This article is in response to Adam Barsouk’s recent article published on in-Training, “How Jimmy Kimmel Failed His Own Test.” The opinions expressed in this article are those of the author and do not necessarily reflect those in-Training or the editorial board.
We are in agreement. A robust and intellectual discussion of health care reform requires knowledge of the factors in play. Yet, we are deeply troubled by the simplicity and lack of nuance in a number of your arguments. Here are some of our responses:
There has been extensive research into the introduction of bias in scientific research due to conflicts of interest and sponsorship. Studies funded exclusively by industry do not always produce the highest quality research and often show greater benefits of a certain medication or device than independently-funded researchers. Furthermore, pharmaceutical innovation do not occur in a vacuum. Vast amounts of biomedical knowledge has been created by NIH-funded scientists and then applied to develop the life-saving treatments attributed to pharmaceutical companies. It also bears noting that few pharmaceutical and medical device companies focus their efforts on the prevention of chronic diseases, due to the lower amount of profits in this endeavor. Contrarily, NIH and CDC among a number of other government health care organizations have devoted enormous efforts to the improvement of diet, physical activity and smoking cessation of Americans, no doubt preventing countless instances of chronic diseases. As voiced in the Hippocratic Oath, “I will prevent disease whenever I can, for prevention is preferable to cure.” Simply comparing the dollar amounts funded by pharmaceutical companies and the NIH is entirely missing the target for improving population-level health. Additionally, we implore you to research the cases of young Americans addicted to opioids due to over-prescription of narcotics from orthopedic inquiries or other chronic pain syndromes. In the 1990s, pharmaceutical research indicated there were “no harms” to opioids and that one “could not become addicted.” This pharmaceutical research couldn’t be further from the truth, as clearly evident by the recent epidemic of overdoses.
The vast majority of Americans don’t choose to suffer from addiction, obesity or cancer. This is particularly the case for children, who are unable to make many of the desirable lifestyle choices simply due to the household environment they grew up in and the influences of their parents. Moreover, the unfortunate reality is that many food companies nowadays just like tobacco companies decades earlier aggressively market their products to children to gain loyalty to their brand and produce life-long “customers.” The food industry has built a multi-billion dollar industry on creating food that is addicting. Kellogg Pringle’s “once you pop, you can’t stop,” has never wrung truer than today. Would you punish an alcoholic who relapsed because the only reduced housing was above a liquor store? Any discussion implying that addiction to cigarettes, food or alcohol is a choice shows a complete lack of the biological factors and years of scientific research on addiction behavior.
Many health care professionals and policy makers agree that the long-term plan of reducing health care costs must focus on reducing preventable chronic diseases. While it is true that on the population-level, many chronic diseases are potentially preventable through lifestyle, it is never a guarantee for any single patient. Charging individuals who make poor lifestyle choices more for health insurance is an incredibly circuitous and counterproductive means of effecting lifestyle changes. Individuals who go to a convenience store to buy cigarettes or a sugary beverage will in most cases not be considering the potential health care costs 15-20 years down the line. Conversely, direct taxation on these products, which was universally enacted through government policies rather than industry self-regulation, has produced substantial population-level shifts away from these risky behaviors. Additionally, the education of health care professionals on the merits of a healthy diet, physical activity, sleep, stress reduction, as well as how to effect behavioral changes in the prevention of chronic diseases is grossly inadequate. The majority of medical schools do not even meet the minimum 25 hours of nutrition education recommended by the National Academy of Sciences, highlighting the large chasm between the best public health knowledge and what the medical community is helping to implement.
Yes, Jimmy Kimmel’s daughter would not have died due to inability to her inability to pay. But what if she was undocumented, a refugee, homeless, handicapped? We refuse to live in a society where the health of our country depends on the good nature of the top 1 percent. This seems to set up an inherently unequal socioeconomic system where individuals who cannot afford health care are somehow indebted to their wealthy neighbors. Ultimately, this will create an increasingly polarized society of the “haves” and “have nots,” given the profound connection between health and wealth. No one chooses a job without health insurance. Most blue-collared jobs and contract work don’t provide insurance, i.e. landscaper, artists, musician, actress and carpenter. Access to health care is a human right, and human rights are not denied based on any inherent characteristics or perceived failings of an individual.
We are deeply troubled to have seen these sentiments voiced by an individual about to enter the medical profession. This kind of misinformed arguments will not help to end the health care inequalities of our nation and will only serve to divide our communities of health care providers and even alienate patients from the medical profession.