Five months after Hurricane Maria barrelled through Puerto Rico, much of the island remains “largely unliveable”, says emergency medicine physician Jeremy Samuel Faust. One knock-on effect of this is that America is drastically short of a staple item of hospital equipment: intravenous fluids for use in drips. The shutdown of several Puerto Rican factories that together produce upwards of 40% of the IV fluid that American patients rely on, means that the supply of these bags is drying up in hospitals such as mine.

However, far from being a disaster, it has actually had the welcome effect of forcing some sensible economising. We’ve long known that, for patients who can keep liquid down, IV drips are not essential. You can just as easily hydrate these patients using a glass of water with a bit of salt and sugar dissolved in it – that’s all IV fluid really is. Yet US doctors have a terrible habit of always reaching for the more expensive, intrusive option. The shortage of IV bags has forced hospitals to save them for people who really need them, and to give everyone else oral solutions. It has worked fine and saved a fortune. “If we could just do this in other areas of treatment before a crisis hit, then we’d truly be getting ahead.”
(Jeremy Samuel Faust, Slate)

Part of the reason for the cost of medicine in the US is the litigiousness of the public and the high cost of medical insurance for doctors. There are 1.34 million lawyers in the US, and law schools are graduating 44,000 more every year. There are about 93,000 American personal injury lawyers, all seeking an income, plus an unknown number of patients all too ready to sue, justifiably or not. The situation is not helped by the fact that there are 210,000 preventable deaths in American hospitals (the American Hospitals Association claim the figure to be 98,000, still a hugely troublesome statistic). Doctors are so afraid of litigation that they submit patients to three expensive procedures where one might be deemed sufficient in Europe. Maybe the more procedures the more likelihood of mistakes? Now American lawyers can see fresh opportunities as the British NHS is gradually privatised under the rubric “profits to the companies, costs to the taxpayer”. But more about the NHS and its death by a hundred cuts on another occasion.