The Federal Trade Commission does not shy away from controlling the monopoly power of banks, pharma, and all sorts of businesses for the right reasons. Monopolies are the achilles tendon to free markets and capitalism, and rightly so. Thomas Jefferson was cognizant of the danger of monopolies, especially of patent rights, so much so that although he had several inventions, he refused to patent them. This by no means infers we are against patent rights, but those rights do interface with monopoly powers.
The fight against monopolies is based on one simple principle carved into the constitution: the right and freedom to choose. The choice is only feasible when there are competing options, the absence of which eliminates that right that is so fundamental to our freedom. Yet, the government seems to look the other way when it comes to the health care industry. Take, for example, Pittsburgh, Pennsylvania. It is the major city in Western Pennsylvania, yet there are only two health care systems, and patients have no choice but to choose between the University of Pittsburgh Medical Center and the Allegheny health care systems.
Likewise, the market in Cleveland is controlled by the Cleveland Clinic and Case Western Reserve University health care systems. In fact, those large conglomerates don't stop there, as they have acquired regional hospitals and practices within a 100 miles radius of their headquarters.
In Iraq, where I grew up, deer meat is a delicacy while rabbit is a poor man's food. In Iraq, we say, "if you want a rabbit, you get a rabbit; if you want deer, you still get a rabbit." It seems policymakers in the U.S. (and maybe worldwide) have the philosophy of large institution preference, although all will get a rabbit, no choice. Sadly, despite all the scientific evidence that shows care at small community-based practices is more accessible, more convenient, and more cost-effective, with arguably better outcomes. In fact, more clinical research and new drug development are done at the small and medium-sized community oncology practices than at academic centers and large hospital conglomerates. This is not a guessing game. It is very much in line with having the Walmart’s and Walgreen’s of the world choke off the mom-and-pop shops.
Those of us who believe in the ideals of the American way will not give up; it is in our blood and genomic framework to fight for the ideas of the free market, freedom of choice, and refusing to bend to the power of monopolies, especially when it comes to almost crucial aspect of our lives, our livelihood, and our health. This is why organizations like ICOP and other similar platforms have recently sprung up. We are not asking for preferential treatment; we strive to provide the best care at a lower cost, very simply. We believe the pendulum has swung too far in one direction, but we believe in Galileo's observation that the farther it swings one way, it will swing at equal distance in the opposite direction, simple physics. We just need to give it a little push.
Nash Gabrail MD
Gabrail Cancer & Research Center
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