In a significant development, the Journal of the American Medical Association (JAMA), the world’s most widely circulated medical journal, has admitted that the glorification of profit is harming healthcare. In an article published on the JAMA website on January 30, 2023, Donald M. Berwick, MD, describes the existential threat of greed in the American healthcare system. Confirming much of what Dr. Rath and our organization have been saying for years now, the article demonstrates that key aspects of our analysis about the damaging effects of the pharma industry and for-profit healthcare are beginning to go mainstream.
Berwick describes how the grip of financial self-interest in the American healthcare system is becoming a stranglehold. No sector of US healthcare is immune from the immoderate pursuit of profit, he says. Particular criticism is leveled at the pharmaceutical industry, where Berwick correctly identifies that drug companies have used monopoly ownership of medications to raise prices to stratospheric levels. The absence of any serious price regulation has yielded enormous profits for drug companies, he explains, even in cases where much of the basic research funding has come from governmental sources.
The role of hospital pricing is also addressed in the article, with Berwick describing how one patient was billed $73,800 at the University of Chicago for 2 injections of Lupron depot, a treatment for prostate cancer that is available in the UK for $260 a dose. Berwick notes that the Massachusetts Health Policy Commission reported in 2022 that hospital prices and revenues increased during a decade at almost 4 times the rate of inflation.
According to Berwick, 41 percent of American adults now bear medical debts, with one in every eight individuals owing over $10,000. As of 2021, he says, 58 percent of all debt collections in the United States were for medical bills. The result is that millions of Americans are forced to reduce their spending on food and other essentials, with many being driven into bankruptcy.
While unchecked greed is not the only driver of the failure of American healthcare, Berwick writes, it is a major one. The cycle is vicious, he explains; unchecked greed concentrates wealth, wealth concentrates political power, and political power blocks constraints on greed.
Acknowledging that there are no easy answers, Berwick sees four main changes as essential. Firstly, he says, healthcare professionals need to become noisier about the conflict between unchecked greed and the duty to heal. Extortionate drug prices and exploitative abuses in the practice of medicine ought not to be met with silence. Silence is assent, he asserts.
Secondly, healthcare professionals should act through their trade associations to ensure that the pursuit of ever higher payments is demoted as a priority. Resources should flow to the neediest in society. The practice of medicine needs to see the protection of all patients as the first and highest calling, says Berwick, and this includes protection against onerous medical debt and bankruptcy.
Thirdly, healthcare leaders and professionals should lobby government to pass legislation to rein in greed. This includes reforming patent laws – a subject that Dr. Rath and our organization have written extensively about over the years.
Fourthly, Berwick says healthcare professionals should insist that their organizations invest actively in improving the true social influences on health. From our own perspective, if this included optimizing nutrition, preventing micronutrient deficiencies, and ensuring foods are produced organically, free from pesticides and GMOs, the results could be transformative.
Campaigners for healthcare reform should welcome the publication of Berwick’s analysis by JAMA. Clearly, while the Western healthcare model has degenerated into a pharma-driven vehicle for creating and maintaining excessive private gain, it doesn’t have to remain this way. All of us have it in our hands to help bring about change. As the American anthropologist Margaret Mead famously put it: “Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has.”