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Will the Corona crisis clean up health care?

Rinckside 2020; 31,3: 5-6.

he writing was on the wall, but hardly anybody saw it or could read it. Anyhow, it’s part of human nature to avoid possible misery — partly by not facing it. There were voices crying in the wilderness describing the portents of disaster. We did not hear them.

In 2007 four researchers from Hong Kong summarized and reviewed research in a 35-page publication. They came to this conclusion:

"Corona viruses are well known to undergo genetic recombination, which may lead to new genotypes and outbreaks. The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored [1]."

The few reactions to this statement were drowned in the general rejoicing about the great future — especially in medicine and radiology where we permanently have great leaps forward, from new gadgets to artificial intelligence. People forget that irrational, incalculable forces hover above human life. The principle of humanity, which has hitherto been so important in the health system, was being pushed into the background in favor of economic or ego-considerations.

Sometimes one should remember the well-known motto of the boy scouts: “Be prepared.”

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Sometimes one should remember the motto of the boy scouts: “Be prepared.”

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Financial or human value?

Some years ago, a major manufacturer of medical and radiological equipment removed the term healthcare from its company name. Its new mission statement read:

“Our purpose is to enable healthcare providers to increase value by empowering them on their journey towards expanding precision medicine, transforming care delivery, and improving patient experience, all enabled by digitalizing healthcare.”

Value in this context is financial value, not necessarily human value. The health politics in some countries appraise private over communal medicine. The medical-industrial complex lobbies for such systems without determining whether they are providing services of acceptable quality at reasonable prices and ensuring that they do not have adverse effects on the health care system [2].

The traditional providers of medical care — and medical research — are challenged by a noisy and critical civil society. Company managers, politicians, and lobbyists want to influence important aspects of medicine — and turn it into a modern commodity. In general, people lacking proper background comment and forcefully interfere with established medical and radiological routines. They believe that they know better. There is an attitude problem in our societies; lay people and political oddballs display a dangerous overconfidence in their ideas that makes them reckless [3, 4].

Why did the politicians and civil servants not implement the existing long-term plans for pandemics? Why were the government stocks of, among others, professional masks destroyed in some countries?

In France, for instance, the government apparently still had a stock of one billion surgical masks and 600 million masks of the professional standard FFP2 until 2010. "But after the H1N1 flu wave of 2011, it was decided that these stocks were no longer needed and that global production would be sufficient," reported Health Minister Olivier Véran. Older masks were destroyed after their date of use and not replaced to the necessary extent to "save" money. The same holds for Germany and other European countries.

Building up reserves in personnel, premises and materials does not correspond to the commercial logic that has found its way into the health care system. Anything that is not constantly used to full capacity is dissolved for financial reasons.

Ethics and imaging

In July 2019, TRTF, The Round Table Foundation, arranged its 9th Meeting on Ethics in Medicine: "The Depersonalization of Medical Imaging."

During the discussions, the participants stressed that healing and nursing, the main tasks of a physician, seem to dissipate in the realm of modern medical imaging. It was argued that the industrialization of medicine — including and most distinct in the service disciplines pathology, laboratory medicine and medical imaging — has turned sickness into a commodity and increasingly depersonalizes patients by standard­ization and inter­change­abi­lity.

Science collects infinite miscellaneous biological and physiological processes and data, but ignores individual human uniqueness in order to abstract the underlying operating mechanisms. Decisions are taken over by machines and relied upon without control. Artificial intelligence and its ethical implications were one of the main topics of the meeting.

There is — or should be — a human beings' right to empathic and personal treatment by physicians, also in the ancillary medical disciplines such as radiology. However, during the last decades we could watch a gradual decline of the old values and of seriousness.

   One of the main lessons to be learnt — or perhaps even the lesson to be learnt — from the ongoing pandemic that tortures mankind is that the gods always seem to fight back the hubris of humans. If you want, the term "gods" can be replaced by "nature". We have made progress in medicine but also lost a lot of compassionate and merciful health care and human interaction. However, when you mention this you are considered a spoilsport.

For years we have been worried about nuclear bombs, intelligent killer weapons, and the climate change. But now a primitive virus is hitting us and we have major problems to strike back. Is this an irony of nature?

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References

1. Cheng VCC, Lau SKP, Woo PCY, Yuen KY. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev 2007: 20,4; 660-694.
2. Relman AS. The new medical-industrial complex. N Engl J Med. 1980; 303(17): 963-970.
3. Relman AS. On breaking one's neck. The New York Review of Books. 2014; 61(2): 26-29.
4. Rinck PA. Have you read the best medical paper of the year? Rinckside 2014; 25,7: 13-14.

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Citation: Rinck PA. Will the Corona crisis clean up health care? Rinckside 2020; 31,3: 5-6.

A digest version of this column was published as:
Nature's fight back against human hubris.
Aunt Minnie Europe. Maverinck. 12 May 2020.

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