Technology aside: the state of healthcare.

I have wondered what Benjamin Franklin would think if he were propelled 230 years into the future into a doctor's appointment, complete with a recommendation to have gastric bypass surgery for his obesity. He would likely feel bewildered and speechless. I suspect he would also miss his country doctor.

Healthcare has changed for recipients and providers alike. The influences driving these changes are many.

The expanding number of drugs available on the marketplace strongly influences healthcare. Direct-to-consumer advertising of pharmaceutical drugs has forever changed the practice of medicine. When drugs are marketed using slick "advertising science" directed to consumers who are not trained in biochemistry', the result will be consumer-driven drug sales to an audience who may not have a medical need for them. Recreational pharmaceutical use is now in vogue, particularly in the arena of sexual performance.

Pharmaceutical companies are losing any credibility they once had with consumers and physicians. Whistle-blower David Graham recently shed light on the FDA's drug-tainted approval process and called the American public "virtually defenseless." The FDA responded, citing its "well-documented and long-standing commitment to openness and transparency in its review of marketed drugs." Armies of drug reps are deployed across the nation to make sure no physician suffers from a deficit of advertising for their product. Advertising is not the same as and should not be confused with science. The prestigious British medical journal, The Lancet, in January of 2003 found pharmaceutical advertising to be "misleading." Computer technology is responsible for many new high-tech diagnostic tests. Many medical problems are now easily and accurately diagnosed by technological advancements. However, they are neither foolproof nor a panacea. A patient can have normal diagnostic tests and still have symptoms, creating a situation where a doctor's old-fashioned diagnostic acumen, skills, and training must be relied upon to help solve medical mysteries.

The Internet has exponentially expanded the amount of medical information that is available to anyone seeking it. Patients are far more medically savvy and knowledgeable in general, especially so in regard to their own diagnoses. This fact both empowers them and leaves them vulnerable to misinformation that is also readily available on the Internet, or to misinterpretation of information.

Regulation of the growing number of practitioners of medicine influences healthcare. State medical boards mandate uniformity in medical practice to help ensure quality. The regulation of medical practice has important benefits, including being charged with protecting the citizenry from charlatans, hucksters, and various sellers of snake oil. However, a narrow, biased, or uninformed interpretation of charlatanism by state medical boards can increase the risk that citizens will be denied access to the kind of healthcare they desire. Regulatory, oppression of ideas that differ from prevailing mainstream medical practices has resulted in the limitation of access to treatment, a difficult pill to swallow for a person who values the freedom to choose his own healthcare options.

Medicare was signed into law in 1965, another influence on the delivery of healthcare in the United States. It was the culmination of twenty years of debate started by President Harry S. Truman who recognized the need for recipients of Social Security to have access to affordable healthcare during their retirement years. The Medicare system has become massive, with its growing number of recipients, its expanding services, and changing Medicare laws. Medicare fee schedules require any participating physicians who treat Medicare enrollees to accept federal reimbursement even if that reimbursement is below their actual cost of providing the service, and to agree not to bill the patient for the difference. As a result, many physicians have had to limit the services they offer to Medicare patients, or work within the system by seeing an increased volume of patients for shorter and shorter periods of time to make up for their inability to bill appropriately. This can leave many patients feeling depersonalized.

Health insurance, though generally regarded as necessity in our healthcare system, must limit healthcare options for its subscribers by covering only selected services to contain costs. Many physicians are now contractually bound to insurance providers and are no longer able to independently use their judgment to determine the best care for their patients independent of insurance formularies and guidelines. The economics of healthcare insurance regulations drive people toward covered services, largely drugs and surgery, and away from alternative therapies that may be more conservative and less risky. Current policy-making practices of health insurance companies do not take into consideration either practicing alternative physicians' experience or patients' preferences.

Just this year, William McGuire, CEO of Minnesota-based UnitedHealth Group, Inc., was awarded an unprecedented package of $1.6 billion in stock options, in addition to his $8 million annual salary plus perks. UnitedHealth Group, Inc. is a company that sells health insurance plans to corporations and Medicare beneficiaries. An April 18, 2006 Wall Street Journal article by George Anders stated "The arrival of the $1 billion CEO would be a head-turner in any industry. But it's especially controversial in health care, where 'people tend to view each dollar of executive pay as money that isn't spent on them,' says Jonathan Weiner, a health-policy expert at Johns Hopkins University. Dr. McGuire and his supporters say the U.S. would be in even worse shape if it weren't for insurers such as UnitedHealth weeding out unnecessary, treatments, bargaining with doctors and encouraging patients to seek out the highest-quality care." I don't think United Health subscribers would agree.

Specialization in healthcare has been borne out of technological advances and has changed the face of healthcare. Mastery in all areas is no longer possible for any one physician. Many people who have appointments with their ophthalmologists, dermatologists, gastroenterologists, pulmonologists, and endocrinologists can feel depersonalized, as if they are merely a collection of parts. Never before has there been such a need for recognition of a whole person, a holistic approach.

Chronic disease plagues Americans as a whole, eating up an estimated 78 percent of healthcare expenditures in the United States. That number will only increase with longer life expectancy.

After all is said and done, it seems to me that none of the problems with our healthcare system has a technological fix. What is required is a return to an effective healthcare delivery style, a return to the roots of medicine: the foundation of a relationship between a doctor and a patient that Benjamin Franklin enjoyed.

What's a physician to do? I" think it would be a bit Pollyannaesque to await reassurance that all is well in pharmacy- and technology-land It would behoove physicians to have as many non-pharmaceutical and non-technological tricks as can fit up the sleeves of their white coats.

Concerned healthcare consumers can seek out physicians who think outside of the pharmaceutical and regulatory box (just in case the solution they need isn't in the box), who are interested in finding the cause of symptoms, who do not use drugs as a first line approach, who are educated in the treatment of health problems in methods that avoid or minimize drug use. and who are self-empowered to make healthcare decisions independent of politically-based expedience to best serve their patients.

Patients and physicians can become informed about the strengths and liabilities of our present healthcare system. Understanding the limitations of drugs to satisfactorily address our nation's chronic health problems, the effects of regulation on the erosion of healthcare choices, the inability of the federal government to meet all the healthcare needs of its enrollees, and the impact of stripping free enterprise from healthcare providers, are philosophical stepping stones along the path of change.

John L. Wilson, Jr., M. D. received his Medical Degree from the University of Minnesota, Minneapolis, MN in 1976. He has practiced for 29 years, the most recent fifteen of those at the Great Smokies Medical Center of Asheville NC in a general practice that integrates mainstream and alternative therapies. Dr. Wilson is a Fellow of the American Academy of Family Physicians (AAFP) and the American Academy of Environmental Medicine (AAEM). He also serves as chairperson of AAEM's Continuing Medical Education (CME) Committee. He can be reached at www.gsmcweb.com.