philosopher of medicine and a living legend. His father was a urologist and his mother was a pediatrician. He has written lots of articles for The New Yorker and several best-selling books.
The first question for him was, “Why are doctors frequently also great writers?” He said it was because they deal with so much drama everyday just seeing patients in the office and also, especially these days when medicine “is a friggin’ mess,” doctors want to try and understand and analyze the bigger picture. I might have added that doctors, especially surgeons, are ego maniacs and have a lot of strong opinions.
The biggest overriding point that he makes in this interview is that everything in medicine and the politics of medicine is about money. The corollary to that is that everything can be revealed by crunching the numbers.
He says he had a gratifying early experience with Obamacare because they have had Romneycare in Massachussetts, where he works, for 10 years before Obama. He didn’t have to try and figure out how to take care of people without insurance. But we still have the problem that we spend more money on healthcare per capita than any other country — it totals about 18 percent of our G.D.P. And yet our health outcomes aren’t anywhere near the top. “Why not? Well, there are a lot of reasons.”
A big one is that we don’t pay for cheap, easy things to prevent expensive things like surgery by Dr. Gawande. Simple preventative stuff like taking blood pressure medicine is not taken seriously enough by doctors and patients because it is a hassle for some distant benefit compared to treating a heart attack that demands attention right now. It turns out that universal health insurance saves money because people are more likely to see their primary care doctor and fill their prescription for blood pressure medicine. Even if saving money is more important to us as a country than the humanitaran need for health care we should still be striving for universal health insurance.
In this interview, Dr. Gawande has many fascinating stories to tell. You really need to hear the whole thing. At one point he uses the word “life span” wrong. Strictly speaking, life span is the longest that a human can possibly live, about 120 years. That probably hasn’t changed much. Life expectancy is the average length of life in the population at a given time, including infant mortality. That has almost doubled in the past 100 years.
In the end, he is optimistic that we are going to do a better job in this country some day. I agree, because I’m an eternal optimist.
1. http://freakonomics.com/podcast/the-most-ambitious-thing-humans-have-ever-attempted (May 27, 2018)
John DiTraglia, M.D., is a pediatrician in Portsmouth. He can be reached by email at firstname.lastname@example.org or call 740-354-6605.