vs. Chronic Health
I recently listened to a talk by James Maskell called Evolution or Revolution: The Rationale for Healthcare from Scratch. He is Founder and CEO of Revive Primary Care, and was advocating the implementing of a new health care system (as opposed to modifying the current health care system) to deal with the chronic disease issues we have today. While his talk was more orientated towards medical doctors, it was a brilliant talk with a unique perspective on current medicine and chronic illness. Chronic health problems are now the most prevalent disease profile facing the modern medical system, so we need to make sure the system in place is fully capable of handling the issues presented.
Evolution of Modern Medicine:
Todays modern medicine developed in the early 1900's and was created around treatments for trauma management and acute disease. This was appropriate for that time as the prevalent issues were trauma and acute infections - which needed to be dealt with if people were to live longer healthy lives. This resulted in a medical system that was a profoundly reactive system - something had to happen before the medical system kicked in (which make sense for trauma and acute infections :)).
However, this is still the primary format for modern medicine - it is a reactive system used for specific situations. Enormous emphasis is placed on diagnostics, and until you have a diagnosis - the is not much in the medical system that can help you. (And this doesn't just apply to the medical system. For example, parents of children with developmental disorders cannot get government assistance until they have a diagnosis.) However, reactive medicine is not an effective operating system for chronic disease. The current medical system is fundamentally opposite to the medicine needed for chronic disease.
"We will never have a truly successful system at dealing with chronic disease if it is purely reactionary, because the reactions happen 25 years to late1"
There is an approximate 17 yr delay between the generation of new ideas in the research literature and those ideas making it into everyday practise1. Given the current chronic disease epidemics plaguing us today - we just don't have enough time! For example, with the current rise in rates of autism, it is predicted that 1 in 2 children will be on the autism spectrum by 20252,3. Chronic disease is the most pressing disease of our time, accounting for 90% of deaths and has a prevalence of 1 in 2 children - and is on the rise1,4,5. Modern medicine is just not designed to deal with chronic disease.
Thus there is a need to create a 'proactive medical system'. One that understands that chronic diseases are multi-systemic (not confined to one organ/system - but instead involves multiple systems), and that is holistic in its approach (as opposed to reductionism). Medical practitioners are needed who are more 'generalist' rather than 'specialist' - capable at looking at the big picture and seeing the interlinking nature of the patient's chronic disease issues.
Patient centred diagnosis: Current medicine is doctor/treatment centred medicine - the doctor has the knowledge and tools to 'fix' the patients, and the patient is a passive recipient. Instead the patient needs to be actively involved - which involves empowering the client and having them play an active role in their own health.
Community Orientated: Acute medicine is one-on-one. It is behind closed doors and private. However, to combat chronic disease, we need to inspire behaviour change - and this is more effectively achieved through communities and relationships. Research shows that community and relationships drives a greater proportion of health, and are a better indicator of future health of individuals1.
"behaviour change is whats necessary if you have a life-style driven illness1"
Thus what is needed is community based systems to deal with chronic illness. Examples of this in action are health supports groups such as diabetes groups, 'Alcoholics Anonymous' and 'Weight Watchers'. Their effectiveness lies in having a supportive group around the individual. In addition, people being vulnerable in front of a group inspires connection and trust and thats what leads to behaviour change.
Germs: Our Current thinking is very 'anti-germ' orientated. From the widespread abuse of antibiotics to the excessive use hand sanitisers, we have been trained to be scared of germs. But we need germs and they need us (hygiene hypothesis). Microbes help us with digestion, immune and metabolism, and without them our system is not able to function (our immune needs training!!) What we need is a 'microbiome maximising system', whereas atm we have micro-biome minimising system.
Placebo maximised medicine: Current thinking is that the placebo effect is seen as a trick - it is not trusted and looked down on. However, it is the most powerful healing mechanism that we have! 18-80% of people get well on the placebo, and even when we know it is the placebo - it still works!! Placebo is more powerful than most medicine. It is the power of thought - thinking yourself healthy. So there is a need to maximise the placebo response. Better yet - its free, so we must harness the thinking that makes the placebo effect effective.
Food as medicine: Doctors have essentially no training in food. In acute medicine - food doesn't matter. But in chronic health - food is CRUCIAL. So many people have been sick and healed themselves with food - we hear it all the time and it is driving this current health and lifestyle movement (it also contributes to the current plethora of health information - making it hard figure out what to do). However, most food is created to keep you addicted to the company product. There is a need to step out of this mentality - to become aware of what has happened to food and make informed choices.
"Food is medicine. every fork-full of food is either inflammatory or anti-inflammatory. And you are choosing your long-term prognosis every time you pick up a fork"
What Comes Next
Iatrogenic Disease is defined as a disease that is caused by medical treatment. Iatrogenic disease resulting in death is the 3rd biggest killer in the US1,6. Modern medicine is exacerbating chronic disease: the vast majority of chronic diseases are lifestyle based, and symptom-based treatments (treatment of choice in modern medicine) at best mask and complicate an already complicated disease profile.
The development of a separate system for chronic health care is ideal. Community based and peer supportive groups will encourage behaviour change, greater awareness and self sufficiency - its all about empowering the patient. Coaching would be the fundamental driver in the development of maintainable behaviour changes.
Ultimately the current medical system is not up to dealing with the chronic illness plaguing us today. As the majority of chronic illnesses are due to lifestyles factors, we need to have a hard look the lifestyle choices we make.
What are good lifestyle choices?
How does ones lifestyle need to change?
What are the contributing factors to poor lifestyle choices?
What is limiting our ability to make good lifestyle choices?
How to effectively implement large scale change - on a community/societal level?
Who implements/governs lifestyle changes?
These kind of questions need to be asked at the individual level as well as societal level. Until we have adequate community based support structures in place, we will largely be working independently - learning what we can and actively increase our awareness in order to restore and maintain our own (and our families) health. As individuals we have so much power over our own health - if we are willing :).
1. Maskell, James. 'Evolution Or Revolution: The Rationale For Healthcare From Scratch'. The Evolution of Medicine II Summit. N.p., 2015.
2. Scutti, Susan. 'In A Decade, Half The Children Born In The US Will Have Autism [VIDEO]'. Medical Daily N.p., 2015. Web. 8 Sept. 2015.
3. N.p., 2015. Web. 8 Sept. 2015.
4. Aihw.gov.au,. N.p., 2015. Web. 8 Sept. 2015.
5. Abs.gov.au,. '4364.0.55.005 - Australian Health Survey: Biomedical Results For Chronic Diseases, 2011-12'. N.p., 2015. Web. 8 Sept. 2015.
6. Detective, Your. 'Iatrogenic Disease: The 3Rd Most Fatal Disease In The USA'.Yourmedicaldetective.com. N.p., 2015. Web. 9 Sept. 2015.