Medical Mysteries

One thing you can hardly avoid in life in the US is the prominent role for medicine here.




It starts when you just walk around. In Europe, hospitals are large and obvious, but other medical practices tend to cluster and be rather discreet. Here they are everywhere. Almost every apartment block seems to have rented out its ground floor as medical surgeries, and quite a few private homes have a medical office as well. There are general practices, large and small, but also an astonishing number of specialities, for things I have sometimes hardly heard of.



Then turn on the TV. Fully 20-25% of advertising is for some medical remedy. In Europe, you see the odd advert for non-prescription medicines like cold remedies, but here these are dwarfed by speciality drugs which require prescriptions.



The industry certainly have money to advertise, but don’t seem to pay a lot to creative agencies, judging by the formulaic and unimaginative adverts. The whole advert usually has people walking around, with an extensive voice over. The walking around tries to convey some sort of discomfort, but never explicitly. Perhaps that would be considered bad taste. An example is a hilarious ad where people seem to spend their lives walking past toilets (rest rooms, in American). I guess we are supposed to discern that sometimes they also walk inside too, and need to do something unpleasant. As the voice over progresses, the actors still walk around, but start to smile more, as though their symptoms are alleviated. Now they walk past the rest room with purpose and a spring in their step.



Meanwhile the voice over has three distinct parts. Part one often starts with the phrase “imagine life without” continued by a description of a symptom and a named ailment I have rarely heard of. Having established a product name (for some reason usually three syllables with the last one –a) can alleviate the symptom, the voice starts to speak more quickly and reads a disclaimer, while the poor actors continue to walk around in the background, unsure whether to act in pain or cured.



The voice over disclaimer is hilarious, and is enough to put anyone off almost any product. For example, it might say that the product can lead to side effects of depression, suicidal tendency or death, before launching on a long list of other potential problems. OK, maybe that one isn’t for me then.



Finally, the happy walk starts and the voice over reverts to the slower tone. Ask your doctor about product X, we are implored, if we really want to walk around all day avoiding rest rooms, and don’t care too much about the suicide risk.



I do not exaggerate, this comes up virtually every break for something ending in –a. After a while it just starts to wash over you.



Not quite so common, but still a major advertising category, are legal compensation chasers. We knows these ones in Britain too, thanks to the lovely banks and their lovely mis-selling. But here, they are everywhere, and usually relate to a medical product which has had bad side-effects. Seemingly, I should be looking out for people who took all these three syllable products and then died or became suicidal, because then I could replace rest rooms with banks and investment products in my own walking life after picking up my compensation bonanza.



So what is happening here, and is it all bad?



After coming to the US, eventually we got around to registering with a GP and a dentist. In Europe, that might involve a quick visit, and never seeing them again in years. Not here.



The first part of any medical visit is the legal and financial part. All surgeries have as many people handling that as the actual medicine. You fill out form after form, with two purposes. One purpose is to tell them we won’t sue. The other is to establish who will pay, usually the insurance that comes from my wife’s work.



Then you make it to the actual physician. They have wonderful equipment and take a lot of time with you. They give lots of tests and send you to other places for more tests. And then they find things to treat. Expensive things.



So I tell the GP I am a bit deaf. In Europe that would lead to a quick inspection for wax and a shrug of the shoulders. Not in the US: I am referred to an audiologist, who turns out to have a financial and legal firewall, followed by impressive assistants and equipment. He sends me for another scan at another place, just to make sure.



The result is that between the four of us we must have made over twenty medical visits in three months. Some are regular, some are following up issues, some are preventative. All lead to a bill for the insurance company, and most lead to a follow up treatment.



And the bills are massive. I have a direct benchmark, since I happen to have had blood tests in Portugal, the Netherlands and the USA during 2012. The USA cost is between ten and fifty times higher, for what I perceive to be similar tests. They probably use more modern equipment, used by more highly paid and plentiful staff, backed by finance and legal overheads and still making good margins.



So now I understand a bit more why so many businesses here are medical. I suppose I can even understand the economics of the advertising, since if I do visit my GP and suggest the three syllable product for my (real?) rest-room problem, she will undoubtedly have the time and inclination (and financial incentive?) to follow it up. In Europe, it would take me two weeks of misery to get to see the GP, who would look at me askance for wasting his time, and probably need to look up the ailment himself.



Much of this is good. I can now sleep easier, secure that I don’t have various ailments that I never thought I had anyway. It is good I am not a hypochondriac, as I would then lose sleep from having so many extra ailments to worry about. But also if I do get something, they will discover it and treat it well – which in some cases must also save the system some money.



But the expense feels horrific, and uncontrolled. The federal government pays for the elderly and the very poor. There is a layer who previously lacked any insurance (and therefore would stay away), but Obamacare will remove that. And for the rest of us we have insurance, paid for by our employers.



Individuals have no real incentive to complain, and generally will not question any recommendation for treatment. It is a brave government which cuts back on expense for the elderly, though one day they will have to. Employers complain, but are not organised enough to make an impact. And big pharma, the many medical professionals, and their friends in finance, insurance and law, will say nothing and quietly get rich.



What can be done? The European systems are far from perfect, and, it now becomes clear to me, are way behind the game in preventative measures and timely checking for common illnesses.



But here things are out of control. Apparently some brave insurance companies are starting to challenge some recommendations, based on statistics. It feels good to me that the payment system rewards them for this, but of course the medics find it an insult that someone sitting in an office with no medical qualification can question their advice. In the end, the government will need to make the same challenges for medicare (older people). It also feels right that individuals should have some incentive to question a treatment.



It will take a long time to fix. Meanwhile, some advice. First, if you have a child, they could do worse than go into medicine in the USA. Second, don’t bet on the USA sorting out its deficit anytime soon. And lastly, if you manage to visit the USA, don’t miss the wonderful TV adverts.

Get out more!

Last week I was in Bucharest. Sometimes I travel there with a colleague, and then we will usually share an evening meal. But last week I was on my own. When that happens, normally I just sit in my room and eat in the hotel or at a fast place nearby.




But last week I forced myself to do something different. One evening I went to the city centre and had a far nicer Turkish meal for far less than I would have paid in the hotel. And I also googled concerts, and got my seat for a choir and orchestra concert at their main hall, the Athenaeum.



So on Friday evening I got in my four dollar taxi and made my way into town to use my fifteen dollar ticket, unsure what to expect. One of the main works of the programme was by a Russian called Taneyev, who I had never heard of.



The hall was full, the choir numbered a hundred and the orchestra nearly the same. The soloist and the conductor gave a lot of passion. I loved the piece I did not know, a cantata of St John of Damascus which I now look up is also known as a Russian Requiem. I loved the whole show.



Then afterwards, the show had started early, so I needed to eat something. I started walking vaguely towards the centre. I almost entered the lowest common denominator, Pizza Hut, just what I would normally do alone and in a hurry, but luckily it looked very busy so I walked on.



Then I came to a Christmas market in university Square. It turned out as tacky as most Christmas markets, and I am certainly not a shopper, but was still an experience, with something for all the senses and a beautiful surrounding. I ended up eating a local seasonal speciality, dough rolled on an outsize rolling pin which is then barbecued and dipped in cinnamon or sugar or nuts. And of course I had a glass of hot wine, which of course was worse than mediocre, but still I got home happy.



I drew three lessons from my unexpected Friday night, one about being active and two about humility.



The one about being active was the most obvious. How much effort did this evening cost me? How much money? I had a delightful time, even on my own, just because I opened my senses and put in a tiny bit of effort. It is clear that the world is a wonderful place and much of it is available to us, yet we plough our narrow, narrow furrows most of the time. We should all get out more! This applies at home as well as away, and doesn’t need anything as dramatic as a night out in an unfamiliar city. Why do I never talk to my neighbour on a plane? Why do I always choose familiar food? Get out more, Graham!



Answering my own questions leads me to the second great lesson from Friday. One reason we stick with the familiar is that we arrogantly assume we know so much about the world that we haven’t got much to learn from or delight in. We don’t reach out to people because we assume we have nothing in common, or worse, that somehow other people are beneath us in some way.



How many times have I had to learn this lesson, and how many times have I just discarded or forgotten it? People always have the capacity to surprise. Romanians can sing beautifully. Composers I have never heard of can write masterpieces (and this is from a familiar genre and culture, what might I be missing from Africa or India?). The most neglected city has wonderful hidden gems somewhere. Traditions can often delight.



Three years ago I joined a specific self-help group for a time, a group which did me a lot of good. Many of the other attendees were quite desperate in different ways, and few had had the benefit of much education or the chance to amass any wealth. One day I was at a meeting with just two of us. I was a bit disappointed because I had a particular dilemma to raise and had hoped for a bigger crowd, while this particular lady I had always discarded as rather dull. I raised the dilemma anyway, with modest expectations. And this lady said three or four things that were as profound as anything I had ever heard, mature, relevant, empathetic. I cannot even remember the dilemma or its solution now, but I remember the lesson that many people have great depths if we can only seek them out. It was one of the most humbling experiences of my whole life – though I wish somehow I didn’t keep making the same mistakes again.



The third lesson is about humility in a different way and came from some thoughts spinning through my head during the evening. As often happens, a moment worked like a bolt, shooting my mind to a memory. The Christmas market sent me to Montreux, and the last time I had been at such a market, and many happy memories of that time. One piece of Rachmaninov reminded me of another, and a moment in my twenties on a plane to a new life with that music in my ipod (or Walkman back then, more likely). Memories are often jogged that way for me.



This concert was probably enjoyed in as many ways as there were people in the theatre, with different memories jogged. Some people may have had a bad day at work, or been stuck in traffic. Others may have enjoyed a compliment, or a hug. Some will have tired, others wide awake. For everyone, the experience will have unique.



Then go wider. There are seven billion humans, all with memories to trigger and hinterlands to be explored. Each of us is made of countless cells that somehow divided when they were supposed to. The Athaneum has a circular mural which I think showed the history of Bucharest – how many people’s lives have been affected? Many in audience will have also been there in Caecescu’s time. So might the homeless people outside. I noticed a young couple on a first date. Flowers laid by a statue recalling the events of 1989. Looking up, I see stars and galaxies.



How utterly bewildering the universe is. How many dimensions of unfathomable scale interact to create history, present and future?



This does not necessarily make me believe in a God. What it does do is make me believe in my own smallness, in the smallness of all of us. We know nothing, yet we muddle along and stuff happens.



I love this thought. It leaves room for wonder and delight and joy. It leaves incalculable space to learn. It leaves reason to hope. But it also helps humility. Whenever I think I know something, or even that collective we know something, I can think about nights like this and realise how little we do know.



That leads to a good sense of exploration, but also a good sense of caution. How can any human make definitive remarks about something like climate change, or something like the limits of the human mind? We are taught to try to be definitive, and to value certainty. We seem to need our politicians and scientists and business leaders and bosses to reassure us, so that is what they try to do. They simplify. But then we believe the simplification, and that makes us too sure, and too arrogant, and stops us listening and observing and learning. And that is how cataclysm might arise. Who can possibly be sure that the complex changes man wreaks on a planet will not end in our destruction? No-one can. Surely we need to start taking out a planet insurance policy?



So, three great lessons from one solitary night. And some good music and barbecued bread too. I must get out more.