The exiting healthcare system is based on treatments, even though 80% of illness is preventable. That means simply that individuals and their doctors are doing precious little to prevent disease, even though they could
This has led to a declining state of health for our population, as well as outrageous high health costs, which are rising every year. More than 60% of adults have a chronic illness and this represents an increase of over six-fold over the past 60 years. Cost in that same period of time has tripled from 7% of our Gross National Product to about 20% with some economists indicating that this could increase to 100% of GNP by the year 2065.1
How did this happen, and can anything be done to reverse this very serious situation? The literature identifies several specific factors that have contributed to this disappointing state of affairs. This includes the following partial list of contributing factors:
1. The general public learns very little about health and prevention in our educational system in the media or in the workplace.
2. Conventional health practitioners learn very little about prevention or natural approaches to reversing chronic disease.2
3. The existing health insurance system is almost exclusively focused on treatment with rules and regulations slanted in that direction.3
4. Scientific studies clearly show that conventional medical treatments are only supported by evidence-based research 20-25% most of the time.4
5. Prescription drug companies have amassed billions of dollars from their treatment-based approaches and use this war chest to keep the treatment-based system intact and keep the money flowing to company executives and shareholders.5
6. The media plays a big role in supporting the treatment-based system by virtue of the rich advertising budgets provided to both electronic and print media by "Big Pharma."6
7. The government agencies play an important role in this support of treatments when political campaigns are funded by drug companies, and others, to ensure that rules, by groups such as the FDA, require strict legislative guidelines and expensive clinical trials that can only be paid for by rich drug companies.7
It is very clear that the current health care system is stacked very much in favor of treatment, with prevention given very little attention. This is in spite of the fact that scientific evidence is heavily weighted in favor of prevention and even reversing chronic disease.8 The "system" simply ignores this fact and allows the financially lucrative treatment-based system to continue to have its way. Is there any hope that this situation can be changed in the near, or even the distant, future? Perhaps it is time to consider self-care as one of the possibilities that warrants further attention.
Self-care can probably be best described as common sense health care whereby people take more responsibility for their health with an emphasis on prevention. Unfortunately, too many people pay very little attention to prevention, and they wait until a health problem of some kind occurs. This results in a medical response, and a treatment of some kind by our conventional health care system. Beside being very expensive, this treatment-based health approach represents the number one threat to the health of our country. 9
About 95% of all health expenditures are related to the treatment of illness and only 5% is spent on prevention. 10 This is very disturbing, because over 80% of all illness is preventable. In other words, in the purist scenario, over 80% of health care costs are preventable.11 This is one of the reasons why the United States has the most expensive health care system in the world, and will likely bankrupt our country if this lack of prevention is allowed to continue.12 Too many people have become "addicted" to the treatment of disease and this addiction will eventually make many people sicker and die sooner than they should.13
Self-care can be defined in many ways, and we should carefully consider its many variations be in order to optimize the opportunity for illness prevention and cost savings.
What are some of the levels of self-care?
1. Passive self-care - This might be the definition favored by many conventional doctors and could involve asking some very general questions about the diagnosis, as well as the recommended treatment for a particular illness. Some doctors do not even want to entertain questions since they feel that patients know so little about medicine that they are not qualified to challenge or question a doctor's diagnosis or treatment.
2. Curious self-care - In this case, patients may ask some questions of their primary care physician and, if not totally satisfied, might seek a second, or even third opinion. This level of self-care usually kicks in when a more serious illness is diagnosed and the patient wishes to avoid an operation or an invasive treatment, such as chemotherapy. The patient may also be frightened enough to ask about less invasive treatment possibilities, and may actually identify some, if one of the doctors contacted has taken the time to study complementary or alternative treatment modalities. However, at the conclusion of this discussion the conventional doctor's opinion would probably prevail.
3. Inquiring self-care - This level of self-care is similar to the previous "curious" definition with the exception that individuals, in this case, would do some research in order to prepare better questions, especially for the second and third opinion doctors. They may even suggest some complementary or alternative treatments, but would not press for them if their doctor discouraged their use. The other distinguishing characteristic of this type of self-care is that it is mainly reactive and is not very proactive or preventative.
4. Consultative self-care - This is the first level of self-care that includes active prevention and consultation between doctor and patient on how to prevent illness, as well as how to treat conditions that have been diagnosed. Patients at this level are likely engaged with conventional, as well as alternative practitioners on a regular basis or have found a holistic M.D. who incorporates many medical modalities. Some medical offices now have a full range of integrative practitioners available from which the patient can pick and choose.
5. Assertive self-care - These individuals are often called self-healers. They usually have several alternative health practitioners with whom they consult on a regular basis. They will sometimes consult a conventional doctor in a true medical emergency, but would much rather research their condition and find one or more alternative treatments for any chronic illness. They are also very engaged in illness prevention. In fact, some people are probably borderline hypochondriacs. They tend to think they will get various diseases and will take many different approaches to avoid them, including restricted diets, regular nutritional supplementation and regular tests to ensure nothing has actually changed in their body.
We can see from the preceding discussion that self-care can be defined in many ways and we should be careful not to see these definitions as comprehensive or rigid. People may move from one category to another over time or change approaches depending on their situation. Some people may think that they are engaged in prevention because they eat a "balanced" diet, don't smoke, get some exercise and take a multivitamin. More detailed definitions are needed because these definitions are a starting point to determine where you are in terms of personal responsibility. The following chart illustrates the main points of these different definitions of patient self-care.
Shifting the Self-Care Paradigm
|
Passive Self-Care |
Curious Self-Care |
Enquiring Self-Care |
Consultative Self-Care |
Assertive Self-Care |
|
Conventional M.D. |
Conventional M.D. |
Conventional M.D. |
Conventional and Natural Doctors |
Holistic or Functional M.D.'s |
|
Ask few questions |
Ask questions about options |
Research other options |
Collaborates with doctors |
Creates holistic plan for doctors |
|
Reads very little |
Reads mass media stories |
Reads specialty health media |
Reads health and medical articles |
Reads all books and articles available |
|
Takes meds faithfully |
Takes meds with some caution |
Takes meds and supplements |
Takes meds temporarily |
Takes supplements first if possible |
|
Eats whatever tastes good |
May reduce fat and sugar |
Tries some health recipes |
Eats whole food diet primarily |
Eats nearly perfect for his genes and metabolism |
|
Gave up exercising years ago |
Walks the dog and bikes community |
Increases heart rate almost daily |
Goes to gym often |
Aerobic, resistance and stretching daily |
|
Doesn't think about stress |
Aware of need to avoid stress |
Uses music or hobby to reduce stress |
Reads about stress and manages it |
Does meditation or yoga every day |
Beginning to Further Define Self-Care
Several factors contribute to self-care in its highest and best form. Here are some of the basic criteria:
1. Lifestyle Factors - At the outset, a healthy lifestyle is the most fundamental need. This includes no tobacco, very limited alcohol consumption, 7-8 hours of sleep per night, managing stress and avoiding as many toxins as possible. Eating according to the Mediterranean or Asia food pyramids is very important, and taking quality nutritional supplements according to your needs is also vital. Information on each of these topics is readily available, and without a sound program in each area, advanced self-care is simply not possible.
2. Information Sources - Where do you get your health information? If you get most of your health information from commercials, conventional doctors and old wives tales, then your self-care prospects will be very limited. If, on the other hand, you rely on magazines, websites and doctors featuring evidence-based health care, you will be utilizing the best quality health care information. Web MD, Pub Med and Doctor Oz are sometimes good sources, but not always the best. However, if you use Life Extension Magazine, Dr. Michael Murray, Dr. Joseph Mercola, Dr. Mark Hyman and Green Med Info, you are more likely to get leading edge evidence-based health and medicine information.
3. Doctors, Tests and Treatments - Unfortunately, the current health care system is not as prepared as it should be for the most advanced version of preventative self-care.
- Doctors - Most doctors are treatment-based and have limited knowledge on preventative medicine. Doctors practicing Holistic, Functional or Natural medicine are better trained and skilled in this regard. Unfortunately, many of these "natural" doctors may not be included in your health insurance plan. If you can afford to utilize one of these natural doctors for prevention and reversal of chronic illnesses, it would be much better for you and your family.
- Tests - Many standard health tests do not catch disease soon enough to be prevented. Examples are mammograms, which usually catch breast cancer too late. Thermography is better.14 Another test called the AIC is not the best for diabetes. A better one is the glucose tolerance test.15 Likewise, cholesterol is not usually the best test for heart disease. Better tests measure C-reactive protein, homocystine and fibrinogen.16 There are many books and articles on these "better" tests, and advanced self-care should encompass them.
- Treatments - Most conventional medical treatments for chronic illness, based on conventional medicine, are based on the treatment of symptoms, not the reversal of the disease. In the conventional medicine world, managing the disease is the goal, however, the side effects and the long-term negative consequences are often not good. Arthritis patients still end up getting knee and hip replacements, diabetes patients still have higher rates of stroke and heart disease, and patients with cardiac disease still end up with high rates of stroke, bypass surgery and stents.17 On the other hand, doctors using Functional Medicine can reverse many cases of diabetes, arthritis and heart disease with plant based diets, exercise and nutritional supplements, such as magnesium, fish oil, vitamin C and CoQ10, just to mention a few important supplements. The science behind this reversal of disease is absolutely undeniable. 18 And yet, conventional medicine continues to ignore the evidence being produced every day with thousands of holistic doctors, including prestigious institutions, such as the Cleveland Clinic.19
It is clear that self-care goes well beyond what happens between people and their doctor; it involves a full range of activities that can dramatically influence someone's overall health and wellness. Self-care includes many lifestyle changes and educational initiatives, which some people are more willing to pursue than others. This is what separates a low-risk person from a high-risk person more than any other single health factor.
Far too many people are satisfied with a laissez-faire attitude about their life. They don't eat as well as they should. A recent study of more than 16,000 people aged 2 to 80 could not find even one person with a healthy diet.20 This study from the National Cancer Institute actually revealed that a vast majority of people were deficient in 11 out of 14 nutritional categories. That would seem to explain why over 60% of adults are chronically ill, compared to only 10% 60 years ago.21 It would also explain why the generation of children born after the year 2000 will be the first generation that will not live as long as their parents did.22
Why is it taking so long for people to pay attention to these very serious health problems? There are articles about this health crisis nearly every day, and yet, most people remain surprisingly unaware about how they need to change their behavior. The following are some possible reasons why the current level of self-care is so low:
1. A vast majority of doctors still treat symptoms.23
2. Insurance companies pay for treatments and very little for prevention. (Less than 5% of costs).24
3. Big pharma influences politics too much, as well as advertising dollars.25
4. Only 20-25% of conventional medicine has scientific evidence to support its treatments.26
5. Workers are too busy to find time to research and implement a good disease prevention program.27
6. Many workers do not have the financial ability to pay for organic food, nutritional supplements, holistic doctors and other out of pocket health expenses.28
7. People tend to think they will live a long and healthy life in spite of emerging health concerns.
8. People feel that their doctor will find and control any health problem if it does happen. This attitude prevails in spite of the evidence to the contrary in study after study.29
The existing health care crisis facing our country will not be resolved any time soon. As previously stated, a recent Economist Magazine indicated that the U.S. will likely spend 100% of its GNP on health care by the year 2065.30 If 80% of disease is preventable, then the only feasible solution is to dramatically increase and improve patient self-care. This requires a revolution of new thinking on the part of most people. The following chart depicts the relative cost impact of these five definitions of patient self-care.
Cost and Benefits of Self-Care
|
Passive Self-Care |
Curious Self-Care |
Enquiring Self-Care |
Consultative Self-Care |
Assertive Self-Care |
|
|
Higher employee health premiums |
Premiums higher somewhat |
Premiums stable |
Premiums getting lower |
Lower employee health premiums |
|
|
Higher absenteeism |
Absenteeism slightly better |
Absenteeism somewhat better |
Absenteeism is lower |
Much lower absenteeism |
|
|
Higher colds, flu and sickness |
Slight improvement in overall health |
Healthier most of the time |
Much healthier consistently |
Virtually sickness free |
|
|
Time on health much higher |
Time on health issues too high |
Time on health issues a little less |
Time on prevention better |
Time with prevention higher |
|
|
Quality of life much lower |
Quality of life lower after age 40 |
Quality of life lower after age 50 |
Quality of life lower after age 60 |
Quality of life much higher |
|
And, here are a few examples of some of the reforms that would help to shift the preventive health care paradigm in the direction of better health and lower cost.
1. We need the media to pay serious attention to disease prevention.
2. We need politicians to create strategies and incentives for prevention and better patient self-care.
3. We need insurance companies to dedicate more time, effort and resources to prevention.
4. We need much better health education programs in our schools and better nutrition in schools, as well.
5. We need better workplace wellness programs with tax incentives for employers and employees for prevention and the use of evidence-based natural treatments.
6. We need to reduce the stress levels for many people, because stress is implicated in 80% of all disease.31 This should involve the reduction of stress in our schools, our families and the workplace.
7. We need doctors to learn more about nutrition and holistic medicine. The government and the American Medical Association should require this change.
8. We need hard prevention targets to improve overall health. Everyone needs to buy in to these targets in much the same way that we target extinct species and global warming.
The current debate about health care cost has centered on such things as the availability of insurance or whether prescription drugs are covered or not. There are endless debates about HMO approval of certain treatments and the lack of time doctors have to spend with patients. While these are important issues, they pale by comparison with the importance and significance of the self-care issue. Fixing all of the technical, administrative and coverage issues combined would not begin to improve health or reduce cost as much as a shift in the self-care attitude of our population.
A majority of our population is in the passive or curious self-care categories. Moving them to the inquiring or consultative categories would save billions of dollars within a matter of months. This is where our effort should be concentrated, not in the debate about how much drugs cost, or which treatment should be covered within an insurance plan. By tinkering with the symptoms, instead of attacking the root cause of our health problems, we continue to give in to the pressure of the almighty dollar. The protection of profits for drug companies, doctors and certain parts of the food industry is put ahead of the health of our population everyday. The power to change this sad state of affairs may be partially addressed by government, the medical establishment and the insurance industry; however it can be much more quickly and effectively resolved through the decisions made by each an every person as they decide how they will define self-care.32
References
1. Patient Heal Thyself, The Economist, March 19, 2011.
2. Deories S., Salen J.E., Eisenberg D.M., et al., A Deficiency of Nutrition Education in Medical Training, AM J. Med., 2014 Apr. 19 (E-pub ahead of print) and Alliance for A Healthier Generation, American College of Sports Medicine; Bipartism Policy Center, "Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention Oriented Care," (white paper) June 2014.
3. Frost B., Rivlin A, The Power of Prevention: US Health Care Reform Should Focus on Prevention Efforts to Cut Skyrocketing Costs. US News and World Report, May 28, 2015 and Lavizzo-Mourey R., We Must Focus on Preventing Disease if We Want Our Nation to Thrive, The Atlantic Magazine, May 30, 2012.
4. Carey J., Medical guesswork, Bus Week Mag. 2006 May 29:72.
5. Angel M, The Truth About Drug Companies; How They Deceive Us and What To Do About It, Random House, August 9, 2005, New York, NY.
6. How Big Pharma and the Media Sell Junk Science, Alliance for Natural Health, ANH-USA, April 22, 2014.
7. FDA: Failure, Deception, Abuse, Life Extension Foundation, Praktikos Books, Mount Jackson, VA, 2010.
8. Available at: https://www.cdc.gov/clinicalevidence.bmj.com/x/set/static/ cms/efficacy-categorisations.html. Accessed January 6, 2015. and Available at: https://concumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/healthy-lifestyle-may-reverse-aging-at-cellular-level-study-finds-680221.html. Accessed January 6, 2015. and Rustum R. Integrative medicine to tackle the problem of chronic disease. J. Ayurveda Integr Med. 2010 Jan-Mar;1(1):18-21.
9. Available at: https://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html. Accessed January 6, 2015. and Available at: http//www.consumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/healthy-lifestyle-may-reverse-aging-at-cellular-level-study-finds-680221.html. Accessed January 6, 2015. and Rustum R. Integrative medicine to tackle the problem of chronic diseases. J. Ayurveda Integr Med. 2010 Jan-Mar;1(1):18-21.
10. Ibid.
11. Ibid.
12. Ibid.
13. Belluck P., Children's Life Expectency Being Cut Short by Obesity, The New York Times, March 17, 2015.
14. Northrup, Christine, Thermography Breast Screening: The Best Test, Christine Northrup. https://www.drnorthrup.com/news/news_article.php. and Desandniers, Veronique, Heal Breast Cancer Naturally, TCK Publishing, 2014, pp. 232-234.
15. Hyman, Mark, The Blood Sugar Solution, Little Brown and Company, New York, NY. 2012, p. 25.
16. Sinatra, Stephen, The Great Cholesterol Myth, Fair Winds Press, Beverly, MA., 2012, pp. 171-175.
17. Carey J. Medical guesswork. Bus Week Mag. 2006 May 29:72.
18. Available at: https://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html. Accessed January 6, 2015. and Available at: http//www.consumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/healthy-lifestyle-may-reverse-aging-at-cellular-level-study-finds-680221.html. Accessed January 6, 2015. and Rustum R. Integrative medicine to tackle the problem of chronic diseases. J. Ayurveda Integr Med. 2010 Jan-Mar;1(1):18-21.
19. Ibid.
20. Krebs, Susan, et al. National Health and Nutrition Survey, National Cancer Institute; Journal of Nutrition, August 2010.
21. The Power of Prevention: Chronic Disease: the Public Health Challenge of the 21st Century, National Center for Chronic Disease Prevention and Health promotion. CDC.gov.
22. Belluck P., Children's Life Expectancy Being Cut Short by Obesity, The New York Times, March 7, 2005.
23. "Patient, heal thyself: How integrative medicine can make health care simpler, more effective and more affordable in five easy steps." Marco Visscher, Ode for Intelligent Optimists, November/December 2009, pp. 45-53.
24. Willett WC, Kolplan JP, Nugent R, et al. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank: 2006. Chapter 44.
25. Abramson J., Overdosed America. Harpers Collins Publishers, New York, NY., 2004(pp.XIII-XIV). and FDA: Failure, Deception, Abuse. Life Extension Foundation, Praktikos Books, Mount Jackson, VA, 2010.
26. Carey J. Medical guesswork. Bus Week Mag. 2006 May 29:72.
27. Person A.L., Cody S.E. and Eubanks, J.W., Barriers to participation in a worksite wellness program; Nutrition Research and Practice, Department of Nutrition and Dietetics, East Carolina University, Mail Stop 505-333 Rivers Building, Greenville, NC, 27858 USA.
28. Ibid.
29. Saul A., Doctor Yourself: Natural Healing That Works. Basic Health Publications, Inc., North Bergen, NJ, 2003.
30. "Patient Heal Thyself," The Economist, March 19, 2011.
31. Salleh, M.R. Life Event, Stress and Illness, Malaysia Journal of Medical Sciences, Vol. 15, No.4, October 2008 (9-18).
32. Begley S., "One Word That Will Save Your Life," Newsweek Magazine, August 22 & 29, 2011, pp. 30-35. and Global Health Report, Prevention vs. Treatment: a False Choice, January 2009. (Originally from Don Wright, M.D., U.S. Department of Health and Human Services.) and Available at: https://www.pmri.org/publications/newsweek/Yes_Prevention_is_Cheaper_then_Treatment_Dean_Ornish.pdf. Accessed January 6, 2015.
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