They ALWAYS Get It Wrong
The gist of this essay, ladies and gentlemen, is quite simple: they ALWAYS get it WRONG. To whom am I referring? The government of the United States Of America, of course. To recapitulate: The GOVERNMENT ALWAYS GETS IT WRONG. This statement is likely to be true in many different realms, but none more so than in health and medical care. Some examples will follow.
Let’s start by taking a look at a “relic” from the 60’s. Remember the “food pyramid?”
The classic food pyramid was a campaign by the United States Dietary Association (USDA) that was published in the 1960s that recommended that Americans get 40 to 50% of their nutrition from grains (cereals, breads, crackers, etc.) with lesser percentages allotted for fruits and veggies and small allotments for meat and dairy. These recommendations turned out to be so wrongheaded that after DECADES of making Americans fatter and fatter, the USDA was forced to mothball the campaign. In 2011 they switched to an entirely different paradigm, this time titled: “My Plate.” This new directive drastically reduced the recommended amount of grains and surreptitiously increased, dramatically, the recommendation for meat, renaming it, quite cleverly, “protein.”
The switch came late, however, for the millions of Americans who consumed too much cereals and breads, thereby gaining enormous amounts of weight. How many people were harmed by the original pyramid’s recommendation is impossible to say, but the numbers must be immense.
Then consider the poor, oft maligned, egg. For years and years it was governmental “gospel” that eggs were bad for you. They were, after all, loaded with cholesterol. We were advised to avoid them like poison. (For many years I eschewed egg salad sandwiches, a favorite of mine, for, what turns out to have been, NO GOOD REASON. We now learn that eggs are an excellent dietary choice. On healthline.com, for example, we now see the following:
It turns out that eggs are tremendously effective in holding down calorie consumption because they produce a feeling of satiety with less calories that just about anything else. Many researches now refer to eggs as a “superfood!” And, remember how egg yolks used to be verboten (think of the millions of gallons of “egg beaters” consumed by Americans believing it was the “healthy choice”) but now turn out to be the part of the egg that is most protective against Alzheimer’s disease!
Then, recall the nearly universal admonition against using salt. Yep, evil table salt. You would have thought that Sodium Chloride was worse than ARSENIC. Now, however, we find that too little salt is BAD for you. In an article published in the prestigious British medical journal Lancet on March 30, 2019 (written by investigators McCarron, Geerling and Alderman, The Lancet, Volume 393) the authors present research which indicates that too low an intake of salt is associated with AN INCREASED MORTALITY RATE! It turns out that our natural cravings for salt are there for a good reason. I can’t help but wonder how many MILLIONS of tasteless hamburgers and French fries were needlessly endured by Americans in an effort to “eat healthy?”
Then there was the ubiquitous recommendation to drink EIGHT glasses of water each day. Turns out that this recommendation was based on a MISINTERPRETATION of a valid research study. The original study found that the average American consumed the EQUIVALENT of eight glasses of water a day, but here’s the catch: the water being referred to in the study was mostly water that was CONTAINED IN THE FOOD being consumed. Drinking eight glasses of water IN ADDITION to the water already contained in food, therefore, roughly DOUBLED the amount of water consumed. And the result of this ill conceived directive was actually harmful. Many, many Americans came to believe that “if some is good, more is better” and went on to drink more that the eight glasses, resulting in a dangerous condition called hyponatremia (low blood sodium) which can cause seizures and even death.
Then there was the near universal recommendation for Americans to maintain a low fat diet. This recommendation was based, initially, on a flawed piece of research called the Seven Country Study which linked dietary cholesterol intake to heart disease. Turns out that the SEVEN COUNTRY STUDY originally included TWELVE COUNTRIES. That’s right, TWELVE COUNTRIES. Why the discrepancy? Well, it turns out that the authors THREW OUT the data from five of the countries because it didn’t support their premise that dietary cholesterol caused heart disease! And, the original flawed study then got support from other flawed studies, the most egregious of which was called the Framingham Study. Turns out that the Framingham study had a major design flaw: it failed to achieve what is called “clinical equipoise” (Balancing incidental variables among the comparison groups) by not balancing very important co-morbidities such as OBESITY and SMOKING. When corrections for such poor equipoise were factored in, no conclusions could rigorously be drawn. None-the-less, as doctors, spurred on by government guidelines based upon the flawed research, implored their patients to abjure dietary fat, millions of Americans wound up eating more and more carbohydrate. As a result, Americans became fatter and fatter with average weight ballooning to unprecedented levels, and the resultant morbid obesity then CAUSED an epidemic of hypertension, diabetes and heart disease. The damage done to America’s collective health is beyond calculation.
Then, if I may get a wee bit technical for a moment, I’d like to discuss a “pet peeve” of mine: misguided governmental directives aimed at DOCTORS. Over the years there have been many questionable medical directives from the geniuses in the District of Columbia, but the one I’ve got in mind here is the governmental directives mandating the use of preoperative “beta blockers”, even in healthy patients with no cardiac history. Beta blockers are drugs which reduce the effect of the body’s own adrenalin on numerous organs. They have been shown to reduce stress on the weakened heart, and have a long record of usefulness in protecting diseased hearts from the physiological stresses of surgery. Based upon a flawed study, however, the government got the idea that preoperative beta blockers would be a good idea for EVERYBODY. They then went on to not only recommend universal preoperative beta blockers, they went on to REQUIRE them. They did this by tying Medicare reimbursement to their administration. An anesthesiologist that didn’t administer the drug might simply not be paid. It turns out, however, that the original study (which demonstrated decreased perioperative death in patients treated with beta blockers) included ONLY data from post op days one through four. The mortality data taken from the actual DAY OF SURGERY WAS NOT INCLUDED! When that data was added, it turns out that the use of beta blockers caused AN INCREASE in mortality! Yes, you read that right: an INCREASE in mortality. In essence, a government requirement resulted in an increase in perioperative death! And, this problem was not a rare occurrence. I am aware of a local case in which the required beta blocker was given preoperatively, as directed, to a healthy adult male with no preoperative cardiac history, who then promptly went in to asystole (no heart beat), nearly died, and had to be resuscitated by a code team. Nice goin’ Uncle Sam! Or should I say “Doctor Uncle Sam” as the government seems increasingly willing to take on the role of Doctor.
And last, but by no means least, is the topic of pain control. Over the past ten years, there has been increasing awareness, rightly, of pervasive opiate addiction in our society. Although recognition of the problem is good (and long overdue) the governmental response is naive and wrongheaded. After decades in which the government actually encouraged over prescribing narcotics, the government now seems to think that they can solve the problem by simply restricting or eliminating those drugs, pronto, from patients who have become dependent upon them. States are now enacting laws, often quite arbitrary, that radically and rapidly restrict access to these medications for chronic pain patients that may have been taking them for extended periods of time, sometimes even YEARS. And, the Drug Enforcement Agency (DEA) is now pressuring doctors to reduce or eliminate prescribing narcotics, again, even for patients that have been on them for YEARS. The whole crisis is blamed, conveniently, on “irresponsible doctors and nurses”, “greedy” pharmaceutical companies, and even patients themselves who are said to have “addictive personalities.” What NO ONE is acknowledging is the GOVERNMENT’S OWN ROLE in creating this crisis. During the 90s and aughts, government regulators (especially in JCAHO, the Joint Commission on the Accreditation Of Healthcare Organizations) decided that hospitalized patients were way UNDER-MEDICATED for pain. They then set about strict monitoring, requiring hospitals to use something called the Visual Analog Scale (VAS) which was a series of cartoon faces (think “smiley face buttons) which supposedly would be understood by all. On one end of the scale was a smiley face beaming comfort and happiness, and, on the opposite side, was a tearful face showing pain and sadness. Patients would then be instructed to pick the face that best described their status. So far, so good, but THEN, reviewers would scrutinize the hospital records, and hospitals would get “dinged” (reimbursements reduced, or WORSE) if they didn’t have enough “smiley faces” in their patient charts. Pain levels were said to be “the fifth vital sign” (after pulse, breathing, blood pressure and body temperature)! Nurses and administrators then pressured doctors to prescribe more and more narcotics and patients became used to larger and larger doses. Later, these patients pressured doctors to prescribe more and more narcotics in the outpatient setting. Fast forward to twenty years later, and, violà!, we have an opiate crisis. So, NOW, the government is “cracking down” with the aim of eliminating chronic opiate use entirely. As a consequence many chronic pain patients have gone into narcotic withdrawal and now turn to non prescription (illegal) opiates to obtain relief. In some cases, suicide has even been reported.
So, this opiate crisis, manufactured
in large part by well intentioned but poorly conceived governmental policy, is now being addressed by an opposite, but also poorly conceived governmental policy.
The government was WRONG back then when they urged overprescribing, and they are WRONG now when they require underprescribing.
So, in conclusion, all of the erroneous health and medical care policy discussed above, is the result of government bureaucracy meddling in the practice of medicine and surgery. And, keep in mind that this is the same wrongheaded government bureaucracy that socialists and leftists want Americans to ENTRUST their health care to?… REALLY??…. Think again, America. Don’t trust the government with your health and well being. They ALWAYS get it wrong!