Monday, May 13, 2013

First, you have to get sick

I recently went to a conference dedicated improving health care. The attendees and the presenters were billed as reformers. They reiterated in all of the sessions that something significant needed to be done.

Funny, though. There were wide variances on what kind of action is warranted. In some cases, they indicated that the problem was only a matter of better communication. Others expressed anxiety about such limited steps, but didn't really outline a cohesive plan.

In one session, the presenter started out with the question, "What is our medical system" as a way of setting the agenda and stimulating conversation. There was an awkward silence, not uncommon in a crowd.

So I contributed what was in my mind, "First, you have to get sick".

He lowered is head a little. His mouth opened a lot, but not to speak. He stared at me for a few seconds. Then he changed the subject and went on.

I am sure that this was not a seminal moment in the history of health and medicine, but it was a sign of the compromised state of affairs. There is a fine-tuned dialog based on derivative issues that are doomed to fail. If only we could get nature to cooperate with our carefully negotiated healthcare deals. Isn't there some way, we would hope, to to embed ourselves into the evolutionary process right now to immediately get what we want?

Of course, the answer is "no".

As emphasized by Dr. Miroslaw Manicki, health plans are typically based on wishful thinking. We have finely-tuned schemes, mostly about how to pay for services, but not about much else. Physicians continue to do pretty much what they want. There is a huge gap between the science and the practice. This is odd, given that much of the apparent legitimacy of medical practitioners comes from their proximity to esteemed scientific research centers. The scientists don't really mind as long as they continue to get funded. They like solving puzzles and they are not really involved in the process of using them or getting others to do so.

Even though nature does not assume a seat around the health care negotiation table, its effects loom large. Largely this comes from poor performance with regard to chronic diseases.

Colin Campbell provides an interesting example of one aspect of the problem. In his recent book, Whole, he describes an encounter with a member of his family and an oncologist. A diagnosis of cancer had been declared. The doctor indicated that there were three options, combinations of these. They were surgery, chemotherapy, and radiation therapy. The Campbells responded that they wish to follow an integrative approach, most particularly an approach that emphasized the role of nutrition. The doctor was openly dismissive In effect, he issued a death sentence if the didn't act immediately.

The Campbells elected to follow the integrative approach, and after several years the results have been very good. Dr. Campbell is clear to say that this result is not a scientific finding, lacking the statistical and sampling requirements for credible generalizability, etc. On the other hand, the outcome was a good one, backed by much research in many related fields -- dating in fact back to Otto Warburg and his observations on the cellular origins of cancer. Genomics, proteomics, metabolomics, and many other research areas are providing evidence of the importance of nutrition and other holistic factors in the ongoing defeat by the body of cancers and other unwanted health conditions.

If Dr Campbell, a world-renowned scientists, was not able to persuade the doctor, what chance do others have? He estimates that approximately 2,000 to 3,000 such sessions between doctors and their clients occur each day in the United States. People need information to gain leverage, if not to supplement their own actions. As recently described in the New England Journal of Medicine, the doctors themselves find themselves in a vise, depending on the expensive, invasive methods and drugs.



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