Medical Priorities: A Shot in the Dark

Today’s New York Times carries an article about the rising costs of vaccines for children.

Twenty-five years ago, it cost about $59 (adjusted for inflation) to immunize one child against routine childhood diseases. That number has morphed into $1600 in today’s medical marketplace.

Granted, more vaccines have been added to the immunization schedule. Those most recently developed—the human papilloma virus (HPV) vaccine and the rotavirus vaccine—carry higher price tags as well. Yet reimbursement is inadequate to cover the costs of procuring, stocking and administering many vaccines.

As a result, some pediatricians aren’t offering the newer vaccines. Yet preventing disease and its sequelae through vaccination has been shown to be one of the most cost-effective public health measures.

Primary care physicians are feeling the economic pinch. As a result, fewer medical students are opting for careers in primary care medicine, electing instead to pursue training in one of the more lucrative subspecialties.

If the situation gets worse, we could see a breakdown in the national immunization program and a resurgence of preventable childhood illnesses.

Meantime, our nation’s leaders, those in Congress and the White House, spend millions of dollars annually on cosmetic dermatologic procedures so they can look their best for their constituents.

In the richest nation on the planet, where 43 million American citizens are not covered by health insurance, it’s time to prioritize healthcare expenditures in this country.

Beauty’s Only Skin Deep

Ronald Regan was our first chief executive with Hollywood roots. I thought of this bit of trivia when I overheard someone comment that Washington, D.C., is just like Hollywood without the glamorous good-looking actors and actresses. But now I read in a recent New York Times article that Dr. Tina S. Alster is working tirelessly to change all that.

Dr. Alster has built a career in cosmetic dermatology by catering to the desires of the political elite. Upper crust clientele such as members of Congress and the White House, heads of state and royalty, ambassadors, and TV journalists underwrite her multimillion dollar medical enterprise. She is even treating two presidential candidates.

With the magic of the laser, Dr. Alster can treat wrinkles, facial telangiectasias, scars, warts on the nose, and a whole host of other blemishes to create the appearance of flawless skin. Many of her clients in Congress consult her regularly the week before scheduled appearances on “This Week” or “Meet the Press.”

Described as “an immaculate blond,” Dr. Alster maintains a professional demeanor herself, choosing to wear conservative but form-fitting Prada and Lanvin dresses. She is “a sought-after guest at cocktail parties, fund-raising events, dinner parties and embassy functions,” and appears regularly in local glossy magazines.

Although she used to treat patients with surgical scars and children with birthmarks, Dr. Alster no longer accepts such referrals; her practice now consists entirely of offering cosmetic treatments—“aesthetic services”—to the well-to-do.

I doubt that these services come cheap. (Dr. Alster recently spent several millions of dollars relocating her practice to an office condominium on K Street, not far from the Capitol.) But we can rest assured that our national leaders have top-of-the-line health insurance coverage—at the expense of the American taxpayer. (Of course, they could always choose to pay out of pocket. I’m certain that the IRS would allow them a business deduction, given their line of work as career spin doctors.)

In his book, Better Than Well, Carl Elliott addresses the role of “enhancement technologies” in what has become the business of modern American medical practice. Those that can afford to pay purchase whatever they choose, from performance-enhancing drugs to breast implants, sex-change surgery to nose jobs, growth hormone injections to Viagra—all in the pursuit of self-fulfillment. Dr. Alster’s cosmetic practice merely serves as one example of this trend.

The old cliché, “beauty’s only skin deep,” says it all. In our superficial society, we’re hell-bent on the pursuit of shallow happiness—and power.

This is what modern American medicine has devolved into: a catering service to Hollywood.

Quality Education

“She’s a high school senior, college-bound. She told me that she’s applied to over ten schools, but Johns Hopkins is her first choice. It sounds like if she doesn’t get in there, she’ll be devastated.”

My Physician Assistant student stood before me in my office, presenting the results of her evaluation of the patient she had just seen. We had discussed this adolescent’s history of bulimia before she stepped in to examine the girl.

“She seems to be a Type A—very driven to succeed. I can’t believe that she’s so obsessed with getting into Hopkins.”

“Many times bulimia and anorexia are associated with young, bright, overachievers—particularly females,” I said.

I thought of this brief discussion when I read the article about Loren Pope, the 96-year-old maverick who spent the second half of his life as an independent college counselor advocating for the small liberal arts college as the place to get a quality education. “I’ve got egalitarian instincts, and that’s why I’m opposed to the elite schools’ status and prestige,” Mr. Pope said in yesterday’s New York Times (February 28, 2007).

Pope is skeptical about parents and students who seek admission to brand-name colleges. “I think all they are thinking about is status,” he said. “A good school is an extended family. The learning is collaborative, not competitive. It’s a community of learning, and values are central — that’s important.”

Pope has written several books advocating for a select group of small liberal arts colleges. One book, Colleges That Change Lives, (Penguin Books, 1996), sits on my office bookshelf. It had been several years since I leafed through its pages.

I opened it up and browsed the Table of Contents, pleased to find that Juniata College in Huntingdon, Pennsylvania, had made Mr. Pope’s cut.

Juniata was where I began my undergraduate education 35 years ago. I still make an annual pilgrimage to the campus every spring.