I am deeply honored to have been selected as the American Liver Foundation physician of the year. I wish to thank my peers on the Medical Board for the award and to thank my colleagues, especially those on the NYU liver transplant team, my patients, students, and friends for their support over the years.
In looking back over the decades I have spent practicing medicine, I feel privileged to have been even a small part of the great progress and achievements of American medicine over the last half century. For no matter what you read on the front page, or the editorial page, or the op-ed page of the New York Times (and the articles in these three sections are often indistinguishable), medicine as researched and practiced in the United States has been and continues to be the best in the world. The achievements of the American medical community in the past half century have been incomparable and outstanding. As an intern at Bellevue I chose to study liver disease, because back then, liver disease was really the challenging proverbial black (or is it yellow?) box. Think of it: we had no sonograms, no CAT scans, no MRIs. We had no interferon and we certainly had no liver transplants.
In the past few years it has become apparent that the United States may not be so great at making automobiles. Our steel industry lags behind. Even Tonka toys come from China. But one area where we are really great is medicine. True, penicillin was discovered by a Scotsman … but after that came the American wave of medical progress. It had started originally with the Flexner report, which transformed medical schools from trade schools into university-associated academic institutions. Along with this new identity came high standards of teaching and—most important—research. Along the way came the National Institute of Health.
Also along the way came the pharmaceutical industry. The pharmaceutical industry has taken a lot of flak lately and they deserve a fair part of it. They really must take those expensive television commercials for prescription drugs off the airwaves. And nowhere in the bible does it say they must increase net profits twenty per cent a year. But, on the other hand, their business is discovering new medications that for the most part save lives. Liver transplantation was essentially a gleam in Tom Starzl’s eye until immunosuppressive drugs came along. The hepatitis C virus was isolated and identified by some incredibly talented scientists working at a biotech drug company. The pharmaceutical companies represented here tonight in our audience were actually responsible for major breakthroughs in the treatment of liver disease.
As you are all well aware, this country is in the midst of a great debate over health care “reform.” As a health care professional, I really have a problem with that terminology. It implies that there is something drastically wrong with our health care. There is nothing intrinsically wrong with our health care. The problem is that it is not getting to all who need it. The real challenge is that of improving health care distribution. This is of course a social problem, not a medical one. But it is a solvable one.
In reality, healthcare is a victim of its own success. Thanks to the wonderful achievements of medical science in the United States, people are living longer and medical care has gotten more expensive. Society has to deal with the social problem. The medical community has done more than its part. It is now up to the economists and society to handle what we have given them. And the solution is not rationing care and encouraging people to make end-of-life decisions. Think of it, every patient on the verge of a liver transplant is the subject of an end-of-life decision—or maybe on the verge of a renewal of life decision. If you deny the transplant, society saves $250,000. For that large sum you save one life. For that amount of money you could probably write 100,000 penicillin prescriptions. Should we stop doing liver transplants to finance penicillin prescriptions? Some MD/MBAs at the Dartmouth School of Business would say yes. However I think this country is capable of providing penicillin to all who need it and liver transplants to all who need them as well.
Medical care in the United States represents 16.5% of the GNP. In part of South America it is 7%. But we really don’t want the level of medical care available to the general populations of these countries. With medical science able to do so many wonderful life saving things, this is really not the time to be talking about pulling $500 billion out of current health care programs to effect “reform”. Only reduction of services can achieve such a goal, not the mythical concept of eradication of waste and inefficiency.
This country can afford subsidies for millionaire farmers, space stations in the great beyond, and earmarked bridges to nowhere, so why can it not afford the most advanced life saving medical care for all its citizens? We should, we can, and we will expand the distribution of medical care in this country to include those currently disadvantaged. However in the politically inspired, artificially created stampede to take care of the 5-10% of American currently not covered, let us not degrade and destroy the high level of medical care currently enjoyed by the other 90-95%.