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U.S. health system’s huge improvements


Jeff Goldsmith, Ph.D.,  president of Health Futures Inc. and associate professor of public health sciences at the University of Virginia, says in a Hospitals & Health Networks piece that U.S. health-system performance has gotten better in recent years.

He gives a lot of attention to total hip replacements, wh0se “breakthrough” started in the mid-1970s.

“There has been no cure for arthritis since and, sadly, none appears even remotely likely. Rather, the real progress in total hip replacement came from continual refinement by the orthopedic community not only of hardware but also of clinical processes inside and outside the operating room.”

“Nor is this seemingly invisible progress through collective learning an isolated instance confined to orthopedics.  Much has been made of the continued frustration in the search for a ‘cure’ for cancer and of the high cost of new cancer medications. The popular press neglects to mention that while we’ve been waiting for a ‘cure’ for cancer, there has been a nearly 25 percent decline in the age-adjusted death rate from cancer in the U.S. since 1990.”

“Though the disease remains scary for patients and their families, cancer treatment today is much less a ‘one off’ search for solutions than it was even a decade ago. Cancer care is increasingly protocol-driven, informed by a comprehensive and growing cancer registry maintained by a network of National Cancer Institute-designated community cancer centers. There has certainly been therapeutic progress for some forms of cancer, including a vaccine for cervical cancer, but the real progress has been an immense and largely invisible collective effort by the cancer community to harness the power of big data and clinical practice experience across millions of cases.”

And:  “Stroke care today begins in the ambulance on the way to the hospital, and hospitals are publicly rated on the number of minutes that elapse between the moment the patient reaches the hospital’s front door and the time that catheter-driven therapy (coils or stents) addresses the cause of the stroke (e.g., bleeding or vascular blockage). Strokes are still a scary health risk, but a massive amount of suffering and brain damage today is avoided by more systematic and focused care. ”

“Though it is still the nation’s leading killer, deaths from heart disease have declined by two-thirds since 1970. This is despite the escalation of cardiac risk created by the obesity epidemic and the resulting sharp rise in the prevalence of diabetes. Absent these two linked developments, one suspects the decline in cardiac mortality would have been even more striking than what we have seen. Twin revolutions in invasive cardiac care — bypass graft surgery beginning in the early 1970’s and cardiac stenting in the 1990s — helped alleviate symptoms, while marked improvements in cardiac intensive care saved hundreds of thousands of lives after cardiac events. ”


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