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Health Care Medicine is a profession that is widely regarded as the place where innovation, invention, and discovery contribute to health, longevity, and quality of life. It is also a discipline where the ideas of one day are replaced by the ones of tomorrow with stunning speed and equally commensurate resistance. Wherever there is profit, there is a desire to sustain the demand for products that are lucrative, and this profit motivation often operates against pure science and the public interest. So, while it is easy to acknowledge the need for changes and/or reform, it is much more difficult to agree on exactly what would constitute an improvement in what currently exists. We would probably concur that the needs of the disenfranchised should be addressed, but when it comes to what kind of medicine should be offered to whom and under what circumstances, there is much less consensus. My own preference is for complete freedom of choice for the patient. In no way does this imply that the market would suddenly become a buyer beware scenario in which only the hugely well-informed could possibly make adequate decisions on their own behalf. Rather, the guiding principle is that one's body is one's own, and one may choose to manage its needs according to one's own judgment and philosophy. Freedom of choice does not imply irresponsibility. Professional institutions and organizations train, test, and licenseand when necessary censure or revoke licensesof their own members. They also establish the curricula of their own colleges and universities and engage in the kinds of evaluations of efficacy not actually carried out by federal agencies. In short, it is the professional organizations, in each state, that are best able to determine the merits of a protocol and the ability of a practitioner to administer that protocol. The problem with regulations is that they fossilize quickly. A technique or drug that was once regarded as useful comes into question; and it takes dozens, perhaps hundreds, of law suits before the authority to dispense a drug is canceled. The best case in point would be mercury amalgam fillings. For many years, it has been illegal to use such fillings in Sweden and Germany. In the U.S., we continue, in most States, to insist that a substance that everyone knows is toxic is somehow safe in mouths. We harass and jail dentists who remove mercury for anything other than cosmetic reasons. Then, finally one town, Duluth, bans the disposal of dental mercury into the sewer systems. Eventually, an Erin Brockowitz comes along and California dismantles its dental board, but the rest of the country is somnambulant. My point is that individual professional groups are in the best position to determine what to do and what to use in the treatment of people who are ill. Granting prerogatives to multinational corporations to market drugs is not really a medically sound function. Patent offices can issue patents, but unless those giving marketing rights are performing 100% independent tests on real people with real health conditions and unless the assessments of response are absolutely impartial, the only real function of an approval is to rubber stamp papers whose merits have not been evaluated in a meaningful context. In truth, patients actually know whether they are getting well or slipping, and no amount of law changes these facts. Therefore, I am for far wider freedom that we currently enjoy and far less federal regulation. I feel that states are fully capable of regulating what goes on within their own borders, and that the function of federal health institutions is to focus on public health issues such as epidemics, sanitation, and relief of suffering among the uninsured and poor.
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Copyright by Ingrid Naiman 2002, 2006, 2009, 2014 |