Monday, April 26, 2010

The Simplicity of Prevention

Everybody knows the health care system is in crisis. But while proponents on both sides of the political aisle battle onward, big medicine struggles to keep its piece of the pie, and health care costs continue to climb out of control. Insurance premiums have begun to rise by 30% beginning in September 09, due to the shrinking enrollment pool (Oregonian 8/30/09). Tired as we may be of listening to all the arguments, this is one problem that will not go away. Whatever the shape reform takes, if it does not change the fundamentals and only repackages the old with a new shiny cover, it will not take long before the system will show itself to be failing again.

When it comes to health care reform, the real question is this: What fundamental principle needs to be changed?

In order to create a real solution, what needs to be addressed, is the fundamental approach of the American health care complex and its continual, tunnel-vision focus on disease screening and management. Ever since the beginning of organized medicine back in the early 1900’s, the focus has remained on diagnosing and treating disease. Institutions grew in the study of pathology. Yes, this has been part of a noble call to understand the processes of whatever disease they were studying and find the magic bullet for each and every illness. Yes, there have been successes large and small along the way—the biggest of which was probably penicillin, saving hundreds of thousands of lives from the ravages of infection. However, the discovery and success of penicillin had a side effect; it launched one of the biggest and most powerful industries of our time, the pharmaceutical industry. With the promises of disease eradication and the end of human suffering, the pharmaceutical industry has slowly and insidiously come to influence every aspect of our lives. This industry has reaped huge profits, while the health of the average American is not even ranked in the G20 countries, despite Americans spending more on health care than any of those countries except for Morocco.

And this disparity in spending versus actual improvement in health speaks to the core issue. The problem now is that the solution we’re being sold for most health problems today has become pharmacology based because sadly that’s where the money is.

What we see being presented as “cure” is merely symptom repression. Have a fever, lower it. Have low thyroid, raise it. Just turn on the TV and watch for 5 minutes and the concept becomes clear, -- if you take a pill to remove your symptoms, all is well. Or is it?

What really is a diagnosis? Generally, a grouping of symptoms is recognized in the same pattern and then a name is given to it. That name, (usually in Latin so it sounds serious and the doctor seems to posses secret knowledge), is really just the name of the symptom. For example, fibromyalgia means pain in the connective tissue.

Next, special medications with fancy high-tech names are given, but more than likely these are merely designed to reduce the symptom and not to address the core imbalance that led to the body’s symptom, which is really just a natural compensation or coping mechanism for the underlying problem. Covering the problem doesn’t actually solve it, and the more serious danger with this type of approach is that usually the body will just find other ways to express the core problem, and then a new diagnosis is given and more medications are added to the list. And of course, the medications themselves have side effects. This vicious cycle of symptom repression and escalating medication would be never ending if the body didn’t finally give out entirely.

All this is the logical consequence of a health care system based on critical care and crisis intervention. Basically the principle is no different that the ridiculous notion of never performing routine maintenance on our cars until they break down. We would never treat our vehicles that way and expect them to perform, so why do we think it’s okay for our bodies? There needs to be a shift in our thinking about health care to true prevention and not just expensive disease screening. Once we find a disease, no matter how early, we still have a major and costly problem. Despite some deliberate misuse of the terms, prevention is not disease screening and disease screening is not prevention (because the disease is already present). This may sound like semantics but it is at the heart of the failure of our health care system. We need to shift the focus from disease management to true prevention.

So, what is prevention? Prevention is detecting and correcting minor dysfunctions before they progress to a disease process. This means looking at the body’s expression, minor symptoms and changes, as a way of looking for imbalances or dysfunction. Currently this is not done for two significant reasons that have nothing to do with health care and everything to do with economics. First and foremost, the American medical system has trained us through the media to cover up any and all symptoms with some type of over-the-counter drug or prescription medication. Second, the insurance companies have established deductibles and co-pays which, in effect, put up a barrier to seeking core answers and encourage the foolish idea of waiting until a health concern becomes a true crisis. The health care system needs to do more than treat people who are already sick; it needs to help us keep healthy people well. How can we do this?

There are different names given to the branches of health care that focus on the natural restorative power of the body. They tend to be referred to as “Complimentary” or “Alternative” healing systems, and the most commonly recognized ones are Chiropractic, Naturopathic and Acupuncture. All three of these disciplines focus on stimulating and supporting the body’s ability to heal itself. Sadly, modern American “allopathic” medicine has tended to marginalize these approaches instead of embracing and encouraging them. Their old argument of these not being scientific has steadily proven false by the volume of research proving otherwise and as MD’s have slowly started to recognize the power and validity of these same treatments and remedies they used to dismiss. The principle that these health care disciplines embrace should be at the very foundation of any proposed reform to our health care system. The reform we need is to develop a system that stresses true prevention. Not the prevention of disease screening but the prevention that looks at and corrects minor imbalances or dysfunctions in the body before these became a crisis. There needs to be comprehensive health education to support and motivate people to understand how to work with their bodies and not against them by covering symptoms.

The crisis in today’s health care system is due to following a faulty paradigm. Focusing solely on crisis care and disease management will continue to bankrupt this country. The reform that is needed is not changing the names of the same ideas or repackaging them. The reform we need is to fundamentally see the need for preventative medicine and embrace the body’s natural restorative powers. The solution may be simpler than expected. Instead of having these two powerful branches of medicine, working at odds with each other, we need to have them working together in a coordinated fashion. Prevention needs to be encouraged with easy access. Investing in health will create large savings down the road. We all know this, it makes logical sense. The current paradigm of medicine has run it course, and it’s time for a shift to true prevention by keeping people well instead of waiting until they get sick. This will save us money and it will make us healthier.

D. Scott Conklin, D.C.