Medicine

Dr Leo Spaceman on the "critically acclaimed"* comedy "30 Rock" once replied to a patient's inquiry with the observation "Medicine is not science."While meant to show that he is not the sharpest graduate of the Ho Chi Minh School of Medicine, it turns out to be more true than intended. Google "is medicine a science" and you'll get varied opinions on that subject. It's evidently a very real epistemological question for those who think about such things.

Brought into the Presidency just as the Crisis was becoming manifest, Obama's first policy focus was on reforming health care in the United States. There was plenty of reason to think that was needed, from people dying because they didn't have insurance, to massive Medicare fraud, to the crazy state of hospitals here.

That last being what sent me in this direction, after seeing the former site of the North Hollywood Medical Center. Google still shows the buildings, but it's currently a vacant lot in the process of becoming apartments. Before that, it was used for filming most of the seasons of "Scrubs." Which is to say that the next best valued uses for a decent sized medical facility were a) as a set for filming a medical comedy and b) as housing in an inflated but still lethargic market. Not as a hospital.

Which brings us to the Supreme Court spending three days on whether the healthcare reform passed - barely - two years ago is constitutional. The first day was concerned with whether they even could examine the question, under laws that require a tax to be paid before a suit can be brought. Tuesday, though, was the start of the big question: Can the federal government require people to purchase insurance? And if so, what is the constitutional justification?

Regulating interstate commerce, of course, is the go-to argument for this. And the precedent that said growing marijuana for your own medical use in a state that had legalized said use and without any crossing of state lines would seem to indicate that this is a wide-reaching power. I would hope this would be applied consistently, since otherwise it seems too much like these folks make up their mind on the outcome, then make the law fit.

The real problem, though, is that the American mindset doesn't like any of the options. The white-hatted cowboy wouldn't let the sick widow die for lack of funds, but he also knows that the free and open range is a place where not everything is able to survive. Americans like the idea that anything is possible, that nobody is stuck where they are and there's always a second chance, - that the town will always join together to help the unfortunate, and never for a lynch mob.

And even if you're a glass-half-full person, you have to acknowledge that's not true. Shifting back to the specific issue at hand, three people with equivalent- even identical - insurance options can have three radically different outcomes. One could go to a nationally-ranked facility, one to a local clinic, the other might do nothing -"it's just a cough." One doctor is an expert in this specific issue and the other dismisses it. Surgery usually cures it unless an infection happens; antibiotics administered are as good except with allergies; a radical treatment works perfectly unless you are in the unlucky 2%.

Maybe Dr. Spaceman is right: Medicine isn't science, since we can't run repeatable experiments well enough to KNOW just how to fix anyone who walks in for treatment. Perhaps no matter how we mess with the economics of the system, or the standards of the professionals, or the availability of preventative options, horror stories will happen.

* All bloggers are required to use "critically acclaimed" for this show. It's in the Terms of Service.