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Regulation in medicine kills

By G. Stolyarov II
web posted September 30, 2002

Back in seventh grade I attended classes with a fellow by the name of John. John was an inquisitive, intellectually proficient student whose interests covered the entire range of his activities. He admired science and loved experimentation, observation, and technology. He was an apt mathematician, fluent in language, and possessing a sound faculty for logic and deduction. I recall once having handed him an Award of Excellence, the highest honor within our middle school, for his commendable academic accomplishments.

Along with a sound mind, John also developed a healthy body, actively engaged in sports from football to baseball, as well as attaining the rank of Eagle Scout for his various outdoors exercises. In heat and snow alike, through hiking and skiing, he would demonstrate an unyielding determination to enhance his endurance, skill, and vitality, and for that reason he harbored a fondness for his lifestyle which permeated his every action and gesture. He did not stifle accomplishment in others, but rather encouraged it, and in our occasional conversations he was always courteous, articulate, and intellectually profound. His exemplar life seemed to me immensely prosperous and productive, and in my hypotheses it would only progress at John matured.

I was dismayed to have heard upon a typical June day the striking, seemingly otherworldly news: John had been diagnosed with leukemia. Neither his athletic prowess nor his intellectual finesse could prevent the emergence of such a dreadful ailment.

For the subsequent six months, the entirety of our school contingent expressed immense sorrow and sympathy for John's condition. John was a friend to all, and he had presented us with the values of his character and his mind while challenging us to develop our own. As eighth grade commenced, we became informed of another dreadful bit of news John's doctor had revealed to him: unless he underwent a bone marrow transplant, he would have half a year at most to live.

Nevertheless, John was provided with chemotherapy treatments that temporarily checked the spread of his cancer. He continued to express an avid enthusiasm for learning and amplified his intellectual arsenal in hopes that he would be able to apply it in the future. He resumed his athletic activities and continued to perform feats on the playing field. His presence was suffused with life, with an eager, joyful, aspiring activity which demonstrated his love for the greatness of man and for the world that man made.

Every week our teachers would remind us of the hopes that John had placed on the critical transplant; every week we were told that he would undergo the operation any day now. We sent him our condolences and our best wishes, along with donating money to the Leukemia Research Foundation in hopes that such a dreadful malignancy would be cured in the near future. These were selfish desires, as none of us wished to be placed in John's situation. It was that selfishness, however, that rendered it noble, that demonstrated our love for our own lives and potential, a sentiment which John shared and fostered within us.

John waited until early December for the transplant which never was. His joyful spark was extinguished on a dreary Sunday night, and the next morning the entire school plunged into a devastated sorrow. John could have lived had he been outfitted with a new bone marrow in time. The question that had tormented me then and throughout later years was, "How could he have been permitted to perish?" Now I am aware of a gargantuan monstrosity that stood between him and the life he sought to retain.

John attended a supposedly private hospital, but these days even private medicine is not free from a host of bureaucratic measures designed to regulate health care and deny doctors the opportunity to transmit to patients those treatments which they consider most efficient. In his essay, "Medicine: The Death of a Profession", Dr. Leonard Peikoff discusses a typical scenario in regard to an operation: "What is being thrust now into that equation? It is not only objective medical facts any longer. Today, in one form or another, the following also has to enter [the doctor's] brain: 'The DRG administrator will raise hell if I operate, but the malpractice attorney will have a field day if I don't-and my rival down the street, who heads the local PRO, favors a CAT scan in these cases, I can't afford to antagonize him, but the CON boys disagree and they won't authorize a CAT scanner for our hospital-and besides the FDA prohibits the drug I should be prescribing, even though it is widely used in Europe, and the IRS might not allow the patient a tax deduction for it, anyhow, and I can't get a specialist's advice because the latest Medicare rules prohibit a consultation with this diagnosis, and maybe I shouldn't even take this patient, he's so sick-after all, some doctors are manipulating their slate of patients, they accept only the healthiest ones, so their average costs are coming in lower than mine, and it looks bad for my staff privileges...'

Would you like your case to be treated this way-by a doctor who takes into account your objective medical needs and the contradictory, unintelligible demands of ninety-nine different government agencies and lawyer squads? If you were a doctor, could you comply with all of it? Could you plan for or work around or deal with the unknowable? But how could you not? Those agencies and squads are real, and they are rapidly gaining total power over you and your mind and your patients." (The Voice of Reason, pp. 306-307) Could even the most experienced, best-trained doctors with necessary equipment have saved John's life when a barrage of procedural formalities stood between them and the Hippocratic council?

When the government "encourages sound financial management" in hospitals, it effectively penalizes doctors for "overspending" on any particular patient, regardless of the severity of his condition. What could a bureaucrat have said to stall prospects for John's bone marrow transplant? "We have a lot of other needy patients in the hospital and in hospitals across the country, in the ghettoes and the slums, whose concerns are more immediate and likely less grievous, whose treatments are cheaper and will result in vaster bonuses for our hospitals from the Federal Government." John's family was wealthy even by suburban standards, but the new system does not permit patients to pay for the treatments they can afford. Need is held as the standard of value, and under such a criterion a druggie from the slums who had fractured his rib in a knife fight is better qualified to receive treatment at the hospital than John. The hospital will eagerly drape him over with a few bandages while leaving John on the waiting list or abandoning him altogether to his last months, as it is more "fiscally sound" for them not to receive the "overspending" penalty and not to lose pull will with the rationing bureaucrats manipulating the system.

All of John's parents' funds and devotion to saving their child would have yielded immense success in a laissez-faire capitalist system, where doctors would not have been required to comply with the opinions of ninety-nine regulating agencies, where they would have been free to operate and receive bountiful payment for it, where they would employ the drugs they, not the autocrats at the FDA, deemed expedient. However, under today's shackles on medicine, John's need was "merely" long-term, and thus the ability within him was permitted to die. Into the calculus were incorporated not merely his and the doctor's desires, but those of hundreds of "middle men" whose useless paperwork, prohibitions, and stimuli to negligence led either to an outright refusal to perform the bone marrow transplant or a time delay John could not afford.

It was not chance nor fate that killed John, but rather a corrupt regulatory system which viewed the collective "need" above the individual's life, which barred those who were able to pay from getting that, which they wanted to pay for. John could have grown up to become a great man had he not come up against regulation, that force which extinguishes greatness in a manner more frightening because it is implemented by thugs disguised as enforcers of the law.

G. Stolyarov II is a science fiction novelist, independent philosophical essayist, and Editor-in-Chief of The Rational Argumentator, a philosophical journal devoted to championing the Western principles of reason, rights, and progress, to be found at http://www.geocities.com/rationalargumentator/index.html. He is also a member of the Objective Medicine Group, a forum for championing the right of physicians to practice their trade without coercion and extortion, whose website can be accessed at http://www.objectivemedicine.org. Mr. Stolyarov can be contacted at gennadystolyarovii@yahoo.com.

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