Posted on Sunday, 26th June 2011 by Bill Bean
Our healthcare system needs to change. Would anyone disagree with that? Doubtful.
But not only the system needs to change. Our concept of health and care also needs changing.
Politicians and pundits, for the most part, are not helping. The kind of fundamental change that is needed isn’t going to come from the government, and it isn’t going to come quickly or easily. Until we want to be well, and until we take responsibility for that wellness, and, to some degree, the wellness of others, it ain’t gettin’ any better.
A change in the delivery system, from private to government, isn’t going to improve America’s health. Even a successful attempt at making our current approach to health care available to everyone, will not result in our nation being healthier. Most likely, it will only mean a more complicated, more expensive, and more ineffective healthcare system.
Caveat: I’m not an expert on healthcare, health, medicine, wellness, doctors, politics, economics, or America.
A recent article got me stirred up, though it really didn’t have anything in it that hasn’t been said by someone already. David H. Freedman’s The Triumph of new-Age Medicine (a provocative title) is the featured article in this month’s The Atlantic.
I think what he’s saying, if I understand him, is that we have to want a preventative approach to health care and that our physicians have to be incentivized (and trained) appropriately to deliver it. (the Government can’t do this). Our system is predicated on an infectious disease model (ie treatment after the fact) and not on prevention or wellness. The article’s title refers to the almost equally positive results New Age or homeopathic techniques demonstrate in comparison to standard treatment models (ie drugs and surgery). He’s not attempting to prove whether or not alternative approaches are legitimate, only making an interesting observation about their comparatively successful outcomes.
Anyone can find a study that backs up their position, and quotes taken out of context can imply entirely different meanings than were intended by their author, but I’m sharing and doing anyway. Here are some snippets from the article I found to be quite convincing:
Heart disease, prostate cancer, breast cancer, diabetes, obesity, and other chronic diseases now account for three-quarters of our health-care spending.
America spends vastly more on health as a percentage of gross domestic product than every other country—40 percent more than France, the fourth-biggest payer.
Aside from getting people to stop smoking, the three most effective ways, according to almost any doctor you’d care to speak with, are the promotion of a healthy diet, encouragement of more exercise, and measures to reduce stress.
diet, exercise, and stress reduction can do a better job of preventing, slowing, and even reversing heart disease than most drugs and surgical procedures.
A major 2004 study that followed 30,000 people concluded that lifestyle change could prevent 90 percent or more of all cases of heart disease.
Medicine has long known what gets patients to make the lifestyle changes that appear to be so crucial for lowering the risk of serious disease: lavishing attention on them. That means longer, more frequent visits; more focus on what’s going on in their lives; more effort spent easing anxieties, instilling healthy attitudes, and getting patients to take responsibility for their well-being; and concerted attempts to provide hope. Studies have shown that when a doctor speaks to a patient about quitting smoking or losing weight, the patient is more likely to do it.
“Doctors don’t tell you the drug they’re giving you is barely better than a placebo. They all spin.” [Ted Kaptchuk, a Harvard researcher] To be approved by the FDA, a drug has to do better than a placebo in studies—but most approved drugs do only a little better, and for many drugs the evidence is mixed. A number of studies have indicated, for example, that most antidepressants don’t do better than placebos, but patients filled more than 250 million prescriptions for them in 2010. The vast majority of drugs don’t work in as many as 70 percent of patients, according to an estimate from within the pharmaceutical industry. One recent study concluded that 85 percent of new prescription drugs hitting the market are of little or no benefit to patients.
A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically. “Last year, 75 percent of the $2.6 trillion the U.S. spent on health care was for treating chronic diseases that, to a large degree, can be prevented or reversed through lifestyle change,” says Dean Ornish of UCSF. Who (besides patients) has an incentive to make changes that would remove that money from the system?
Clearly, if we all started demanding a model of health care that would help us change our lifestyles, it would take some time before the economics of that demand resulted in a change to the system, but it would come. As long as money and elections drive this conversation, we’re going to keep getting the same thing. And in that case, we probably deserve it.