To the Editor:
Two important points were left out of your editorial about assembly line sports medicine.1 First, in your comparison of "gym sports physicals" to the mass production of automobiles, you did not emphasize that people, even children in sports, are not mass-produced assembly line products. Genetic scientists have calculated that a potential exists for 64 billion unique genetic individuals just on the basis of the 4 amino acids in the genes. The oft heard complaint about medicine being a cottage industry is probably unjustified. In the past, one of the strengths of the cottage industry was the ability to switch if the provider did not meet your needs. The arrogance of statistical medicine leads to ignoring the fact that medical statistics are valuable only if you, as an individual, happen to fall within the norm. Outliers are kaput in commercial insurance and commercial medicine.
The second ignored point also has to do with commercialism. Nothing in life is free.
Even breathing clean air takes energy. Although some individuals volunteer to do gym physicals altruistically, a large number see it as a means of building their practices. Be they chiropractors doing scoliosis screening or "sports medicine specialists" doing gym physicals, the exercise pays off in advertising and self-referral.
Perhaps the current medical student or resident will find it economically rewarding to develop a method of mass production of medicine and will have an IPO in which all of us can invest. However, I doubt that it will serve the cause of the statistical outliers very well. The current emphasis on attempting to manage health care the way production lines for automobiles are managed is a real danger facing society and individuals who are out of the norm. Humans are different from Fords.
Glenn Austin, MD, FAAP
1. Altemeier WA III, Robinson DP. Preparticipation screening by assembly line. Pediatr Ann. 2000;29:139-1 40.
Dr. Altemeier's response:
Dr. Austin's points are valid and appreciated. People are unique. The editorial was not intended to advocate assembly line medicine, but rather to stimulate thought about new ways to practice.