I love this post from James Altucher so much I had to post here!
I’m a doctor. That’s not quite enough. Some might take that to mean I’m a “Doctor of Philosophy”. A PhD. In fact, I was rudely thrown out of graduate school. I asked to at least use the office for the summer but they said, “No.”. I needed to pack all my stuff and be out by afternoon. While packing my desk I found a woman’s earring underneath but that’s another story.
No, what I really mean is I’m a “MEDICAL” Doctor. In other words, you can come to me with your ailment, I can either diagnose them or tell you you need more serious help and recommend a specialist (for instance, if your finger has been accidentally amputated by a lawnmower , then I am NOT the guy to sew it back on. You need to go to a hospital where they have sewing machines for that sort of thing) and I can recommend treatment for you: take 5 of these pills, for instance, and call me in a week and avoid a diet that is high on carbs for at least this week.
Wait a second? I’ve read through all of this blog. James DID NOT ONCE ever mention going to medical school.
Yeah? So? If you came to me with a headache, for instance, I would ask you a bunch of questions. Did you fall? Did someone hit you? Are you vomiting? Then I would take an ophthalmoscope (that little miner’s light where the doctor says, “now open wide” and a bright light shines directly into your eyes”) and I would look at the back of the eye (“the fundus”) to see if I can detect any swelling in the brain or any brain tumors. A simple check on the Internet will show many examples of pictures of a swelled brain compared with an unswelled brain. I might do an EEG also to see if there’s anything abnormal. If I see anything abnormal that requires immediate surgery or a neurologist then I would send you off to a specialized hospital. Else, take two aspirin and call me in the morning.
That wasn’t so hard, right? But to do that I need about 12 years of education and go about $300,000 in debt and then pay massive malpractice insurance. And not only that, what if your headache was the result of an ear infection or an eye infection (easy to tell by various methods that are easily found via Google)? I would have to prescribe you an antibiotic.
Now we’re in trouble! If you don’t have insurance then it would cost you up to $600 to take a four week regiment of most antibiotics. Not to mention I have to charge you a few hundred dollars for my time even though I only spent ten minutes with you and now I’m going to hop from room to room to see all my other patients.
[And just as a footnote: all I did was look at your eye and maybe do that rap of the knuckles on your spine that doctors always do to justify the $300 cost of your visit. And in order to do that rap on the spine and maybe the little hammer on your knees and let’s check your pulse you have to completely humiliate yourself by taking off all of your clothes, standing on scale that has been specifically designed to prove to you you were ALWAYS three pounds overweight so stop lying to yourself and then you have to lie down on a this weird mechanical chair/couch that the last 30 patients with infectious diseases also had to lie down on and then your head is tilted so you are looking at me at this upward weird angle the way you’ll look at God after you die when you have no idea where you are and all you want to do know is, “is this heaven. Or am I in hell?”
By this point you are so utterly dehumanized and I come in with my white coat and my oddly costume-like miner’s light strapped to my forehead combined with a magnifying glass so now it’s truly like I’m god because I can see right through to you in my sterile environment- I can see everything- and then to finalize the demonization of the doctor-patient visit I ask you the crucial question that you HAVE TO ANSWER before I treat you further – “have you had many sexual partners of late?” – ok, enough footnote. I didn’t even need to footnote this but it’s not crucial to the point. It just adds the simple flavor. You’re an idiot and doctors act like gods.]
So now the patient has to spend $1200 (antibiotics + the first doctor’s visit for treatment plus the second doctor’s visit where I walk in andi say, “how are we feeling today?” and I’m smiling and you say, “good, doctor. Very good.” And I say, “well, we’ll see about that” And you’re stripped down again and wearing that beautiful paper gown (so sexy) and I rap on your back, look at your fundus, wrap on your knee, and maybe slip my hand into your vagina (wearing rubber glove, of course) and then say, ‘yes, you are the spitting image of health, tell the nurse up front to make an appointment for about three months from now just to make sure.”) and why should the patient spend anything? After all, although the certificate on the wall says I’m an “M.D” it’s all a lie. I, of course made it up. I’m the guy who screwed Yasser Arafat out of $2mm and pretended to be a psychic. Why should I be a doctor?
Because the entire industry is completely messed up and we all know that but nobody just simply tells it like it is. We all want to put Band-Aids on the situation instead of transforming the situation. This is our gut reflex in almost all aspects of life. We’re unhappy in our marriage so we figure maybe some diamonds and an expensive vacation can help. We’re unhappy in our jobs so we figure maybe if we take the boss out to lunch it might help. These are all bandaids. It’s time to just say the truth about what will help.
Most situations require radical transformation. Don’t be afraid to do that or say,”of that can’t be done.” At least consider the transformation.
Time to end the FDA, traditional medical education and the insurance companies. Just get rid of them.
Let’s start with the worst and most corrupt semi-government institution known to mankind: the Food and Drug Administration. The administration that lets you smoke as many cigarettes as you need to get lung cancer, drink a ton of alcohol to get liver cancer, but then won’t let you take any of the drugs or treatments for lung cancer or liver cancer.
I have to tell you something: almost every cancer has been cured already. But let’s say I’m a scientist with a bad personality (I’ve been accused of being a bad scientist with a congenial personality but never the former). Let’s also assume I’ve developed a drug that will cure your liver cancer without chemo. Now what do I do?
Here’s the four steps I would CURRENTLY have to do:
A) It costs a billion dollars to get a drug through the Food And Drug Administration.This is why I mention the bad personality part. There’s zero chance I’m going to raise this money. Instead, because my personality is so bad I have no friends at the various research magazines so I’ll never get my findings published and consequently I’m going to get fired before I get tenure and I’m going to end up as a cashier at Walmart. What sort of tests do I need to do? I have to round up potentially thousands of people to take my drug, take placebos, check for safety, effectiveness, blah blah blah. It takes ten years to do this so potentially valuable drugs stay out of the hands of patients who will most assuredly die in this time.
B) At any one of these four steps, judges at the FDA can decide if I passed or failed my trial. These judges are often people who have worked at my competitors or who want to work at my competitors, making it extra hard to get through the implicit corruption that surrounds the FDA.
C) Now I have to convince the insurance companies to pay for my medicine so patients don’t have to pay the full cost. Because I just spent a billion dollars on approving my medicine (over a TEN YEAR period on average) the medicine is VERY expensive so I can make back the cost. Insurance companies don’t want to pay for my medicine. They don’t want to pay for any medicine really. So this is a hard process. And I have to raise another $50 million to survive long enough to hire people who will convince all the insurance companies to accept my drug.
D) Finally, I have to educate doctors that my drug will cure liver cancer. Doctors could care less about me. They are going on cruises funded by the big pharma companies (who just finished spending billions on their drug trials) and the big insurance companies where they are told what billion dollar drugs to recommend to their patients. They aren’t going to listen to me.
So basically, if I have the cure for liver cancer, nobody is going to ever find out. It’s like a five year old with the talent of Mozart who never touches the piano. Nobody will ever know. I’ll give up in the laboratory before I even tell anyone. The best doctors do, in fact, educate themselves and illegally prescribe “orphan drugs”: Drugs that might have been approved for kidney cancer but NOT approved for liver cancer and will recommend those drugs for liver cancer. But most doctors will not do that because it’s technically illegal..And certainly no doctor will recommend a drug that has NOT been approved by both the FDA and the insurance companies.
Wow, you might think. This is a disaster. Will Obamacare help? Will anything help?
And the answer is “Yes”. Here’s the very simple solution:
A) Get rid of the FDA. Simple. Let the Internet be a virtual FDA. A drug will have a web page, a scientist with verified credentials will document his research, and comments from users will describe their experiene with a drug. Many people die and get sick from FDA-APPROVED(!) drugs. The same thing will happen here. But will save the billion dollars and will allow drugs to be quickly tested by the audience that needs it most – people dying of terminal diseases. These people will quickly report back if there is success and we’ll know what works and what doesn’t. If there are bad stories then it’s a guarantee we will hear about them. And it won’t require a billion dollars and ten years to hear about them.
Well, what about the rest of the FDA? Oh, you mean the part that puts labels on cigarettes and allows hot dogs (also related to intestinal cancers) to be colored red? You can get rid of them also. They cause more cancers than they cure anyway.
But don’t they fight drugs? Uhhh….Good luck with that.
What’s the net outcome of having zero FDA?
The cost of drugs will go down from $600 for a month’s use to $10. And drugs that actually cure things (instead of drugs that had the personalities behind them to raise a billion) will actually make it to market. The net result: more people will live longer. And drug research will be infinitely more productive.
B) Get rid of 90% of insurance companies. Once drug treatment costs go down to zero and there’s more competition among drugs (because more drugs are available) then why do you need to insure for them? I still might want to insure for things like long-term disability or life insurance but almost all medical insurance will be eliminated. Why is this a good thing? Because medical insurance, which claims to help you, is actually on the other side of the table from you – they will try to deny that you have an illness, or they will try to limit the amount of treatment you get- simply because they don’t want to pay for it. So they are not your friend. As I mentioned in my post “How to Deal With Crappy People” – stop hanging out with the people who are not your friends.
C) Get rid of Medical Education. Doctors graduate with $300,000 in debt often. So they have to make it up by recommending every treatment possible to you and charging as much as possible so they can pay back their loans. This is not in your favor. Almost everything I can learn in an expensive medical school I can learn with a combination of Passion + Internet + Apprenticeship.
So if someone truly wants to help people and be a “MEDICAL DOCTOR” here’s what I recommend:the following three (or four) step medical education:
1) At the age of18, spend a year changing bedpans at a hospital and let’s see if you truly have the passion AND compassion to be a medical doctor (most don’t have either but by the time they finish their $300,000 in debt education they are forced to continue in order to pay back their loans and to justify the 12 year time invested).
2) Spend a year where you pay a GP (or whatever field you want to go in) to be their intern. This should cost you about $20,000.
3) Spend a year as an apprentice for the same GP but charge a lower rate to patients.
4) If you want to be a surgeon, go to a 1-2 year “surgeon school”
5) A yelp-like system should be created to review both drugs and doctors. Yelp has proven to be extremely efficient for ranking the most important aspect of our society – our culinary tastes. Why not use it for other important things. Like where and how we get treated for illness.
Now you’re an MD. At theage of 20 or22. Not 32.
Net result of all of this:
A) Cheaper and more drugs
B) More diseases cured
C) Bigger community discussing the diseases and various treatments. This is what social media is for. It should be transformative of the medical industry.
D) More doctors.
E) Less expenses all around for the patient
F) More medical facilities around the country
G) Less corrupt influence of the big insurance and pharma companies
H) Less government expense by eliminating the FDA.
You can argue, “But more people will die from bad drugs.” Many many more people will be saved also. And once a drug is truly discovered (and this will happen much faster in my system) to cure liver cancer then that drug will quickly rise to the top in the yelp-system and everyone will begin using it and all the people with liver cancer will be saved. Let’s not forget, the FDA recalls as many drugs as it approves. How come? Because the real world is different from a laboratory. And once a drug is approved it often is shown to have harmful effects when it’s prescribed. So then it’s recalled, showing once again the FDA does nothing useful but cost people money.
On top of all of this, my system will create many more doctors with much more compassion. And if they want to suddenly change jobs, then let them. They haven’t invested 12 years and$300,000 to be a doctor. But that’s ok, because there’s many people lining up to replace them.
What about all the jobs lost at the insurance companies and the FDA? Well, maybe they should become doctors and help people instead of hurt them!
So, for anyone needing a pap smear, or a check of their tonsils, or having problems with depression or post-traumatic stock market stress, give me a holler. Office hours are open.