In my role as CEO of The Permanente Medical Group, I frequently travel between San Francisco and Washington, D.C. I use the time to catch up on my reading, often finding articles of interest to reference in future Forbes columns.
On one back-and-forth trip, I read five articles, three from The Washington Post going East and two from The Wall Street Journal on my return flight. All were thoroughly researched, well written and featured prominently in the first section of the paper. The first one I read highlighted breakthrough science that might someday save lives. The next two revealed distressing shortfalls in American healthcare today.
In total, the pieces provide a powerful lens into the polar extremes and contradictions of our healthcare system.
A Scientific Triumph
The first article, “Pondering ‘what it means to be human’ on the frontier of gene editing”, describes the powerful scientific technique called CRISPR (clustered regularly interspaced short palindromic repeats). CRISPR enables scientists to modify the genetic structure of simple organisms—and someday perhaps humans.
This technique is based on a natural process that bacteria use to protect themselves from destructive viruses by eliminating harmful genetic material (DNA). Scientists have figured out how this process can alter human DNA and correct inherited abnormalities.
For patients with diseases such as cystic fibrosis and Huntington’s chorea, and for children with a variety of inherited biochemical abnormalities, this process could be life-saving. Theoretically, scientists could remove the defective gene in patients with sickle cell disease and replace it with a normal one. The simplicity of this approach is groundbreaking.
But despite the promise at hand, the technology and its applications raise major ethical issues that will need to be addressed before researchers and clinicians can begin to apply the process to humans. And, not surprisingly, even before commercialization, vicious patent battles have already erupted.
This type of research represents our nation’s scientific dominance. And as might be expected, the institutions at the cutting edge of this next-generation technique are leading American universities, including the University of California at Berkeley, MIT and Harvard. And reading about what will be possible in the future for our nation and the world made me smile. Hopefully, the technique will provide the next generation of physicians with even more powerful tools than we have today.
Medical Errors Unchecked
Yet my optimism was cut short when I turned the page and saw two graphic descriptions of our current healthcare system’s shortcomings. They demonstrate why, despite our leading in scientific breakthroughs, we lag in overall quality outcomes.
The second article, “Researchers: Medical errors now third leading cause of death in United States,” describes a recent study in the British Medical Journal by Dr. Martin Makary and Michael Daniel from the Johns Hopkins University School of Medicine.
The article referenced the 1999 Institute of Medicine (IOM) report, “To Err Is Human.” That study shocked the nation with its calculation that 98,000 people die each year in the United States as a result of medical error.
But the new study demonstrates that the IOM report significantly underestimated the magnitude of the problem. In short, the problem is actually much worse than thought.
In this new study, the authors expanded the definition of medical error from single events—such as nurses dispensing the wrong medication—to include major communication errors between and among physicians in cases where patients obtain care from more than one specialist. By this new definition, the number of preventable deaths from human error more than doubles to a staggering 251,000 per year. Dr. Makary points out that “it boils down to people dying from the care that they receive, rather than the disease for which they are seeking care.”
Kenneth Sands, who directs healthcare quality at Beth Israel Deaconess Medical Center, is quoted in the article lamenting that improvements in patient safety since the IOM report have proven to be minimal. He concludes, “One of the main barriers is the tremendous diversity and complexity in the way healthcare is delivered.” The approaches of the past, with doctors working alone, unsupported by advanced information technology, can’t provide patients with the excellence in clinical care they deserve, no matter how many scientific breakthroughs we accomplish.
The Threat of Superbugs
The final, equally gloomy article, “1 in 3 antibiotics prescribed in U.S. are unnecessary, major study finds,” reports on the results of a study from the Journal of the American Medical Association (JAMA) on the prescribing habits of American physicians.
Looking at in-person prescriptions written by physicians in office-based practice, the researchers found that 47 million antibiotic prescriptions written per year—one-third of all such scripts—may be inappropriate. Most of these unnecessary prescriptions were for conditions that didn’t warrant antibiotics—such as viral illnesses against which they are completely ineffective. An accompanying editorial in JAMA noted that this massive number actually undercounts the real overuse because the study leaves out telephone prescriptions and those written by nurse practitioners and physician assistants.
One major consequence of this inappropriate use of antibiotics has been the emergence of bacterial resistance to many of the very antibiotics that have been the mainstay of clinical practice. As a result, patients in hospitals and nursing homes are increasingly threatened by impossible-to-treat infections caused by new, drug-resistant “superbugs.”
Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, warned that “if we continue down the road of inappropriate use, we’ll lose the most powerful tool we have to fight life-threatening infections.” And his prediction proved accurate. Less than two weeks later, a woman in Pennsylvania was found to have a particular strain of bacteria that was resistant to colistin, what physicians think of as “the antibiotic of last resort.”
All That Glitters
When it comes to how we perceive our healthcare system, we have a split personality. On one hand, we celebrate its scientific achievements and sophisticated technology. On the other hand, we ignore the reality that, compared to other industrialized nations on globally recognized measures like life expectancy and childhood mortality, our clinical outcomes are below average.
As a nation, we focus on the excitement, the glamour and the glory. But we often ignore the ordinary, the straightforward and the proven. And in healthcare, on balance, the ordinary, the straightforward and the proven usually yield better results. One thing is certain: It will be decades before the number of lives saved through genetic manipulation each year matches the number of lives that could be saved next month by eliminating avoidable medical errors.
Opportunities abound to save hundreds of thousands of lives each year through time-honored fundamentals. Washing hands to avoid hospital-acquired infections. Following best-practice recommendations. Providing preventive care services more broadly. Double-checking medications before administrating them. Taking the time to explain to patients why an antibiotic is not needed.
But all of these actions pale in excitement compared to something new and shiny like gene editing. For the U.S. healthcare system to be truly great, we will need to become as expert at consistently and reliably accomplishing the routine and expected as we are at the remarkable. Otherwise, bacteria may come once again to rule the world.
This article appeared on June 9, 2016 on Forbes.com