Random bits on politics of medicine

Started my sub-I this week with a very interesting attending, someone who I kind of feared before because he's always so argumentative during morning reports, but he's actually been a really good teacher, also very efficient and practical... to the point that we have been very efficient in discharging patients, and he spent a lot of times to talk to us in teaching, and also sharing his very interesting life stories, politics of medicine, etc.

Politics -- one would hope that the leaders of medical care would want to first and foremost benefit the patients, but many times that goal is kind of pushed aside to pursue after $$.

There's also a huge emphasis on research in medicine -- and while some researchers might really believe their research is making an impact in practice of medicine, many times faculty in academia is pushed to do research in order to get grants--again, money, fame, "expertise", academic advancement.

Sadly, our attending showed us examples of some practice of medicine that's based on limited research studies on ideal patients... and in reality, we are spending $$ on lots of medicine that might not really have real benefits.

Something like this: The fallacy of the calcium-phosphorus product
http://www.nature.com/ki/journal/v72/n7/full/5002412a.html
We give sevelamer to lots lots of ESRD patients who has high phosphorus -- yet, to what end?

Also some researchers, or big dept chairs, are not great clinicians -- they spent their time thinking about their research or other admin duties, they don't necessarily think too hard about the patients they treat, and hence can make big mistakes.

Even in the field of research, there are lots of politics. Famous big shots get paper published easily, jump into authorship of papers without much contribution. Then there are also cheating going on in research data, etc...

Then there's a whole other problem of difficulty changing the status quo, even when the status quo has lots of problems... including a certain med school president who had a midlife crisis and made some funky online videos... then subsequently made some terrible leadership decisions.

One can either go with the flow and become one of them, or go against the tide.  What do you really care about-- money, fame? or taking good care of patients?

A little pessimistic view of medicine, but rest assured that there are individuals who really care enough to think, stand up and advocate for the right thing to do.