According to the Institute of Medicine (IOM), Americans today not only live shorter lives, they’re also sicker than the people of virtually all other well-off nations.30 And according to the United Nations, the US ranks number 43 in life expectancy, below Costa Rica and Cuba and just ahead of Lebanon.31, 32 Life span has declined over the past two decades in the US for the first time since World War II.33 Now, in 43 percent of US counties, women are no longer living as long as their mothers.34–36
Personal habits such as smoking and drinking are part of the cause of our shorter, sicker lives, but only a small part: Americans smoke and drink less than people in a number of peer countries.37, 38 What the US does have compared to other wealthy nations are higher rates of violence, obesity, and drug use.30 Only three nations included in the IOM report have higher homicide rates than the US: Mexico, Turkey, and Estonia.30 But even these issues account for only a fraction of the excessive mortality in the US.
One huge problem is our squandering of resources on ill-advised treatments. The US spends trillions of dollars on healthcare each year, and 20 to 30 percent of that care is considered unnecessary.39–41 Many treatments do significant harm beyond wasting resources: medical interventions (including implantation of medical devices) are now the third leading cause of death in the US, killing an estimated 225,000 to 440,000 Americans each year.42 That’s more deaths than from diabetes, murder, car accidents, and AIDS combined. By 2012, prescribed medicines, such as blood thinners and drugs for diabetes, were causing so many deaths that the nonprofit group Institute for Safe Medication Practices conducted a study to quantify the number of deaths and concluded that prescribed medicines are “one of the most significant perils to human health resulting from human activity.”43 Although the precise number of deaths from medical error, drug and device complications, and overtreatment is subject to debate, even if the numbers were cut in half they would still comprise the third leading cause of death in the US.
We also have a problem unheard of in other wealthy nations: a large uninsured and underinsured population, which is associated with an estimated 45,000 avoidable deaths per year.44 Despite the promise of the Affordable Care Act of 2010 (often called Obamacare), unpayable medical bills continue to be the leading cause of bankruptcy in the US.45–47 As we spend more and more each year on healthcare, we threaten not only patients’ lives but also their personal finances and the nation’s economy.
The causes of these devastating statistics are numerous and complex, with roots in politics, economics, and social and cultural forces. But at the heart of the problem is the growing wealth gap, which has a profound effect on life span, and a massive healthcare industry that is sapping our economy.48–51 Healthcare is now the single biggest sector of the US economy. It is bigger than big oil, bigger than big banking, and bigger even than the famous military-industrial complex that President Dwight Eisenhower warned about in his farewell speech. In 2013, the most generous estimate pegged the price of the military-industrial complex at $1.3 trillion, while healthcare expenditures in 2015 were $3.2 trillion, consuming nearly one of every five dollars spent in the US.52, 53
We may be less healthy and long-lived than the people of dozens of other nations, but in one respect America comes first: we are number 1 in healthcare spending, far surpassing all other countries.
Life Expectancy vs. Healthcare Spending by Country, 2015.
Credit: Longevity from World Health Organization data; expenditures from the Organisation for Economic Co-operation and Development.
The poor performance of US healthcare strongly suggests that we are not getting what we should in exchange for this massive investment. And the wealth and power of the healthcare industry helps to explain why this is so. Over the past two generations—since the late 1960s—American healthcare has gradually been transformed from a relatively modest professional endeavor ruled mainly by traditional ethical norms governing independent doctors into a vast network of institutions dominated by for-profit corporations whose chief loyalty is to their shareholders and nonprofit organizations that function much as for-profit entities do.
While universities, government agencies, and some not-for-profit organizations such as certain hospitals and clinics continue to play an important role in developing, regulating, and administering healthcare treatments, they have been increasingly forced to follow the dictates of for-profit medical groups, hospital chains, insurance companies, drug manufacturers, and medical device makers, whose huge economic footprint translates into enormous political clout. Taken together, this interlocking network of organizations makes up the medical-industrial complex. In October 1980, Arnold Relman, then editor of the New England Journal of Medicine, described “The New Medical-Industrial Complex,” comparing it to the military-industrial complex, and said it posed “troubling implications.”
The birth of the medical-industrial complex can be traced in part to the explosion of new healthcare technologies beginning in the 1950s and ’60s, an era of healthcare innovation marked by the development of the first vaccines against polio, measles, and mumps.54 The cardiopulmonary bypass machine first came into use in the early 1950s. Pacemakers, hip replacements, organ transplants, polymerase chain reaction, DNA fingerprinting, gel electrophoresis, stents for heart disease, and stem-cell therapy were all developed after 1960. CAT scans and MRIs were first performed on humans in 1971.55 Commonly prescribed drugs exploded from a mere handful to many thousands, aimed at treating everything from high cholesterol to infections, restless leg syndrome, balding, overeating, and cancer.
Some of these innovations offer amazing benefits to the victims of age-old afflictions. Certain childhood forms of leukemia are now curable.56 Infections that were previously life-threatening have been transformed into minor inconveniences. Diseased and worn-out human hearts, livers, and lungs can be replaced or transplanted. The discovery of stem cells, the primordial cell type that gives rise to every other cell type—from hair to brain to liver and nerve—has brought researchers around the world close to developing lab-grown organs of every sort. Doctors have successfully implanted lab-grown skin, corneas, and bladders into human patients.
Some of the most recent breakthroughs have been so dazzling that they strain credulity. When an Internet image of a mouse growing a human ear on its back went viral, some viewers said it must have been digitally altered. It wasn’t. The hairless laboratory mice running around in cages with ears on their backs were developed by Robert Langer, an MIT researcher, and Dr. Joseph Vacanti, director of the Laboratory for Tissue Engineering and Organ Fabrication at the Massachusetts General Hospital, in Boston.57 The human-size ears, which take up almost the entire back of a mouse from neck to tail, begin life as a biodegradable ear-shaped scaffold, which the researchers seed with bits of cow cartilage. The structure is surgically implanted under the skin of “nude mice.” The ears can be made to order for shape and size to match the needs of the human recipient.
The growth of complex body parts took a giant step forward in early 2008, when Doris Taylor created the first beating lab-grown heart.58 Like Vacanti, she created a scaffold by dissolving the cellular material of a rat heart, then placing a mix of heart stem cells on the matrix. With careful environmental controls, the cells not only began to beat, they also even grew their own blood supply. “It’s gorgeous,” Taylor said of her creation. “You can see the whole vascular tree, from arteries to the tiny veins that supply blood to every single heart cell.” By coupling lab-grown hearts with pacemakers, she hopes to create a supply of made-to-order, rejection-free human heart implants—a salvation for thousands of people who die each year while awaiting traditional transplants.
Can technology conquer death itself? It might seem reasonable to wonder these days. Researchers are studying telomeres, the little end plates on chromosomes that have been compared to the plastic tips on shoelaces that keep them from fraying. If the telomeres could be protected, chromosomes would never wear down and could duplicate forever, allowin
g humans to become immortal. The president of the American Academy of Anti-Aging Medicine, which on its website calls itself “the world’s largest non-profit scientific society of physicians and scientists dedicated to the advancement of technology to detect, prevent, and treat aging related diseases,” claims humans are “on the cusp of immortality.”59 Ray Kurzweil, described by the Wall Street Journal as “the closest thing to a Thomas Edison of our time,” declares humans will be immortal by 2035.60
As these amazing examples illustrate, some medical breakthroughs of the last sixty years have been impressive, even awe-inspiring, and genuinely important. They represent some of the finest achievements of an enormously wealthy and understandably self-confident American society at the height of its power and influence. But they also carry the seeds of serious trouble.
Today, like big oil and big banking, the medical-industrial complex has become so vast, so wealthy, and so powerful that it is increasingly insulated from the effects of its own errors and misdeeds. Virtually every major drug and medical device company has been caught in one or more scandals, and they pay massive fines as part of the cost of doing business.61
We often pay little attention to the companies that manufacture supposedly lifesaving drugs and medical devices until something goes wrong and we are suddenly caught up in the gears of the healthcare system. By then we may be too sick and scared to ask many questions. But whether we’re paying attention or not, the inner workings of the medical industry touch our lives—literally. It’s surprisingly easy for the products of profit-hungry companies to find their way into our bodies, whether they’ve proved safe and effective or not.
How did this happen? What is its impact on the lives of ordinary Americans? And what can we do about it? We can begin to understand some of the answers by returning to the story of Dennis Fegan.
Chapter Two
Age of Miracles
FROM HIS CHILDHOOD, DENNIS Fegan’s family remembers him as a bit of a cutup. His sister, Catherine, says he was “funny and happy-go-lucky,” with an adventurous, even mischievous nature that led to some early pranks. His mother, Irene, recalls that at just five years old, Fegan managed to get out of their fenced-in yard by pushing his tricycle up to the gate and standing on his tiptoes on the seat to open the latch (she figured this out only after she accused the water-meter reader of leaving the gate unlatched, but she was embarrassed and apologetic when she later saw her son attempting the stunt again). Once outside the gate, Fegan rode to a nearby supermarket, where he parked his tricycle in a parking space as if it were a car. Then he walked into the store, according to the manager, “just like he owned the place.”
His pranks persisted long into his adulthood and would become the stuff of family lore.
In early May of 1965, Irene packed up the five Fegan children, ages two to eleven, in the family’s 1954 Pontiac and headed to the St. Patrick Catholic School to drop the older children off. As she entered an intersection, going through a green traffic light, she saw another driver entering from her left. She could see he was going to run a red light. “I knew I was going to be hit,” Irene recalls. “I was standing on the brakes.” But it was too late: the driver broadsided the left-side passenger area of the car, where her children were seated, sending the car into a spin.
The Fegan family’s 1954 Pontiac had no seat belts. (It wasn’t until 1959 that the first auto manufacturer installed them as standard equipment in their cars.) Dennis, then seven years old, was ejected from the backseat through an open window onto the street. When his family got to him, he was bleeding from his head.
1965 car wreck that ejected Dennis Fegan, then 7 years old, through an open window, causing his head injury. (Photograph courtesy of the Fegan family)
Fegan has no memory of the accident itself, though he does remember waking up at Corpus Christi’s Spohn Hospital, where doctors examined him. His medical record reveals that the doctors took X-rays of his skull, knee, and shoulders. They noted a “deep laceration with multiple hematomas” (bruises) over the right side of his head and another half-inch laceration on his forehead. They sewed up the lacerations with 4-0 silk, gave him a tetanus shot, and kept him in the hospital for two days of observation. He did fine after his discharge, and nothing further was made of the event for many years.
A strange incident occurred not long after the car accident. Neighbors of the Fegans were surprised to hear their doorbell ring late one night. When they opened the door, they found seven-year-old Dennis politely standing on their doorstep. He was stark naked. He had apparently sleepwalked to the house, where he stood waiting for someone to come to the door. The neighbors were understanding and returned the boy home. Fegan, forever humiliated by the incident, would sleep in pajamas for the rest of his life, lest he ever sleepwalk again.
At age eleven, in 1969, Fegan watched in awe as Neil Armstrong stepped onto the moon. He decided he would become an astronaut and learn everything he could about NASA. But he had a backup plan in case he couldn’t make it as an astronaut: he’d become a rock-and-roll star. Which required, of course, rebelling against his parents’ strict code of behavior. “I did everything I could to piss them off,” he says. “I wanted to be on my own, and I didn’t want to follow rules.” And break the rules he did. As a teenager he started hanging out with fast crowds, drinking beer and smoking pot, which caused a fair amount of parental angst.
By the age of nineteen he was married, with a newborn child and new expenses. His marriage didn’t last, and he was separated from his wife six years later. He says, “I was angry with Kathy for years following the divorce because I laid all the blame on her. Actually, we probably were both equally at fault. We were very young when the children came along. Neither of us was mature enough to be starting a family.” Kathy and Fegan remain on good terms, and he is close with his two sons, Michael and Derrick.
With children to support, Fegan decided to leave the small printing company where he worked after graduating from high school for a lucrative job as a roughneck in the hardscrabble world of the Texas oil industry. Soon he was scaling impossibly tall derricks. For the first week or so, the higher he climbed, the more afraid he became. But eventually, like other roughnecks who didn’t give up or get killed, he became numb to the dangers and began scuttling about on the high platform as if he were on the ground.
Day in and day out, Fegan hauled heavy thirty-foot lengths of two-and-a-half-inch-diameter metal pipes to the top of the derrick and dropped them into the oil-well hole. Once at the top, he would tether his harness to safety ropes and lean out over an opening between the platform and the oil hole to drop the pipe in. This meant that for a few seconds he was essentially hanging, weighted by his cargo, over a straight drop from the top of the derrick to the concrete work floor some eighty feet below. A fall would mean certain death. It was hard and dangerous work, made all the more exhausting by the mind-numbing and incessant roar of the machinery.
One afternoon Fegan made his usual ascent and leaned forward to drop his pipe. Not unusually, he was standing at a do-or-die angle. The slightest extra tilt forward, or the slightest wind behind his back, would make it impossible for him to right himself, and if he lost his balance he would fall into the well hole just inches from his feet. Realizing the precariousness of his position, he reflexively put his hand behind him, reaching for the harness hook at the small of his back to assure himself that he was attached to a safety rope. His grasping fingers found the hook—but no rope. The blood drained from his head as he realized that when he’d returned from lunch, he’d forgotten to reattach his safety rope.
Studies by the Bureau of Labor Statistics report that the death rate for drilling workers is eight times the national average for all workers.62 Roughnecks, who often work twelve-hour days, have the riskiest jobs on oil rigs. Fegan didn’t know the statistics. He just knew that guys died on the rigs. In that terrible microsecond when he realized he wasn’t tethered, he managed to jerk his upper body backwards, pulling himself
upright onto the platform. His narrow escape left him shaking. But there was no time to fret over what happened; he had to keep the pipe moving. He kept working and comforted himself with the same thought that keeps many roughnecks going: there is always cold beer at the end of the day, when workers gather to unwind, drink away their jitters, and tell their stories with studied nonchalance, transforming their fear into boasts.
Dennis was changing from youthful rebel to responsible adult, yet the cheerful mischief maker remained. His brother Matthew recalls family get-togethers at their parents’ house, where Fegan, his three brothers, and a gaggle of nieces and nephews would spend long Saturdays hanging out in the backyard:
Thanks to Dennis, those days would eventually involve some kind of prank played on someone, usually Richard or George [Fegan’s other two brothers]. My brother George liked to think of himself as a real macho tough guy, but if he wasn’t careful he might end up driving back to Austin with some highly embarrassing bumper stickers affixed to his car. One time he drove away without realizing Dennis put two stickers on his rear bumper. One was a picture of Hillary Clinton. The other was a picture of [exercise celebrity] Richard Simmons, wearing his trademark tights. I remember George saying that if the mailman walked up to his house with some new magazine subscription that he had certainly not signed up for, he knew right away it was Dennis to blame.
Fegan made friends easily. Henry Gonzalez, a supervisor with the Corpus Christi Regional Transportation Authority, has been a close friend of Fegan’s since tenth grade. They attended Mary Carroll High School in Corpus Christi together. Later they worked four different jobs together. After work they played cards and chess. Fegan, says Gonzalez, is a “super nice guy” who looked out for his friends and found them jobs when they needed work.
The Danger Within Us Page 2
