GPI, Genuine Progress Indicator

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http://genuineprogress.net/genuine-progress-indicator/
In an attempt to give a more accurate indication of the economic health of an economy, economists have proposed the GPI which starts out with the GDP and adds environmental and human factors. Even this greatly improved metric still lacks the human factor of health. It would serve well to add the global burden of disease (GBD) ranking to the GPI in order to understand the extent to which the US falls behind economically. Health is an intrical part to the economic equation.

What They Don't Tell You in Medical School

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Disease is arguably defined as a maladaptation to the environment. Given this concept, one might consider the environment as well as the patient in looking for a diagnosis -- the other side of the coin, if you will.
The environment offers many challenges: social, employment, nutrition, substance abuse, chemical toxins, packaged food additives, the pneumoconiosis, air pollution, parasitic hazards, pollens, geographic locations and even the weather and the seasons. Hippocrates did a better job of considering the environment than we do.
This week's Case 12-2014 from The Mass General Hospital famously illustrates this concept -- A 59 yr old man with fatigue, abdominal pain, anemia and abnormal liver function; Friedman, Simmons et al NEJM 2014; 370: 1542-1550 http://www.nejm.org/doi/full/10.1056/NEJMcpc1314242?query=TOC http://consortiumlibrary.org/services/ill/.
This one is worth pursuing. Read the abstract and do your own differential. Then read the case and the CPC. (sorry no autopsy) Note the number of times this patient was sent home before he was finally admitted. The pre-admission scenario may reflect the emphases increasingly placed on rapid turnover and treatment by protocol ("best evidence") without adequate diagnosis or recognition that you do not yet have one. 

Burwell

Share | Burwell's greatest asset may be a W. Virginia origin. Certainly Harvard and Oxford are impressive along with Gates and Clinton.
There may be no way to make it otherwise, but leading us out of the mess we are in as a medical profession, requires both clinical savvy, macro economics, vast clinical experience and leadership. Without vast clinical experience, I see no way to fathom the cause of the medical problems or to address the dismal ranking of US medicine in the (GBD) global burden of disease.
Disincentives, built into nearly all past bureaucratic efforts to control cost, stifle progress at nearly every turn.. Privatization, incorporation, insurance and standardization opens the purse strings -- the feeding trough, if you will -- to greed, exploitation and a welcome mat for any and all new gimmicks, technologies, drugs and procedures with a price tag set by the producer.
Never mind the shiny new hospitals that are not even clean inside, have only fractional bed occupancy but discharge patients before it is safe -- all due to the profit motive. Medicine is not a business. It is not a free market; it requires science, dedication and humanity beyond the capacity of most outsiders.
But given all of that, I wish Burwell good luck. I wish I could say more..