***
Reposted
****
What Makes Hospitals So Deadly and How Can We Fix It?

****
https://substack.com/inbox/post/152051147
****
Since I no longer have the time to respond to all the correspondences I want to respond to, I began doing monthly open threads where I could focus on addressing the remaining questions that had accumulated over the last month, and tagging each open thread to a topic I have wanted to write about but didn’t feel quite merited its own article.

In this month’s open thread, I’ll share my thoughts on a question many have asked me since Trump and RFK Jr. won the election and an actual window has been created to change healthcare policies in America—what could be done to increase the survival rates in our hospitals and how can you protect a loved one that’s hospitalized?

This question, in turn, is a reflection of a sobering realization many had throughout COVID-19—what many of us believed about our hospitals was utterly incorrect, and rather than help patients, hospitals effectively functioned like assembly lines that ran disastrous protocols (e.g., remdesivir), denied patients access to their loved ones and refused to use alternative therapies (e.g., ivermectin) even when it was known the patients were expected to die otherwise.

For example, during COVID-19, one travel nurse who was assigned to a New York hospital with one of the highest death tolls in the nation realized something very wrong was happening throughout the hospital and decided to covertly record her colleagues and become a whistleblower


Within her testimony, one particular recording she made was particularly illuminating as a doctor perfectly illustrated the dysfunctional mentality that has infected our medical system by stating he was unwilling to try any alternative therapy (which had some evidence behind it) for patients he knew would otherwise die.


Much of this in turn, was due to a series of standardized treatment protocols being created for COVID-19, which heavily financially incentivized remdesivir and then ventilator care while simultaneously avoiding an effective off-patent treatment for COVID-19. Despite remdesivir actually increasing the death rate from COVID-19, hospital administrators still pushed their doctors to use it (and retaliated against those who did not follow the NIH COVID protocols) because of how powerful the financial incentives were for doing so.

Note: the NIH COVID treatment panel continued to make remdesivir the standard of care for COVID-19 and forbid alternative therapies (e.g., ivermectin) even as a mountain of evidence piled up that argued against it. This was due to Anthony Fauci appointing the committee and selecting chairs that had direct financial ties to Remdesivir’s manufacturer—an issue that sadly holds true for many other committees which create the guidelines that dictate medical care in the United States (e.g., in a previous article I showed how America’s cholesterol guidelines were authored by individuals taking money from statin manufacturers and that the conclusions those panels reached were the exact opposite of an independent one which evaluated the same data).

Overall, the remarkable illustration of this corruption was the fact that families eventually began suing hospitals to allow the use of ivermectin for a relative who was expected to die even after being subjected to Fauci’s hospital COVID protocols. Remarkably, because there was so much money on the line, the hospitals chose to fight these lawsuits in court rather than just give ivermectin to the patients. In turn, of the 80 lawsuits filed by lawyer Ralph Lorigo, in 40 the judge sided with the family, and in 40 with the hospital, and of those, in the 40 where patients received ivermectin, 38 survived, whereas of the 40 who did not, 2 survived—in essence making suing a hospital arguably the most effective medical intervention in history. Yet, rather than take this data into consideration, the profit-focused hospitals banded together to develop an effective apparatus to dismiss further lawsuits.

As I had expected something like this to happen, shortly before the pandemic, I put into place a plan to treat people at home (e.g., by procuring high-powered oxygen concentrators with non-invasive ventilation) and subsequently had numerous people in my immediate circle who we successfully treated at home, whom I am almost certain given their condition would have immediately been hospitalized and likely die at the hospital.

Note: this approach built upon the fact prior to COVID, we had other patients we felt merited a hospitalization but simultaneously expected to be put on the palliative care pipeline once admitted, so we’d learned how to provide a significant amount of the care you’d receive in a hospital at home, alongside the integrative therapies that were highly likely to actually help the patients recover.

Likewise, I also heard of more stories than I can count throughout the pandemic where a relative snuck an “unapproved” therapy to a patient in the hospital, which in turn saved the patient’s life, and a few cases where a doctor who was hospitalized needed to change their own treatment (while the nurses were gone) because no one would listen to the rationalizations they provided for optimizing their care.

Sadly, while this is quite depressing, it’s simply illustrative of a few more toxic trends that have taken over medicine.

Reductionist Realities
Anytime something happens, there are two aspects to it—the concrete variables of the situation and the intangible process that exists between those variables. Typically, modern science and academia focus on controlling and optimizing the concrete variables, while the essence of the phenomenon and its greater whole gets cast aside.

In turn, those who can nonetheless attain proficiency in those intangible areas end up excelling in their fields and rising to the top, because few can learn an art within a reductionist system that actively works against anyone developing those capacities.

In medicine, this dichotomy is illustrated by the contrast between the algorithmic version of medicine (where physicians are trained to rapidly execute precise protocols for each patient) and the art of medicine, where physicians constantly question each aspect of a patient’s care and take the time to both develop the plan that makes sense for the patient and foster each of the intangible aspects of the doctor-patient relationship which often bring about healing.

Sadly, as the years have gone by, medical training has shifted more and more away from teaching doctors how to treat patients and more and more to following treatment guidelines their corporate employers will expect them to implement, rather than independent practitioners whose clinical opinions were valued by the hospitals they worked in.

In tandem with this, the costs of healthcare in America have ballooned


Note: healthcare spending at the beginning of the 20th century was 0.25% of GDP, reached 1% in 1933, dropped to 0.38% during World War II, and went back up to 1% in 1961 before experiencing the meteoric rise it has seen in recent decades.

Most remarkably, despite spending 2-4 times as much on healthcare as any other affluent nation, the United States has the worst healthcare outcomes amongst the affluent nations (which is detailed within these charts). This I would argue, is a result of our healthcare spending prioritizing what corporate interests want, not what produces effective healthcare. Sadly, as I have shown in this article, pervasive corruption has entrenched itself throughout the Department of Health and Human Services and our healthcare officials.

As this costly trend is impossible to ignore, various proposals have been made to address it. Unfortunately, all of them have arisen from the same mentality that gave birth to the problem in the first place and thus have made it worse (e.g., creating more regulation to “improve” healthcare but having that regulation be created by bureaucrats who did not understand the realities of healthcare and shaped by corporate lobbyists who only care about profits).

Economic Enticements
In medicine, one of the most reliable means the government has to change the behavior of the healthcare system is by financially incentivizing the behavior they want (e.g., putting patients on remdesivir and then ventilators) since doctors and particularly healthcare workers will prioritize whatever the guidelines are regardless of what is in their patient’s best interests.

A key aspect of this process is the quality scores of hospitals graded on the quality of care they give patients (e.g., what percent of central lines become infected). In turn, some of these metrics are helpful, but many others are not (e.g., what percent of patients do you vaccinate). This is unfortunate because the rates at which Medicare reimburses hospitals (and then often other insurance providers) are set by how well they meet these metrics, so as a result, administrators will do everything they can to ensure hospitals do.

Note: much of this is mediated through JHACO. This non-profit organization assesses the quality of care hospitals provide, and hence their administrators put a great deal of effort into appeasing JHACO.

After age 40, the amount of money spent on healthcare increases exponentially, with 22% of all medical expenses (and 26% of Medicare expenses) being spent in the last year of life. Since there has always been a looming threat that Medicare will go bankrupt, reducing those expenses has long been a focus for healthcare bureaucrats (as best as I can gather, this began in 1979 but really kicked into gear with Obamacare).

Note: the individual that many of my colleagues believe was responsible for that shift was Ezekiel Emanuel, an oncologist and medical ethicist who was one of the chief architects of Obamacare (at which point he faced many accusations of promoting “death panels” which would deny costly care to people at the end of their lives) and later was placed on Biden’s COVID-19 advisory board.

Because each day you keep someone in an American hospital costs $2,883 (going as high as $4,181 in California) and strains the limited staffing resources, reducing hospital stays has always been a critical metric for healthcare bureaucrats. This in turn, has been accomplished by approaches such as:

•Giving hospitals a set fee for a patient admission rather than one dependent upon how many days they are in the hospital (which requires hospitals to eat (pay) the cost for a prolonged hospital stay).

•Having both JHACO and Medicare accreditation for critical access hospitals (which Medicare pays more to) be dependent upon the average length of hospital stay being 96 hours or less (as over that denotes “inferior care”).

As such, hospitals do everything they can to reduce the length of stay. This includes strongly pressuring doctors to shorten the length of stay, both through financial incentives for doing so and by reprimanding doctors whose patients stay too long (e.g., many hospitals have committees which identify “excessive” lengths of stays and then heckle the supervising doctor and require them to immediately provide a strong rationale for why the patient hasn’t been discharged).

Note: another major issue is that ER doctors have very different criteria for who they will admit to hospitals (e.g., some admit patients who are not very ill to avoid liability, while others only accept people who actually need hospital care). This creates a significant challenge on the hospital’s end both because it strains the limited hospital resources (by filling the beds—hence making the hospitals want to empty the beds as quickly as possible) and because it gives insurance programs an unrealistic expectation of how long patients require hospital care due to the less and more severe presentations of the same disease getting juxtaposed. together.

Time to Heal
Whenever a problem arises in medicine, the bureaucratic tendency is to find ways to micromanage the concrete variables at the expense of the intangible aspects of patient care. As such, almost all the protocols physicians are trained in (which are meant to improve the quality of medical care) tend to cast the intangibles to the side—to the point doctors are often penalized if they break from the protocols.

One area where this is particularly problematic is dosing, as different patients simply need different doses of the same therapy. For almost all therapies, a specific dose exists where most patients will begin to benefit from the therapy and another where they will begin to show toxicity.
*****

****
Note. Some Links locking editor display up, use GoDuck for your reference.
*******
Medical Disclaimers apply. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the assistance of health care professionals for any conditions. We are not doctors.
***Medical Disclaimers apply:: """"Forwarding, not a line by line endorsement of all items.""""" **
******