UGA PREMED
Money Medicine
A MAGAZINE FOR STUDENTS INTERESTED IN SCIENCE AND HEALTH GRADY COLLEGE OF JOURNALISM
p res c rip t i o n s - a n t i b a c t e r i a l re sista n c e -globa l h e a lth in su r a nce
1
Science | love and other drugs
STAFF Faculty Advisors Dr. Leara Rhodes
Executive Editors Lisa Dinh Annika Carter Selin Odman Sona Rao Galit Deshe Heather Huyen Ersta Ferryanto Lily Wang
Writers
Amanda Pham Amna Jamshad Charyse Magdengal Christina Naajar Emma Burke Haley Vale Huyen Nguyen Jesse Hu Katy Barry Leah Ginn Megan O'mara Monisha Narayanan Nikhil Gangasani Nneka Ewulonu Saakya Peechara Sarah Caesar
Designers
Christina Crupie Dori Butler Katy Barry Melody Modarressi Sam Sego Wayland Yeung
Photographers Nneka Ewulonu Ersta Ferryanto Jason Jwak Lily Wang
Copy editors
Charyse Magdengal Hirel Patel Monisha Narayanan Sarah Caesar Jesse Hu Sehar Lalani
premedmag.org
2
FIND US ON SOCIAL MEDIA @ premedmag
www.premedmag.org @ UGAPreMedMag
@ UGAPreMedMag
@ premedmag
American University of Integrative Sciences, St. Maarten School of Medicine AUIS is recognized internationally for its innovative Allopathic MD with Integrative Medicine sub-curriculum.
Pre-Med: 7 year High School to Residency. Pre-Med taught at accredited US University. Financial aid available for qualified students. Assistance with VISA requirements!
Basic Sciences: 5 terms on beautiful St Maarten. MD/MS with Integrative Medicine. Classes start January, May and September Clinical Sciences: NO WAITING!
Complete all clinical rotations within two years. Clinical clerkships US and Canada.
Healing The World, One Student At A Time, One Dream At A Time 4426 Hugh Howell Rd., Suite B176 Tucker, GA 30084 678.269.4707 www.auis.edu | info@auis.edu
REASONS TO ATTEND AMERICAN UNIVERSITY OF INTEGRATIVE SCIENCES, ST. MAARTEN SCHOOL OF MEDICINE: • • • • •
Innovative technology-enriched classrooms and labs. Financial Aid and Loan Options for qualified students Small classes with 1:11 ratio professor to students. Affordable fees. Academic excellence rewarded with tuition reductions. No MCAT required, however, Basic Science Scholarships available for high MCAT scores
Dear Readers, Indulge me in this flowery riddle: My worth depends on you, but you need me. Still though, you use me. I don’t mind being used, Because I am hard as a rock and as light as a feather. I am a vagabond. I have no legs, yet I will travel far and frequently. I will leave you many times, but you still love me. What tragedy, Because only famous men will be found on top of me. I’m talking about money: the focus of this issue’s theme, “Money and Medicine.” Finance in medicine can be a paradox. It’s like a fractal: the closer we get, the more indistinct and perplexing the system becomes. Take the Pfizer and Allergen (non)merger. This would have resulted in a combined worth of $160 billion for the conglomerate and therefore the largest merger in the healthcare industry. The glorious coupling promised cheaper drugs and more pharmaceutical fecundity. A double-edge sword, the merger would have outsourced thousands of jobs to Ireland and been a modern-day monopoly as well. The closer to a system you get, the more complicated the system becomes. But do not furrow your brows. Let this issue be your segway into money and medicine. Don’t be afraid to challenge the viewpoints brought up, and if you read something you do not like, endeavor to change it. Because money doesn’t grow on trees, nor does the understanding of it. It is something you have to work for, to study, and to earn. In this issue, let’s talk about money.
Best, Lisa
This is my last issue working as Editor-inChief of PreMed Magazine. It has been a wonderful learning experience and an honor to be a part of such a promising resource for UGA students. I exult in the accomplishments of our 2015-2016 team in a mere year (print issues, scholarship funds etc), and have fittingly high expectations for PMM under the wings of its new leader, Editor-in-Chief, Annika Carter.
premedmag.org
4
f o e s l t b n a T onte C 5
Science | love and other drugs
SCIENCE 13 The Real Cost of Antimicrobial Resistance 20 The Modern Woman's Greatest Ally: Organic Chemistry
HEALTH 7
Why all doctors fear promotions: the negatives of being a hospital administrator
9
The Tuth Behind Your Prescription
11 To take medicine or to prevent needing it? 15 Peru's Healthcare Crisis 17 Are Rising Health-Care Costs Putting the US Economy At Risk? 21 The Remarkable Business-model of an Indian Eye Hospital
INTERACTIVES 27 How Does Healthcare Even Work? 29 The Price is Right: Medical Edition 31 Healthcare Policy and the 2016 Election 33 Health Crossword for Health Conscious Readers
premedmag.org
6
why all doctors fear promotions
the negatives of being a hospital administrator BY JESSE HU
D
uring the summer of 2015, I had the opportunity to intern at the Greater New York Hospital Association (affectionately known as GNYHA or “Greater New York”). GNYHA is a trade association that represents almost nearly 250 healthcare facilities in the greater New York area, New York State, New Jersey, Connecticut and Rhode Island. I entered this internship interested in working both as a physician and in some broader public health capacity such as hospital administration, public service or a nongovernmental organization. The opportunity to immerse myself in GNYHA, a nexus sitting at the intersection of public policy, hospital administration, politics, emergency preparedness, medicine, law and the healthcare system has opened my eyes to so many different aspects of healthcare that I did not know even existed. In particular, I found that the reality of what I learned about hospital administrators and finances shattered a fantasy of medicine that I previously held. Fans of the televisions show Scrubs will recall the penny-pinching Dr. Kelso, who always stepped in with ledger in hand and a firm push out the door when the hospital encountered an uninsured patient who could not afford care. Given that hospitals are meant to serve the sick, and that healthcare supposedly
7 health | money and medicine
serves the purpose of providing health, not the purpose of making quarterly profits, it seemed incongruous and wrong for the head of a hospital to deny health care. I had taken the character of Dr. Kelso as a joke to be written off with the other crazy exaggerations of television. So when I had the opportunity to meet with the CFO of Bellevue Hospital in NYC as part of my internship, I didn’t anticipate encountering Dr. Kelso’s business-centric perspective. I had a rose-colored fantasy of a visit in which my humanitarian and patient-centered belief of medicine was confirmed. I believed that medical care would be provided first, and finances taken care of later, no matter the cost because human life would be considered priceless. Medicine would trump money, and there would be no issue with putting the latter on hold so that the former could proceed unimpeded. Therefore, I expected my talk with the CFO to focus on hospital operations in context of benefits to patients and healthcare workers. In reality, while he certainly talked about patients, he didn’t get excited until he hit the topic of “Lean Management.” It spoke volumes of the healthcare management industry that he spoke of patient care as merely a cursory point, but he had a gleam in his eye when he started discussing
methods of cost reduction and efficiency within the context of the hospital’s budget. Of course this makes him an ideal CFO, and his goals certainly serve to better the hospital in its goals of being able to help the most people with its limited resources. But that money-mindedness seemed to run counter to the outside perception of what “being a doctor” or working within health care means. To many aspiring doctors, the desire to help others is a cornerstone in their decision to pursue medicine. When’s the last time someone said that they wanted to become a doctor because it seemed like “easy money” or that they were really interested in the optimization of “Six Sigma Lean Hospital Management structuring?” After all, this is the audience of Pre-Med Magazine I’m writing to, not an undergraduate business cohort. The harsh financial realities placed on a doctor often gets lost in the mix of curiosity for science, compassion for future patients, worries about MCATs and dreams of making the world a better place. But the need to worry about finances is crucial as well, especially when you consider that the US spends the most in the world on health care costs by several thousand US dollars, that hospitals have provided $459 billion dollars in uncompensated care since the year 2000, and that the
average cost for a physician to start a private practice falls in the low six figure range. So it is important to keep in mind that the need to consider money is absolutely crucial for the success of medicine. Though medicine may hold patient care in highest regard, it is by no means free from the logistical and financial realities of this world. On a final note, while it may seem that finances sometimes restrict medicine, or at times downright subvert the goals of medicine in grotesque fashion (we are looking at you Martin Shkreli), there is still room for both money and medicine to coexist. For those of you Scrubs devotees, you may recall that Dr. Kelso only serves the role of villainous Scrooge on a surface level. Though he maintains a hard exterior, he secretly does still care for patients; however, he has to balance this care with the overall betterment of the hospital. From time to time, he is known to look the other way so that loopholes can be played for patients to receive free care. Though perhaps not the best way of doing so, this sentiment is one that all doctors, future and current, ought to keep in mind. Medicine has to be a balance of care and practicality.
YOUR NEXT STEP TO A CAREER THAT MATTERS. Physical Therapy Physician Assistant Occupational Therapy Public Health Clinical Laboratory Science Medical Illustration Augusta Area Dietetic Internship Learn more about our undergraduate programs at the College of Allied Health Sciences augusta.edu/alliedhealth or cahs@augusta.edu
the truth behind your presciption BY SELIN ODMAN
W
e rarely see the same prescription twice, even for recurring conditions like seasonal allergies or high blood pressure. Our physicians are regularly convincing us to try expensive new drugs, claiming that they will work better or present milder side effects. This influx of new drugs may seem progressive, but there are other forces at work which control doctors’ pens. Although the US is known as a leader in medical research, the funds major pharmaceutical companies spend is disproportionately allocated between research and development and sales and marketing. The top 10 “Big Pharma” companies collectively spent $98.3 billion on sales and marketing in 2013 while only spending $65.8 billion on R&D. This business strategy brings in big sales for companies, but are advances in medicine being slowed down as a result? None of us expect a perfect world where pharmaceutical companies are completely devoted to the greater good of patients, but we do have that mentality when it comes to our doctors. However, most of the marketing spending doesn’t go directly towards ads. At least, not in the typical “billboard on the highway” or “TV commercial” type of advertisement. The marketing money is strategically focused on our physicians. Pharmaceutical representatives have a poor reputation that a quick Google search will unveil. Usually characterized as vapid, selfish and physically attractive, “pharma reps” are the tools of choice for Big Pharma companies trying to connect with physicians. In fact, in 2012, the pharmaceutical industry collectively spent $3 billion advertising to consumers while spending $24 billion marketing directly to people who work in health care.
9
health | money and medicine
DESIGNER: GALIT DESHE If you’re not concerned about the integrity of your prescriptions yet, you should be. Pharma reps are not doctors with the knowledge and experience to recommend drugs to the healthcare community. Their job is to convince physicians to prescribe the drugs from their companies, even if the drug is not necessarily the best, and they will do this through any means necessary. Pharma reps are instructed to befriend physicians through manipulative tactics, carefully tailored to each doctor’s personality. For example, these reps memorize personal details about family, hobbies and goals. They keep up a regular relationship with doctors, taking them to dinners and asking about their spouses and children. Doctors are showered with gifts like tickets to sporting events, concerts or anything else that may come up in conversation. There is even a database where pharma reps can enter this information for record-keeping, allowing other reps to use this information if needed. This friendship enables pharma reps to ask doctors for favors - which in this case are prescriptions. But how could doctors be so trusting and easy to manipulate? The reps are prepared with literature and writing from other respected doctors. If that doesn’t work, reps will focus on the rest of the staff, wining and dining them, hoping that a collective group will help get the pharmaceutical company’s message across. What can you do as a consumer? Stay informed and aware. The next time you go to the doctor’s office, look at the mugs and pens on their desk. Do you notice any familiar drug company names? Ask your doctor if they accept pharmaceutical money and question them about prescriptions that they write. Patients deserve to feel safe and they deserve the treatment that works best for them not the treatment that makes doctors and companies rich.
photo provided by: Nneka Ewulonu
TRUE MEDICINE
TRUE. SGU is the #1 provider of doctors into first-year US residencies for the past 5 years combined, including over 830 US residencies in 2015.
TRUE. SGU has a network of over 13,000 graduate physicians who have impacted health care worldwide.
TRUE. SGU’s US and Canadian students achieved a 97% first-time pass rate on the USMLE I, surpassing students from US and Canadian schools 5 years in a row.
St. George’s University, located on the tip of the True Blue peninsula, is committed to the belief that One Health, One Medicine is the portal to a comprehensive medical education. Since 1977, more than 13,000 School of Medicine graduates have gone on to successful careers in medicine and public health. Find your true calling. sgu.edu/md | 800.899.6337 Text TRUESGU to 313131 to speak to a graduate today!
PREVENTATIVE MEDICINE
better than drugs? B Y: L E A H G I N N
D E S I G N E R : L I LY W A N G
S
ickness is an inevitable part of life. Primordial doctors sought after the healing qualities of plants, spiritual practices, mind and body techniques, and other natural remedies. As technology expanded, so did healthcare practices. We could understand illness and disease in ways not previously possible, and drugs became the predominate form of treatment. The conventional view of medicine became that disease is derived from the environment and that we should heal our bodies with chemically-designed medicines. Another idea carried through time remains today, though faintly -- the body is a strong system that strives to heal itself when disease strikes and can do so as long as a strong immunity is maintained. Has this idea of preventative healthcare become obsolete, bought out by the bigger, more powerful pharmaceutical industry, or could we still benefit from keeping our immune systems strong, rather than simply fixing them when they are weak?
11 health | money and medicine
American health care has the largest medical budget in the world, projected at $3.2 trillion this year. When the average American is expected to spend nearly $10,000 on healthcare per year, it seems necessary to wonder if cheaper and more efficient forms of healthcare exist. It is also curious why drugs, a large portion of citizens’ medical spending, are always composed of synthetic chemicals rather than cheaper, more attainable, natural ingredients. The answer is simple -- natural substances are not patentable. Naturally occurring substances, even ones proven to have therapeutic value, cannot be “owned” or patented, and serve the pharmaceutical companies no source of the profit they so desire. As citizens in need of health care, we supply this profit to the industry every time we rush to our doctors and ask to be prescribed the latest FDA-approved synthetic drug to cure all of our symptoms. The synthetic drugs Americans rely on present another interesting paradox: likely every synthetic drug has several risk factors and side effects, some life-threatening. At least 160,000 Americans die from drug reactions every year and at least 2.21 million Americans have adverse drug reactions that require hospitalization. The reality is that society has blindly adopted conventional health care, choosing to ignore alternative medical practices.
"Natural substances are not patentable."
I recently had a conversation with one of my friends who has practiced veganism for many years. We discussed obesity, stroke, heart disease, and cancer and how inevitable these diseases have seemed to become among the American people. My friend shared the story of his father, who experienced heart issues several years ago and was in need of triple bypass surgery. As any caring son would do, my friend encouraged his father to change his diet and lifestyle in order to avoid having a major heart surgery. When his father consulted his doctor regarding whether he should make these diet and lifestyle changes, his doctor replied, “Of course you could do that. Most people just don’t want to take such extreme measures.” In comparison to open heart surgery, eating healthier foods and engaging in regular physical activity hardly seems “extreme.” The story ends with his father cutting out the processed foods, and high-cholesterol meats and fats, and living more actively. He never underwent the heart surgery and is now healthy and happy. My friend’s father chose to preventing disease by taking care of his body naturally, rather than waiting until he was in a hospital bed at a young age, relying on chemical treatment plans. The topics of diet and physical activity are just the tip of the iceberg when it comes to alternative and non-conventional medicine. Massage therapy, acupressure, meditation, chiropractic, and yoga are all forms of alternative medicine that many practicing physicians are now researching and implementing, alongside conventional practices. Research on the effectiveness of these remedies is a rapidly expanding database of successes and failures. More knowledge will only allow future practitioners to provide medical treatments other than prolonged and harsh chemical ingestion. If we can avoid the illnesses and diseases of our generation by keeping our bodies in healthy through preventative measures, why would we not take advantage of that opportunity?
premedmag.org
12
the REAL c o s t of anti microbial resistance
Â
BY ANNIKA CARTER DESIGNED BY GALIT DESHE
O
n September 7, 2012 at 7:45 pm, Patient #19 became the seventh fatality from the microbe Klebsiella pneumoniae Carbapenemase (KPC) at the National Institutes of Health (NIH). His name was Troy Stulen and he was only 19 years old. Eight months earlier, the NIH had come to what they believed was the end of a six-month KPC outbreak in the intensive care unit (ICU) of their hospital. The outbreak began in 2011 when a patient with a rare lung disease was transferred to the NIH ICU from a New York hospital. Five weeks after the patient was discharged, KPC reappeared in the ICU. This time, none of the hospital’s isolation attempts worked.
13 Science | money and medicine
The bacteria spread outside the ICU. Six months later, it disappeared almost as abruptly as it appeared, leaving six of the 18 total infected individuals deceased. KPC is a highly-resistant gram-negative bacteria that infects the digestive system and is capable of spreading its resistance to other bacteria. With the increased use of antibiotics, antimicrobial resistance (AMR) is becoming a greater problem. AMR is a natural process whereby bacteria develop resistance to drugs and, thus, survive medical treatment and successfully reproduce. Antimicrobial treatments become less effective and, eventually, useless against these bacteria. In recent years, AMR has become
a world-wide dilemma. The widespread effects of AMR are mainly due to the ease with which resistant bacteria can be transmitted from person-to-person; resistant microbes are communicable in the same manner as their non-resistant counterparts. The leading source of AMR is the overuse of antibiotics, especially in the food industry. Adding to the problem is a lack of market incentives for pharmaceutical companies to develop new antibiotics or research possible solutions to AMR. If a company developed a new cardiovascular drug, they would make tens of billions of dollars in a year. If the same company developed a novel antibiotic, the antibiotic is saved for only the sickest patients, so profit is limited. The presence of cheap generics also designates that corporations cannot sell antibiotics for the same prices they sell other medications. On top of it all, AMR is incredibly difficult to predict, so a new medication might be useless by the time it appears on drugstore shelves. The solution to AMR seems pretty straight-forward: increase research funding. Unfortunately, it is not so
simple. In the United Kingdom from 2008-2013, only 1% of government research funds went towards AMR-related research. Reallocating government spending is hardly easy, especially with the polarized politics of today. Other than developing new drugs, research focuses on studying old drugs with the hope that resistance to these drugs has decreased. A current project known as AIDA, combining the funds and minds of 11 European countries, is testing five drugs developed before 1980 for their reusability. AMR is a largely-ignored medical issue among the general population, yet it cannot be ignored any more by citizens or by pharmaceutical companies. If overlooked, the cost of antibacterial resistance will be much more than money -- it will be 300 million lives by the year 2050. But with increased awareness, limited antimicrobial usage, and expanding research efforts, mankind will be able to remain one step ahead of the mutant bugs.
"The leading source of AMR is the overuse of antibiotics, especially in the food industry."
IMG Clerkships, International Medical Graduate Clerkship, is dedicated to assisting the next generation of qualified Medical Students who are committed to pursuing the goal of becoming a physician practicing in the United States or Canada. We have three main focus areas including:
USMLE PREP
Clinical Clerkship
C.A.R.L
Live Step 1, Step 2 CK & CS courses taught in Atlanta, GA. We help prepare you to pass your USMLE Step the first time, making your chances of obtaining a residency much higher.
Clinical core and elective rotations for medical students including Foreign Medical Graduates.
C.A.R.L. is a technology tool for clinical education that connects Medical School Clinical Staff, Students and Preceptors .
International Medical Graduate Clerkships 4953 Presidents Way Tucker, GA 30087 Ph 770.400.0987
WWW.IMGCLERKSHIPS.ORG
INFO@IMGCLERKSHIPS.ORG
PERU’S HEALTHCARE CRISIS BY ANNIKA JONKER PHOTOS BY ANNIKA JONKER DESIGNED BY GALIT DESHE
I
n March of 2016, I had the privilege of traveling to Cusco, Peru alongside other UGA students with MEDLife, a national nonprofit organization that aids impoverished communities around the world through medicine, education and development. The people, the food, the culture, and especially the medicine are unlike anything I have ever experienced in the United States. Imagine this: sitting on top of a mountain, a view of beauty stretching across the horizon, with no disruptions save for the footsteps of a tired mother who has walked over two hours to get her ill son to the doctor. Sadly, this is a reality for many impoverished communities in Peru. Peru is a stunning country – mountains as far as the eye can see, vibrant color everywhere, and the smell of delicious food lingering in the air. However, these very mountains are filled with impoverished families, the bright colors are a representation of the poverty-ridden but hopeful country, and the food often lacks necessary nutrition. A large number of communities have difficulty accessing care because the nearest hospital is hundreds of miles away. In fact, Cusco, one of Peru’s largest cities, contains only 2 hospitals for all 75 surrounding communities. If families wish to visit the hospital, they are forced to walk miles to get there, only to wait hours in an overcrowded waiting room for service. This misfortune compels many families to avoid the cumbersome journey to the doctor. To make matters worse, most families aren’t even eligible for health care. Peru has three main types of healthcare: the Ministry of Health (MINSA), which applies to 60% of the population, El-Salud, available to 30% of the population, and the private sector, which is only affordable for 10% of the population. The large disparity
15 health | money and medicine
between the middle and the lower class citizens’ health stems from Peru’s health care class differentiation: only the upper-middle and rich classes can afford the private sectors. Low income families are forced to turn to public hospitals, which often offer lower quality and quantity of care compared to the private hospitals. Furthermore, about 46% of the lower class lacks health insurance. This portion of the population rarely, if ever, makes trips to see the doctor, resulting in infections worsening or diseases spreading. Peru allocates only 3.5% of its GDP to health care, a value lower than other Latin American countries, which spend over 7% or more of their GDP on health care. Over the past two decades, Peru has striven to improve GDP spending and expand health services to all of its communities, but numerous problems still exist. Peru has one of the highest rates of disease, ranging from lung disease to breast cancer. Organizations like MEDLife aid countries like Peru by bringing medicine to communities that lack access to doctors and medication. MEDLife also emphasizes preventative medicine and infrastructure development to these rural communities to improve their quality of life for years to come. These development projects include building staircases, fabricating new stoves, constructing chimneys, and painting houses. During my time in Cusco, we painted kitchens and built stoves, which were made from sugar, salt, clay, lamb manure, and human hair. These ingredients alone stand as a representation of the life of many impoverished communities in Peru: they do what they can with what they have. From day one in Peru, I became immersed in the culture and lost my heart to the people I met there. Each day, we
traveled to different rural communities and set up mobile clinics, then spent the rest of the day aiding nurses, seeing patients, and shadowing various physicians. While I was shadowing an OB/GYN, one of the patients explained how she had been suffering from chest pain. After examination, the doctor asked her if she had recently put stress on or received a heavy blow to the chest. The woman’s reply was simply, “My husband beats me.” She said it in such a calm way that I almost missed the meaning of her words. When the woman left, the doctor told us how male chauvinism is very common in Peru, leading Peruvian women to have one of the highest rates of breast cancer in Latin America. The doctor also explained that STDs in Peru are very common since the men do not believe in using condoms. Not only are women suffering, but children and men are, too. In Peru, many children suffer from malnutrition. Unlike the poverty in other countries of the world, it is not the lack of food that is the cause of malnutrition – rather, it is the lack of the necessary vitamins and nutrients within the food. It is actually cheaper for a family to buy and eat rice for a week than it is for them to purchase meat and fresh vegetables. This problem was evident in all parts of Peru. One family came in to the mobile clinic with their hair falling out at the slightest touch. Why? They were lacking enough protein in their diets to maintain proper hair growth. Cases like this attest to another major problem in Peru: the lack of education. Only 24% of children finish primary school, but sexual education, sanitation and health are mainly taught in middle and high school, meaning that a large portion of the population doesn’t even get educated on how to take care of themselves.
The disparity in health care and class differentiation in the cities and communities was very apparent. During the mobile clinics, a number of the patients said that they could not afford the needed medications or would not risk taking time off of work to get the necessary surgeries. This occurred more often than I would like to admit. I remember meeting an elderly lady, with a bright smile, beautiful long hair and a colorful sweater that lit up her face. She seemed so happy that morning, but I would soon find out her sad story. She had experienced 16 urinary tract infections (UTIs) in the last year, and the infection had already reached her kidneys. The physician told her to go to the nearest hospital – which is in Lima, 723 miles away from Cusco – to undergo dialysis as soon as possible. The elderly lady told us that she had no means of getting to Lima, nor did she have the funds to pay for it. The result? The physician prescribed her multivitamins and told her to take regular baths to prevent further infections. The woman thanked the doctor, smiled at us, and walked out of the room. To anyone who has ever wanted to visit Peru or Latin America: Go! The people, the food and the community are unlike any other. To anyone who has ever wanted to change lives: volunteer with MEDLife. And to those of us living in America: although we often times find ourselves complaining about our health care system, take a moment to reflect on the communities in Peru and how their health care affects their health and their education and realize how grateful we are to live in a developed country.
premedmag.org
16
ARE RISING HEALTHCARE COSTS PUTTING THE US ECONOMY AT RISK? B Y: S A R A H C A E S A R D E S I G N E R : L I LY W A N G A N D L I S A D I N H
O
ver the past few years, the US has witnessed a steady rise in overall healthcare costs. This rise, which has been brought on by numerous factors, adds yet another burden on the already downward-spiraling economy. The country’s health spending per capita has more than doubled over the past thirty years and is currently over 20% of the GDP, or approximately $4 trillion. Although there are a plethora of reasons why healthcare costs have risen over the years, investment in expensive new medical technology has definitively had the most significant impact. According to Jencks and Schieber (1991), malpractice litigation, limited price competition among providers and a rise in physician supply are also contributing factors. Researchers who surveyed 50 hospitals discovered that most hospitals resort to raising medical fees for uninsured, out-of-network patients and auto insurers because they do not get enough money from Medicare or other private insurers.
17 health | money and medicine
Medicare, since its inception in the 60s, has provided health insurance to millions of Americans, mostly younger people with disabilities and those aged 65 and older. However, as a result of rising healthcare costs, the program is finding it more and more challenging to meet the financial needs of their enrollees. To make matters worse, Medicare enrollment is projected to increase from 47 million to 79 million in the next 12-15 years. This could put immense strain on federal, state and local governments who invariably will have to rely on cutting funds for other important issues, such as education and infrastructure, in order to successfully pay off Medicare and Medicaid costs. Research statistics show that richer, more developed countries, like the US, tend to spend more on healthcare. Even among competing nations, though, the US consistently remains on the high-end spectrum and is in fact considered an outlier with regards to healthcare spending per capita.
premedmag.org
18
Despite this, US life expectancy rates continue to decrease and mortality rates continue to rise, both of which are inconsistent with projected livelihood. Jencks and Scheiber believe these inconsistencies arise from having an unproductive medical system, in spite of vast technological advances in the medical field. Economists agree that healthcare spending utilizes a lot of resources that could be better used to fund other organizations or programs and that it is absolutely essential to contain healthcare costs in order to prevent the economy from collapsing. The White House Council of Economic Reform (CEA) has listed a multitude of economic benefits of health care reform, which many presidents, including President Obama, have fought hard to establish over the past few years. The benefits include being able to decrease the Federal budget deficit, increase labor supply and lower the unemployment rate. Any hope of ameliorating the medical system, politicians say, will take time. However, by modeling nations like Canada, which has managed to increase its life expectancy rates and decrease infant mortality rates while maintaining a healthcare spending per capita equivalent to half of that of the U.S, America has a much better chance of recovering the healthcare system and preventing an economic crisis.
1-888-ALL-NAVY
15 science 19 Science | money and medicine
ORGANIC CHEMISTRY: Advocate of the Modern Woman
Although a mechanism of pregnancy prevention was discovered in the 1930’s, the cost ($80/gram) of harvesting sex hormones stunted its implementation, delaying the impending sexual revolution. In 1951, an organic chemist by the name of Djerassi created norethindrone from estradiol cost-effectively by harvesting the hormone from the Mexican yam, making birth control affordable. This nowaccessible resource aggrandized women’s sexual freedoms, proliferating the evolution of an independent and liberated female population.
How Birth Control Works Norethindrone, a synthetic form of the sex hormone progesterone, is a key ingredient of birth control. The pill helps stabilize the body’s hormone levels, preventing a peak in estrogen. Without this spike, the ovaries fail to release an egg, and ovulation is prevented, along with the possibility of pregnancy.
Norethindrone
premedmag.org
16 20
the remarkable businessmodel of an indian eye hospital B Y S AT H V I K N A M B U R A R DESIGNER: GALIT DESHE
I
n the perennially humid, dusty town of Madurai of Southern India, a public health and medical miracle has been blossoming over the past 30 years. The Indian healthcare system is notorious for low quality services and its paltry budget, but Aravind Eye Hospital in Madurai has been able to overcome these obstacles to provide world-class eye care at a fraction of the cost of Western hospitals. Even more remarkably, 70% of all surgeries at this wholly private hospital are performed for free, yet the hospital has an annual financial surplus of roughly $8 million. Surgical error and complication rates are comparable between Aravind and Western hospitals and are, in fact, often significantly lower at Aravind. Despite the miraculous nature of Aravind, the hospital’s business model, in which profits made from patients who pay for surgeries are reinvested to offer free surgeries to the poor, is ingeniously simple and has been replicated throughout the developing world—this business model offers some important lessons to the American healthcare system.
surgeries each year, a figure that is five times the Indian national average. Aravind’s efficiency ensures that a large volume of people can receive eye care, which is crucial in heavilypopulated southern India.
I spent several weeks at Aravind last summer to study medical waste at the hospital, and the first quality I noted was the hospital’s efficiency. The business model of Aravind emulates that of McDonald’s, with an assembly-line approach to medicine. Each Aravind surgeon works with a dedicated and experienced team of nurses and performs approximately two thousand
Because of the advent of Aurolab and its efficiency, Aravind has been able to take advantage of market inefficiencies to perform a large number of surgeries for free, while still earning a financial surplus. Aravind’s paying patients pay the same for surgeries as they would at any other hospital, but because Aravind is able to save money by manufacturing
21 health | money and medicine
Aravind is also noted for its innovation. Though Aravind is now the world’s largest eye hospital, in the 1990s it was still a comparatively small venture due to the high cost of importing intraocular lenses, which are implanted in the eye during cataract surgery to restore a patient’s vision. Cataract surgery is by far the most common procedure performed at Aravind, so the high cost of intraocular lenses prevented the hospital from being able to perform many charitable eye surgeries. As a result, hospital administrators decided to begin Aurolab, an in-house factory to manufacture lenses and surgical tools. This move, which led to the development of a mostly-automated manufacturing system, allowed Aravind to make these items at a tenth of the cost of importing them.
intraocular lenses in-house, the hospital makes a significantly larger profit from each paying patient than if Aravind had purchased the lenses from an outside supplier. This increased profit is then used to fund free surgeries and eye camps in Indian villages. Paying patients, for their part, continue to flock to Aravind because of the hospital’s reputation for excellence and low complication rates. This ingenious business model has been termed “compassionate capitalism,” and it has been incredibly effective at Aravind and at other hospitals that have adopted Aravind’s strategies. Although Aravind’s business model may not be perfectly replicable in the United States, we can still apply Aravind’s lessons to the American healthcare system. For one, we in the US must improve our efficiency in healthcare. For example, my research on medical waste showed that surgeries at Aravind produce about 1/3 of the waste produced in US hospitals, leading to decreased costs. Thus, it would be financially beneficial to revise medical waste laws in the US and decrease the amount of medical waste produced. Also, we must continue to innovate, just as Aravind did by creating Aurolab. Telemedicine is used extensively at Aravind to reach rural communities; in America, we could use telemedicine to help treat the elderly or those in isolated areas, which would decrease brick-andmortar costs. As we continue to seek ways to improve the American healthcare system, however, let us not lose the compassion that is so crucial to effective healthcare. Aravind’s founder believed that humans could attain spiritual consciousness, a greater connection to the world and fellow human beings that would drive our innate desire to help others. He posited that in helping others, “it is ourselves that we’re helping. It is ourselves that we’re healing.” Solutions to America’s healthcare problems may not always be immediately visible, but so long as we maintain our honest, innate desire to ensure that everyone receives quality health care and aggressively pursue ways to lower health care costs, America too can create miraculous changes.
premedmag.org
22
UGA s e v PRE i t c a r e t in med mag The following pages are interactive spreads to encourage engagement with the magazine and content.
23 interactives | money and medicine
premedmag.org
24
25 interactives | money and medicine
about the photos
T
he two preceding photographs were taken by Editor-in-Chief Lisa Dinh on her trip to Peru with global health organization MedLife.
AU
G
US
TY
"We noticed a lot of clinics had been previously established in the area [Lima, Peru]. In the first photo, a sign of an old clinic is featured with cognates clueing you in on the services once offered; the second photo shows the clinic now used as shade space for local children. These services, intended to be free, are now non-existent and their utility defunct due to a lack of continuous funding. While not all global health initiatives may be relegated to the negative stereotype of voluntourism, we must recognize the importance of economic sustainability for every project we enlist in--especially when it comes to providing aid for others."
TA U N I V E R
SI
At the state of Georgia’s medical school, our students define us. They are academically excellent and personally altruistic. They consistently rank at or above average on objective measures such as the Medical College Admission Test and United States Medical Licensing Exam. They consistently secure spots in the country’s top residency programs. They volunteer to tutor and mentor local grade-school students. They help build community by providing seasonal fresh fruits and vegetables to our urban neighbors. This year, students in Augusta celebrate the 25th anniversary of their clinic for the underserved. Students in Athens started their own clinic within a year of their arrival. For nearly a half century now, our students have spent a portion of their summers with high school and college students from underrepresented-in-medicine populations across our vast state, sharing what it really takes to be a doctor and serving as inspirational examples. They’ve even been known to sing a song and dance a step to raise support for children with cancer and their families.
Come change the world with them. The Medical College of Georgia at Augusta University For more information about the Medical College of Georgia at Augusta University, please visit, augusta.edu/mcg or augusta.edu/mcg/admissions or call the Office of Admissions at 706-721-3186.
how does healthcare even work?
BY HALEY VALE DESIGNER: GALIT DESHE
We hear a lot about about healthcare reform in the United States. With the upcoming presidential election, some candidates point to European systems of healthcare as the clear way forward for the US, while others shun those “Socialist” systems completely. But what are these systems? There are four basic systems of
1. The Beveridge Model In the Beveridge model the government pays for all health care through taxes. Also known as “socialized medicine,” the Beveridge model gives the government power to set lower healthcare costs, since they employ most doctors and own
most clinics and hospitals. This system is used in the United Kingdom, Spain, New Zealand, and Cuba.
2. The Bismarck Model The Bismarck plan is also called an “all payer system.” It uses insurance monies funded jointly by employers and employees to pay for healthcare services. Unlike in the United States, insurance plans in the Bismarck system must cover everyone and the insurance companies do not make a profit. This system is used in France, Germany, Belgium, and the
Netherlands. While most hospitals in these countries are privately owned, the government still carries a lot of market power to regulate prices of health services, because they regulate what insurance plans will cover.
27 interactives | money and medicine
3. The National Health Insurance Model
This model is also known as a “single payer� system. Through income and sales taxes, citizens pay into government-run insurance funds which cover healthcare expenses. Because the insurance funds are run by the government, there is no profit made and thus, no reason to deny claims. Every citizen is covered. Hospitals are privately
owned, however, the government has large negotiating power to keep prices low because they regulate what services National Health Insurance will cover. Countries that use this system include Canada, South Korea, and Taiwan.
4. The Out-of-Pocket Model The out-of-pocket model, as you might expect, requires citizens to pay directly for all of their health services. Under this system only the rich can afford health care, while the poor must make due with home remedies. If lower class citizens in these countries do have enough money to pay for
services, there is no guarantee they have transportation to get to hospitals or clinics, which are often located many miles apart. This is the case in rural parts of India, Burkina Faso, and most other parts of the world.
premedmag.org
28
e c i r n p o i t t i e d h e th rigedical is m BY EMMA BURKE
CAN YOU CORRECTLY MATCH ALL OF THESE THERAPIES TO THEIR PRICES?
A. $205,000
___ Open Heart Surgery
B. $797,200
___ Soliris
C. $1,206,000
___ Bone Marrow Transplant
D. $7,172
___ Harvoni
E. $669,000
___ Pancreas Transplant
F. $289,400
___ Double Lung Transplant
G. $1,125
___ Intestine Transplant
H. $324,000
___ Stelara
I. $676,800
___ Liver Transplant
J. $577,100
___ Tracheostomy
19 29 Pre-Professional interactives | money | love and and medicine other drugs
T
he skyrocketing cost of healthcare has been a hot political topic in recent years. From the high cost of developing drugs, increased use of technology in hospitals, and mountains of loans accompanying medical education, there are many reasons for healthcare becoming so expensive. However, some procedures and treatments stand out for their exorbitant price tag. The heart must stop beating for open heart surgery to be successful. To do this, the patient’s body temperature is lowered by pouring cold saline on to the heart and by routing blood through a heart-lung machine. This gives surgeons more time to operate without damaging the brain. The machine oxygenates the blood and must be operated by a specially-trained team. Soliris is a medication used to treat atypical hemolytic uremic syndrome (aHUS) and paroxysmal nocturnal hemoglobinuria (PNH). Both of these chronic diseases are very rare and are characterized by red blood cells breaking apart. aHUS causes clots to form in the blood vessels of the kidneys, which leads to renal failure and death. PNH patients develop clots in their veins which can also cause death. This price is a price per year of treatment. Bone marrow, found in the hollow center of long bones, contains a plethora of stem cells that develop into blood cells. Sickle cell anemia as well as many cancers can cause a patient to need a bone marrow transplant. Before the transplant can be done, the defective bone marrow must be killed using chemotherapy or radiation. In an allogeneic transplant, stem cells to be transplanted are harvested from a living donor or umbilical cord blood. Harvoni is a medication used to treat Hepatitis C by preventing the virus from replicating its RNA, preventing viral reproduction. Hepatitis C affects the liver and can become chronic. It is spread through blood that contains the virus. Examples of means of transmission are needlestick injuries, use of a dirty needle, and sexual intercourse with somebody who has the virus. The price given is a price per pill. Pancreas transplants are useful for combating type I diabetes. Insulin-producing cells in the pancreas are killed by the immune system in type I diabetes. Unlike many transplant surgeries, the defective organ is not removed in this operation. While the old pancreas makes inadequate insulin, it still makes enzymes that aid in digestion. Thus, it is left behind to work in conjunction with the new pancreas. All organs needed in this surgery must come from non-living donors.
the hospital stay can range from one to three weeks. Like all transplant surgeries, the first few months after the operation are crucial. There are many follow-up appointments and tests that must be done to ensure the new organ is functioning properly. There are three types of intestine transplants. In isolated intestinal transplants, only the intestine is removed and replaced. The other two types, combined liver and intestinal and multivisceral, require the transplant of more than just the small intestine. Multivisceral includes the intestines and possibly the stomach, pancreas, and liver. Combined liver and intestinal involves replacing the intestines and liver. These complicated procedures are only used when total parenteral nutrition (TPN) is no longer an option for the patient. TPN delivers vital nutrients through a vein and can cause many complications. Stelara is an injection used to treat plaque psoriasis. Plaque psoriasis is a chronic disease that results in scale-like formations of dead skin cells. These areas, called plaques, can be very noticeable on the skin. They are sometimes raised and can be bright red and itchy. Plaques form in response to an overproduction of tumor necrosis factor. Coupled with an excess of a few other proteins, tumor necrosis factor causes skin to grow much faster than usual. As a result, dead skin piles up, forming the visible patches. The matching price is the price per shot. The liver is the largest and one of the most important organs in the human body. It performs a multitude of functions such as cleaning the blood, storing fats, and creating bile. While the liver can regenerate itself to a certain extent, transplants become necessary when it no longer works correctly. Scarring of the liver, called cirrhosis, is the main reason that a patient needs a liver transplant. A small portion of livers can come from living donors, but this can cause health issues for the donor, so1 is only used in desperate cases. The rigid, bumpy tube that can be felt from t
Patients with conditions such as chronic obstructive pulmonary disease (COPD) or cystic fibrosis may consider double lung transplants when medicines are no longer effective. After a successful operation,
premedmag.org premedmag.org 20
30
With the 2016 U.S. presidential election underway, the state of our nation’s healthcare system moving forward is a central issue. Currently, the Affordable Care Act (ACA) - signed into law by President Obama in 2010 - serves as the most recent, comprehensive attempt at tackling the complexity of U.S. healthcare. Candidates in this election have their own ideas for healthcare policy in years to come, ranging from bolstering the ACA to starting from scratch with a new plan.
Hillary Clinton: Strengthen the ACA Incentivize expansion of Medicaid Create public health insurance option to broaden coverage choices for consumers Improve outreach programs to increase health insurance exchange enrollment
Bernie Sanders: Medicare for All Provide coverage for more Americans than ACA has covered Create single payer public healthcare program Fund single payer health insurance through taxes
Donald Trump: Repeal and Replace the ACA Allow consumers of health insurance to deduct their premiums from tax returns Decrease barriers to entry to pharmaceutical industry Promote purchase of health insurance across state lines
Ted Cruz: Repeal and Replace the ACA
Incentivize Health Savings Accounts (HSAs) Make health insurance portable by delinking it from the employer Promote purchase of health insurance across state lines
I L L U S T R AT I O N S B Y M E L O D Y M O D A R R E S S I
Nikhil Gangasani 19 31 interactives love and other | money drugsand | premed medicine magazine
Training healers. Coaching leaders. Transforming healthcare.
The residents, faculty and staff of the Athens Regional Medical Center Internal Medicine Program, believe that the very best healthcare is evidenced-based and patient-centered: grounded in science, respectful of the needs and values of each individual, and responsive to the needs of the community. To find out if Athens Regional is right for you, please visit http://gme.athenshealth.org to learn more or call us at 706.475.7869.
Untitled
health crossword for the conscious crossworder
Across
Across
2. Cancer-causing. 2. Cancer-causing. 5. The expensive surgical procedure 5.most The most expensive surgical procedureone onecan can get-get-costscosts over over one one million dollars. million dollars. 6. Above 100.4 degrees of this means 6. Above 100.4 degrees of this meansa afever. fever. 7. Doing this regularly reduces risk cardiovascular 7. Doing this regularly reduces risk forforcardiovascular disease, diabetes makes you just feelreally reallygood. good. disease, diabetes andand makes you just feel
Down
Down
This is developed when overuses any 1.1. This is developed when one one overuses any sort ofsort of antibiotics including hand sanitizer. antibiotics including hand sanitizer. Abbreviation healthcare legislation. 3.3. Abbreviation for for healthcare legislation. weakened or dead strain of a microbe used to incite 4.4. AA weakened or dead strain of a microbe used to incite immunity to a immunity todisease. a disease.
8. Drug company blue logo. 8. Drug company withwith blue logo. 9. This disease is a virus spread by a mosquito vector
9. This disease is a virus spread by a mosquito vector and has been in the news recently. and has been in the news recently.
10. The science and practice of the diagnosis, treatment,
10. The science and practice of the diagnosis, treatment, and prevention of disease. 11. Students are on this track when studying to become physicians.
33 interactives | money and medicine