Between 2007 and 2010, due to the subprime mortgage crisis, the United States faced a horrific financial disaster. This period in US history has been labeled as the Great Recession. It was a time when neighborhoods and communities across the country become abandoned, boarded up, foreclosed on, and left for ruins. It was an eerie thing to experience and one that we are still recovering from today. Numerous media publications have described parts of the United States hit the hardest during this crisis as “recession ghost towns.” Such descriptions are reminiscent of old abandoned mining towns such as Bodie, California that were left for waste following the Gold Rush.
The individuals and families who lost their homes during the Great Recession found it impossible to pay their bills due to unconscionable mortgage agreements with banks, the lack of employment opportunities and an economy that was hanging by a thread. But the cost folks paid for this Great Recession cut much deeper than their pocketbooks and bank accounts. Many people lost homes and properties that had been in their families for decades. Homes with memories dating back to their childhoods, their parents’ childhoods, and beyond.
While we watched these individuals and families lose their homes and struggle to survive, we also watched absolutely ZERO accountability be handed out for those on Wall Street who were responsible for these catastrophic losses. Charles Ferguson, the director of Inside Job (released in 2010) once described this financial disaster by stating:
When the system is rigged, when ordinary citizens are powerless, and when whistle-blowers are pariahs at best, three things happen. First, the worst people rise to the top. They behave appallingly, and they wreak havoc. Second, people who could make productive contributions to society are incented to become destructive, because corruption is far more lucrative than honest work. And third, everyone else pays, both economically and emotionally; people become cynical, selfish, and fatalistic. Often they go along with the system, but they hate themselves for it. They play the game to survive and feed their families, but both they and society suffer.
During the peak of subprime mortgage lending, many people got rich and the officers and directors of the financial institutions backing these non-prime lenders became unbelievably rich.
Later, in 2013, The Wolf of Wall Street came out in theaters, and we were given a three-hour glimpse into the extravagant, excessive, and dysfunctional lifestyles maintained by some of the wealthy and powerful on Wall Street. As difficult as it was to watch all the lying and backstabbing (considering we were just on the heels of the Great Recession), it was also difficult to turn away from watching their lifestyles of mansions, exotic cars, private jets, and all the sex, drugs, and alcohol you could handle.
But this pursuit of wealth goes far back. Whether it’s the “recession ghost towns” of today or old ghost mining towns such as Bodie, California, the memories are still there to haunt us. Historian H.W. Brands once commented on the significance the Gold Rush had on capitalism in this country: “California presented to people a new model for the American dream – one where the emphasis was on the ability to take risks, the willingness to gamble on the future.”
Those freedoms to take risks and gamble on the future are part of what make capitalism so appealing. Freedom and risk taking allow for innovation and technology to evolve and improve. Specific to healthcare, this leads to additional treatment options and our ability to cure disease. But, with examples such as the Great Recession, we still feel the burn of what happens when you remove all laws and regulations designed to protect the consumer from corporate greed at their expense.
In this day and age is anyone really surprised to hear that Capitol Hill, Wall Street, the banking and finance industry, big corporations, or big pharma are corrupt? Just turn on the television and you’ll likely see somebody from one of those five groups getting indicted due to some alleged white-collar crime.
But what about this capitalist approach of risk taking and gambling when it comes to service-based professions such as your healthcare providers?
One recent example of putting profits and greed over human life can be found with the polypropylene transvaginal mesh (“TVM”) kits that have flooded the market over the past decade. Approximately two million women in the United States alone were treated like guinea pigs by their doctors when they were told they needed a “quick and easy” procedure that would cure their incontinence. Often these doctors who were implanting women, young and old, with mesh had little exposure to these kits in a real operating room setting (they had spent a handful of time practicing on a cadaver) and many of these women were these doctors first attempts at putting it into a patient in their practice.
These same women trusted their OBGYNs to take conservative steps in their treatment. Some had been going to their same doctors for decades and trusted their OBGYN would only recommend invasive procedures and undergoing the risks of general anesthesia for the most necessary of circumstances. They assumed their doctors would never take a risk with their healthcare and they would adhere to the Hippocratic Oath when it came to these specialized surgical procedures: “I [the OBGYN] will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.”
But rather than trade stocks or take financial risks with people’s financial portfolios or family home like we saw on Wall Street, these OBGYNs were taking risks with women’s health by performing surgeries they were not qualified to do, implanting medical devices they knew little if anything about, with the understanding that it would be a quick and easy way to make more money in their practice. Many are still taking these risks with their patients today.
With TVM we have sat back and watched OBGYNs convert non-life-threatening conditions such as stress-urinary incontinence (“SUI”) into exotic sports cars, mansions, second homes, and a life of luxury by utilizing what equates to a bank in their practice: their medical license. The same was true for those doctors who were implanting even larger amounts of preconfigured mesh available in various pelvic organ prolapse (“POP”) kits.
It could be argued that many OBGYN’s practices have almost completely converted from a traditional family practice to an exclusive TVM implant surgery center. Sadly, this has left millions of women in the same situation: they entered their doctor’s office with a non-life-threatening condition (urinary leakage or “SUI”) trusting their doctor who told them they needed a TVM implant to get better, only to leave that same operating room with a lifetime of serious pain and complications. Also, the same SUI and/or POP they had when they entered the operating room will most likely return, but now it will be joined with an overwhelming number of life-long painful complications due to the TVM implant.
This isn’t to say all OBGYNs or all doctors are bad, but just like Wall Street, greed continues to permeate the healthcare industry as well. One doctor, sharing his concerns to his colleagues wrote: “the most corrosive effect of greed and the tacit approval of greed is to the profession’s philosophy of service. Where most of us were trained to believe that our service is based solely on trust, with firstly avoiding harm as the ultimate measure of every medical action, an ethic of greed changes our elemental belief that the buyer is always responsible. With an ethic of greed doctors cease to base their motivation on compassion and caring to become merchants selling medical services to the highest bidder.”
If we revisit the 1970s, we see a time when the “physician-entrepreneur” movement really took its roots in healthcare and provided many doctors the opportunity to run incredibly lucrative practices. The 1970s were a time when federal and state planning agencies were trying to control costs by limiting the amount of new equipment that could be purchased by hospitals. In order to get around this barrier, physician lobbying groups were able to successfully pave the way for “free-standing” facilities that could avoid those same government restrictions being forced on hospitals.
Today, it’s common to see MRI centers, Dialysis clinics, emergency medical stops, and various surgery centers on the side of the road all over the country. The modern healthcare business model often involves surgeons and doctors owning their own surgery centers where they conduct medical device implants on their patients, without many of the same federal regulations imposed on hospitals. These federal regulations often create more stringent by-laws for monitoring surgical practices and ensuring doctors are qualified to conduct the procedures they perform in the operating room. A private surgery center is not subject to that same level of credentialing for operating room privileges as you see within hospitals.
The Huffington Post published an article in 2014 addressing the concerns we see with capitalism and our healthcare system: “our society runs on capitalism, few would argue that idea. And the roots of capitalism run everywhere – wherever there is profit to be made, someone will come along and figure out a way to make a dollar. It’s fine if you’re selling smartphones or electric cars, but what happens what health care is the target of profit mongers? The answer lies in our daily news – health care is a booming, for-profit business.”
TVM has been one of the biggest scandals in the history of women’s healthcare. Physicians implanting these TVM kits have made millions of dollars at the expense of their patients lives. As we’ve seen with Wall Street and the subprime mortgage crisis, federal regulations or laws, or even accountability, all seem to be suspended when you are exchanging billions of dollars.
The Food and Drug Administration (“FDA”) has proven its irrelevance over the years as well in providing the United States consumer with any real protection or information from what gets placed on the market and into the hands of our physicians. Many OBGYNs have proven through their deplorable conduct how little these surgical centers and many hospitals are regulated or policed to establish uniform standards of care.
These millions of women who have been implanted with TVM are an example of relationships of trust that were violated by their healthcare providers in the name of money. TVM has proven to be such an enormous cash cow for big pharmaceutical and doctors generating billions and billions of dollars of revenue over the years.
So where does that leave us? What can we do to stop greed from spilling over into our healthcare system? How can we ensure that our doctors are adequately trained and have experience with the procedures they present as options in their office? How can we ensure that what they recommend is truly necessary at that stage in our treatment? How can we ensure that our doctors disclose ALL of the potential risks and complications, as well as their likelihood of occurring post-implant, for medical devices they pose as treatment options for our care?
We need our government to protect us and fight for our safety. Whether it’s banking regulations, financial laws, or ensuring there is a certain standard of care adhered to within our healthcare system, there has to be some measured accountability moving forward.
In the meantime, at least with respect to TVM, there will continue to be thousands of women in the United States having their lives and marriages ruined by doctors they have trusted for years who just talked them into having a “simple and fast” mesh implant.