Methods of diagnosis and treatment are improving before our eyes, but for some reason we did not get sick less. Rather the opposite. A paradoxical situation arose: the more progressive the medicine, the longer the list of diseases. The floor is given to the Head of the Department of Hematology and Geriatrics, Head of the Department of Standardization in Healthcare of the Moscow Medical Academy. IM Sechenov, Doctor of Medical Sciences, Professor Pavel Andreevich Vorobiev.
The longer a person lives, the more actively he gets sick. A hundred years ago, more than half of the people died from infections, now - a negligible percentage. However, instead of infections, we got other diseases that also lead to death: myocardial infarction, stroke, malignant tumors, etc. The more diseases we cure, the more we end up getting. More precisely, new diseases do not arise out of nowhere, just before a person did not live to see them. The human body is programmed to die, whether we like it or not. The only question is whether a person will die relatively healthy, with a clear mind, or a decrepit wreck that has not been out of bed for several years.
The situation is complicated by the fact that … non-existent diseases began to be actively treated. The root of this problem lies in the economic sphere. The Russian doctor is now in dire conditions. He receives a beggarly salary and is forced to seek a livelihood. How it ends, we saw in the report about kidney transplantation: for the sake of money, organs are removed from people who have not yet died. According to our law, it is not clear how to fix the death of the brain, it can be done from left to right and from right to left. As soon as there are liberties in the interpretation, it is no longer difficult to find a loophole. The moral, ethical and legislative problem is shifting to the economic plane.
Doctors defend themselves
The Russian doctor is a beggar, he earns money by any means, and he found himself in poverty through the fault of society. But no one cares that the doctor receives strictly according to the tariff schedule approved by the state, and legally cannot earn a dime more. On the one hand, a doctor is paid a penny salary: five to seven or ten thousand rubles, depending on the region. For a graduate of a medical school, this is ridiculous money, for doctors aged - the end of the world. On the other hand, there are no conditions for legal earnings. For example, in Moscow, official commercial activities in public health facilities are prohibited. The hospital cannot officially make money!
Instead of honestly allocating the amount of free medical care and offering to pay for what is in excess of it, it is argued that in all hospitals, treatment is free: come and help you. People come and keep a fig in their pockets, believing that if the doctor is not paid, he will not provide any help. Why is there no such thing in the West? Are the doctors more honest there? Of course not. They just get paid legally for their work. And here money is transferred in an envelope or put in a pocket. The amount of money that today goes illegally in medicine is estimated to be equal to all the money in the country's healthcare system.
Chief doctors are looking for funds to feed their subordinates. They cannot be blamed for this. It is impossible to exist on a beggarly salary of a doctor. In order to change the situation, you need to honestly explain to people that medical care has never been free, that someone pays for it, and for this there are special financial schemes.
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It is beneficial to treat what is not there
Invented diseases are an attempt by doctors to protect themselves from a society that robs them, preventing them from earning. The mechanism is very simple: the patient is taught that there is some kind of pathology, which in fact does not exist. More precisely, there is still no patient, there is a healthy person who is promised on TV to help from all diseases, existing and future.
The list of non-existent diseases is quite long. For example, cellulite. According to its name, it is a disease ("-it" - inflammation). In fact, there is neither disease nor inflammation, but obesity. You don't have to do liposuction, but eat less, move more, or accept the fact that you have such a metabolism, because it is difficult and futile to fight it.
Osteochondrosis is an invented pathology. Skeleton images in people after 50 will show that almost everyone has osteochondrosis, these are age-related changes. Whether a person suffers from sciatica is another question. With radiculitis, we say: the disease is associated with a change in the skeleton, but osteochondrosis itself is an age norm. Now there is a similar problem with osteoporosis, which almost all people over 60 have. In most cases it does not cause physical suffering, these are the same age-related changes as wrinkles. Well, you will identify osteoporosis in 99 out of 100 elderly people, will you treat it? Money is spent on the treatment of a non-disease, but there is not enough money for the disease.
There are diseases associated with trying to lose weight. I buried one such patient. A very plump woman dramatically lost weight, her kidneys sank, she developed kidney failure - and she died. Fast weight loss is much more dangerous than obesity! And there are a lot of stories about how sepsis (blood poisoning) develops after liposuction. In principle, this is a normal complication of any operation, but is the cosmetic effect worth it to go for such complications, sometimes ending in death?
They make up a lot of things, including many infections. But their treatment causes unconditional harm to health. Antibiotics are the number one drug for pneumonia, sepsis, pyelonephritis, etc. But when infections are invented, it is a load on the gastrointestinal tract, complications on the kidneys and liver. We live in the world of microbes and every day we encounter a variety of pathogens: we have a lot of them in our mouths, on our hands, in the intestines, etc. Until now, we have lived with them and put up with them. And now we are offered complete sterility from the screen using antibacterial soap. But if we remove the flora with which we now live, then pathogenic microorganisms will multiply in countless numbers, fungi, viruses will appear, and all this will end sadly.
The second side of the problem: since there are many pathogens and it is not so difficult to identify them, any disease can be associated with any pathogen. “However,” does not mean “as a result”. There is a joke: "People get heart attacks because they eat cucumbers." Why? Because all heart attack patients have ever eaten cucumbers. These are facts, but making a connection between them is foolish. It's the same with infections. Almost everyone has chlamydia, E. coli, measles virus in one form or another. Seemingly simple analogies require very tough checks. There must be clear evidence: such and such a pathogen causes such and such a clinical picture and nothing else. The hepatitis virus (A, B, C) causes hepatitis, but not prostate adenoma. Although why not write that he is to blame for this disease too? Chlamydia is diagnosed and treated at every step. I'm not the only one who knows caseswhen doctors enter into an agreement with laboratory assistants and in the analyzes "find" everything they need.
“A very recent example of a fictional disease is SARS. There is a causative agent, a clinic - too, - continues Pavel Andreevich Vorobyov. - But is there a problem? According to official statistics, 40 thousand people die annually from various respiratory tract infections in Russia. From SARS worldwide - less than a thousand. Can these figures be compared with the costs incurred even by our country, not to mention China?
Society turned out to be very easy to make people believe in anything.
Magnetic zirconia bracelets are a terrible thing. The ad directly states, “I stopped taking my medication. My friends too”. This means that some part of hypertensive patients will stop being treated and die from a stroke. Once with hypertension, you can not take medicine (which is prohibited by all recommendations in the world!), Then someone will die. The question from the ethical plane turns into a criminal one: the inducement to refuse drugs is an act.
Half of the dietary supplement manufacturers advertised on TV can be sued because they claim to cure disease. In fact, only drugs are treated, and dietary supplements are not included in them and are not registered as their quality. This means that the consumer is being misled, which damages his health.
Non-existent diseases are invented for wealthy people for the sake of pumping out money. Since wealthy people are most often young, which means they are relatively healthy, the corresponding diseases are invented so that they can be found in a healthy person. Old women and old people usually get sick, no one invents anything for them. Try to find a retired woman with chlamydia. But there are plenty of young people. Because the grandmother cannot pay for the treatment, but the young can.
Gold rush diagnosis
The most beneficial now is not so much treatment as diagnostics. It is impossible to check anything. You are given test strips, which you can use to identify hundreds of diseases. They should not be confused with strips for determining sugar in diabetics, they are vital. Cell resonance devices, diagnostics in 40 minutes are examples of how easy it is to fool people. Alternative medicine, the Voll method, has actively developed. They talk about diseases that a person does not have now, but tomorrow they will definitely be. There is no responsibility for such a "prediction", but a person is "treated" for what he does not have.
We are being drummed into the idea that early diagnosis of the disease is the best way to deal with it. What early diagnosis of acute myocardial infarction, acute pneumonia, meningitis can be? Until they have taken place, there can be no early diagnosis.
Even the need for early diagnosis of tumors was shaken. After the publication of the results of the global statistical analysis, the entire medical world was in a state of excitement. Patients with early-stage breast cancer (the most common cancer in women) live longer than those with advanced cancer. But when they analyzed millions of cases of breast cancer, they found out that all women will die at the same age. They will live different numbers of years after being diagnosed with cancer, but the age on the day of death will be the same. For the medical world, this is a sensation. Let me emphasize that we are not talking about a specific person (some patients die at 35, others at 70), but about statistics, that is, about the average age at which women die from breast cancer. It is the same in the early and late stage cancer groups. There is no difference in life expectancy in these two groups. The explanation is very simple: before, breast cancer was treated promptly, and now, chemotherapy is first performed. And the current drugs can cure breast cancer in almost 80% of cases in the late stages. There are medications for treatment and achieving such results, but, by our standards, they cost crazy money, so the question is - are they available to Russians?therefore, the question is different - are they available to Russians?therefore, the question is different - are they available to Russians?
Today in Russia, there is a rapid development of mammography rooms, which means that money is being invested in diagnostics that is unnecessary on such a scale, instead of spending part of it on the development of a medical network: for the purchase of modern (very expensive!) Drugs and for effective treatment of sick women. Please note this only applies to breast cancer! If we take other cancers, this discovery does not concern them. One thing is colon cancer, which is difficult to treat, another thing is breast cancer, which with modern drugs can be cured in 80% of cases, even in advanced cases - provided that we spend a lot of money on treatment.
Another example is syphilis. They constantly talk about the epidemic. She's really raging. But among whom - all Russians or people from risk groups (prostitutes, drug addicts, teenagers from disadvantaged families)? Why should everyone do an analysis on the Wasserman reaction? When it was introduced many years ago, syphilis was widespread. Anyone had a real chance of getting sick. The situation has changed long ago. But the analyzes continue to be done to absolutely everyone, which means they throw huge money down the drain. We calculated how much one case of detected syphilis costs using a total check of all hospitalized. Several annual courses of treatment for tuberculosis patients! And if we add to this tests, which are duplicated in a polyclinic, one hospital, another, etc., the amount will increase tenfold. Suspect syphilis - get tested: in prisons,homeless people, etc. Why waste money on everyone else?
The richer the weirder
The situation of invented diseases is a world practice. The USA is in the lead, they are the main developers of PR companies. If Russian doctors treat what does not exist, from poverty and hopelessness, then in the States they simply do business on medicine.
In the West, more attention is paid to exotic diseases. In the States, mental illnesses are in the lead, such as: bad behavior at school (a child runs during breaks - feed him with tranquilizers), poor academic performance (stimulants must be served), poor appetite (stimulants). And how much talk about depression! There is a manic-depressive psychosis, a serious illness, with a rapid personality degradation. God forbid anyone to face this. But depression has nothing to do with him. Depression occurs in everyone, and this is not a disease, it is a mood. Well now, the mood to heal? And when will a person fall in love and equate love with illness?
I was very amused among the non-illnesses "allergy to the XXI century", such a diagnosis appeared on the website of the British Medical Journal. What it is? Unclear. But once a diagnosis is made, it means that someone is probably treating him with something. Chronic fatigue syndrome (CFS) is a disease from the same series. It's like a slow virus is causing CFS. This is already being treated with us.
Weight loss fashion is of American origin. In the States, insurance is risky, that is, the higher the risk of getting sick, the more you pay for it. What should be done to ensure that the maximum number of healthy people has a high risk? Include weight in risk score. I specially took my students to the intensive care unit with the task of finding an obese patient among patients with a heart attack. This can be done extremely rarely, because mainly smokers suffer from heart attacks, and smokers for the most part are thin people. They get fat when they quit smoking.
If you build two lines - relatively thick and thin - then among the so-called normal there will be no healthy. In the line of normal weight there will be smokers, patients with diabetes mellitus, tumors, tuberculosis, thyrotoxicosis. All healthy people will be among the fat ones. Of course, when a person grows, all the strength and juices of the body are spent on this, so thinness is normal in youth, but by the age of 30, the thin no longer fall into the cohort of healthy ones.
There is a way out, but it's far away
There is no universal recipe for determining false diagnoses. The first thing to be prepared for: if you come to the doctor with money, be sure that you will be cheated. And it doesn't matter if you pay legally in a private clinic or illegally in a state one. Be prepared for the fact that you will be deceived, just like in the store - to weigh. Here's an example. A friend of mine went to a good dentist. He looked into his mouth and threw up his hands: “What fillings you have! They all need to be removed. The man had 8 fillings removed, with which he lived for many years, and now he cannot eat, because the configuration of his mouth and teeth has changed. Maybe they put good seals on him, but this is pure deception and extortion of money.
A person cannot figure out which doctor is lying and which one is telling the truth, and in fact he should not do it. In an amicable way, it is necessary to change the payment system towards voluntary health insurance (VHI). Why does the question of insurance arise? Medicine is a rather complex area in which a person who does not have a special education cannot figure it out for himself. When buying serious equipment, you call your acquaintances who understand it and are able to help with the choice. It is even more difficult to understand medicine. This should be done by a specialist, and an independent specialist, interested in the patient's health and in not overpaying the doctor. Such an interested person is an insurance company that is able to monitor the correctness and necessity of prescriptions and treatment. This is not an ideal solution to the question,but this is at least some solution. As long as the patient pays directly to the doctor, nothing good will come of it, they will not stop cheating.
When we got to the Western health systems, it turned out that they are all bad enough. For example, in the States, insurance is compulsory for employers, who more or less do not care what a person is sick with and how they are treated. The insurance company there is interested in having big money, and not in human health, because it has nothing to do with a specific consumer.
From here it seemed to us that everything was fine abroad, but it turned out that there were their own problems, with which they were trying to fight the same way we were with ours. Moreover, some countries, especially Great Britain, have copied the health care system from the Soviet one. The funny thing is that they continue to do this even now. In the second half of the 90s, when we told the Germans about standardization, they groaned and were indignant: how can it be that medicine cannot be brought to standards, the doctor himself must make a decision … born in Moscow.
Rich people in our country have already switched to voluntary health insurance (VHI), to some extent they have protected themselves from cheating by doctors. But the problem is that voluntary insurance is underdeveloped in our country; only a few percent of Russians have resorted to it. The bulk of them are residents of Moscow and St. Petersburg. If you voluntarily insure yourself somewhere in the outback, then you simply have nowhere to be treated: you will end up in the same hospital as with a compulsory health insurance policy (MHI). Today, voluntary medical insurance cannot influence medicine in any way, because if insurers start making claims to the head physician, he simply breaks the contract with them. There is no economic incentive. If voluntary medical insurance becomes widespread, then its budget will be comparable to the budget of the compulsory medical insurance and will turn into an economic lever for medicine. But this system must come into play. Today we cannot nod towards the LCA and say that it is bad there too. Yes, bad, but only because it is a drop in the ocean.
The problem is to convince people of the need for voluntary insurance. After all, the first thought, as in the case of the pension fund, will be the same: robbed! Today voluntary medical insurance is very expensive (about a thousand dollars a year per person) simply because there are few insured people. But already now, insurance companies have begun to build their hospitals, as they cannot work with government agencies.
In 1992, when the gates to heaven were opened, the famous 42nd order of the Ministry of Health was issued, in which there is only one line: about granting the status of a legal entity to pharmacies. The same order originally included medical institutions and blood transfusion stations. The last two positions were crossed out by the unwavering hand of the Deputy Minister - and the order was issued only for pharmacies. As a result, the pharmacies, having gained freedom, established the pharmaceutical market, and today the country has full access to modern medicines. You can find everything in pharmacies, but buy … But this is not a question for pharmacies, but for the state, which has not regulated the system of providing medicines. By the way, the same VHI system can take over a significant part of the drug market. Medical institutions remained in an uncertain status: many do not have their own accounts, statutes,the chief physician has no rights in the distribution of money, he cannot transfer money from his salary for repairs or medicines and vice versa, and if he receives some additional profit, he is very rigidly squeezed by the framework in its distribution. Until medical institutions become independent organizations, no VHI will work. Where will the insurance company pay? To the regional cash office, which will distribute money to all polyclinics in the area? But she must pay the hospital or the clinic where a particular patient was cured, and not the entire district. And the insurance company cannot influence the quality of medical care in any way. Until medical institutions become independent organizations, no VHI will work. Where will the insurance company pay? To the regional cash office, which will distribute money to all polyclinics in the area? But she must pay the hospital or the clinic where a particular patient was cured, and not the entire district. And the insurance company cannot influence the quality of medical care in any way. Until medical institutions become independent organizations, no VHI will work. Where will the insurance company pay? To the regional cash office, which will distribute money to all polyclinics in the area? But she must pay the hospital or the clinic where a particular patient was cured, and not the entire district. And the insurance company cannot influence the quality of medical care in any way.
This has been discussed for many years, the understanding has matured, if not a catastrophe, then a dead end. And now conversations have reached a level from which decisions can be made."
Olga Dyubankova