In his book, Scrubbed Out: Reviving the Doctor’s Role in Patient Care, Dr. Salah D. Salman says, “The United States needs a universal health care system, which is already available in less affluent industrialized countries. I believe that health care is a human right, and it has been neglected in this country.”[i]
“Dr. Salman studied and trained at the American University of Beirut and at the Johns Hopkins Medical Institutions. He spent his professional life in academic medicine. He is a former Professor & Chairman of the Department of Otolaryngology at his Alma Mater. In 2009 and after 23 years, he retired from being a Surgeon and Director of the Sinus Center at the Massachusetts Eye & Ear Infirmary, and a lecturer at Harvard Medical School in Boston, Massachusetts.”[ii]
Dr. Salman points out that “needed reform is slow to come to the U.S. health and insurance industries.”[iii] He recounts that U.S. Presidents have attempted health care reform, starting with President Truman who tried and failed to pass a compulsory universal health insurance law in 1945. “President Nixon in 1974, President Carter in 1979, and President Clinton in 1995 each put forth proposals to broaden health insurance coverage and make it universal.”[iv] Each of their proposed plans also failed due to the opposition of businesses.
“Congress has acted courageously on more than one occasion in the past for the interests of the public—why not now?”[v] Saldan asks. He points out that President Johnson succeeded in introducing Medicare and Medicaid in 1965.
Salman contends that “market forces have been allowed to play important and decisive roles in health care, with catastrophic results. Medical leaders have supported and even adopted business principles that were not designed for the practice of medicine or the management of suffering.”[vi] He adds that “Leaders in the medical field have learned from administrators and others that the appearance of propriety is more important than propriety itself. The concept of right or wrong seems to no longer exist—almost any behavior to increase income and cut down expenses has become justifiable.”[vii]
Saldan discusses the financial interests that contaminate the practice of medicine, in every area, including medical schools that divert funds away from the training of doctors, health insurance companies, medical device corporations, pharmaceutical companies, hospital administrators, doctors who perform unnecessary surgeries and order unnecessary tests, and medical organizations such as the AMA that serve to protect the financial interests rather than perform their stated roles. For example, “as another example of business priorities, the AAO-HNS’s president and chair of the board of governors launched a campaign called ‘2001: A Sinus-free Odyssey’ as part of Sinus Awareness Month in March 2001. The aim of the campaign was mainly profit. Letters to academy members asked them to inform the thirty-seven million sinus sufferers in the U.S. that medical and surgical relief was available for chronic sinusitis, thereby indirectly promoting a wave of unnecessary and costly surgeries.”[viii]
Saldan says, “The sad story of chronic sinusitis and functional endoscopic sinus surgery is worth describing in some detail. When fully told, it illustrates many of the problems that have plagued health care and that this book discusses. As an ENT surgeon, I have witnessed its unhindered growth and development for years; a new theory about the cause of sinusitis and a new surgical technique to cure it were widely adopted fast, without convincing proofs of their value. Evidence against them was suppressed when it surfaced. The medical and hospital leaderships failed to intervene when they should have to monitor quality of care and to control cost. The see-no-evil attitude of medical doctors helped the wide spread of a questionable theory and a questionable surgical technique.”[ix]
“FES quickly acquired enormous—and in retrospect, suspect—popularity in the U.S. Shortly after its introduction, the reported incidence of sinusitis increased rapidly and for no apparent reason. For example, from 1986 to 1988, the federal government reported fifty million workdays lost to sinusitis. Between 1989 and 1992, the numbers increased to seventy-three million. I suspect that the numbers would not have increased so dramatically had FES not been introduced, aggressively marketed, and popularized. Indeed, because FES was lucrative, its indications were stretched to a suspect extent.”[x]
“Hospitals encourage abuses because of the business unnecessary surgeries bring. Direct advertising and reporting in the lay media have helped increase FES’s popularity. Critical voices are suppressed or ignored. Conflicts of interest have become commonplace. As a result, we now face an epidemic of unnecessary and incomplete sinus surgeries, which have resulted in deaths and serious complications, and which have significantly contributed to the escalating cost of health care.”[xi]
Dr. Saldan wrote critical papers that were constantly turned down by medical journals. He concluded that “The medical and business beneficiaries of this ‘miraculous’ surgery are too mighty to fight; they have a whole arsenal of political, legal, and monetary weapons with which to resist control and regulation. A system that does not provide a forum for critics to be heard or their opinions acted upon is not a good system to protect patients and control cost; it is a system crying out for reform.”[xii]
Where should reform begin? Saldan believes that “we need to replace the current medical leaders with new, committed, capable, and powerful leaders who can make a difference. We also need a new entity to oversee reform, with authority over the current health care players: a powerful, apolitical, independent organization that can make and implement the needed hard decisions, which none of the present players have done or can do. Whether appointed or elected, these new leaders must be aware of and accountable for their responsibilities toward the medical industry and the public—responsibilities that transcend bookkeeping, balancing budgets, and protecting the interests of doctors, medical schools, and hospitals. Instead, these new, top leaders should be willing and able to make unpopular decisions that serve the interests of the patients and the public in general, and should be able to fight the commercialization of medicine and the prioritization of corporations’ interests over patients and public health.”[xiii]
“To reform the medical leadership, this book advocates a solution first proposed in 2004 by authors Barlett and Steele: an independent government organization that is largely immune to politics should be created, called the U.S. Council on Health Care (USCHC).81 Such an organization would essentially be analogous to the Federal Reserve System, and would shape health care policies much as the Federal Reserve oversees the nation’s money and banking policies.”[xiv]
Saldan says, “The solutions the book proposes are not easy to design and apply, but they are necessary and unavoidable. And they’re far more realistic than waiting for the impossible to happen: for the insurance and pharmaceutical companies to become philanthropic; for the legislators to become insensitive to their generous corporate contributors; for the administrators to alter their priorities; and for the lawyers to become saints. We do not have to wait for the impossible; we need to take action now, before the system collapses and the health care reform signed into law in 2010 fails to achieve all its intended long-term purposes.”[xv]
[i] Salah D. Salman M.D. (2011-09-06). Scrubbed Out: Reviving the Doctor’s Role in Patient Care (Kindle Locations 2536-2537). AuthorHouse. Kindle Edition.