Prevention of Ill-health, Creation of Health
The Treatment Model
“Why is our medical system so expensive and inefficient? What can we do to fix this?”
The Scottish Government's answer to such a question is to throw more money at the system, give it more resources, more staff, more buildings...just more. It is the mantra of more.
Local NHS authorities will not discuss the issue with the public or if they do, as I have found when I have asked for meetings, their hands are tied, and their minds stuck in a very rigid, conventional, narrow treatment paradigm.
Since 1983, NatCen Social Research’s British Social Attitudes (BSA) survey has asked members of the public about their views on, and feelings towards, the NHS and health and care issues generally. The latest survey was carried out between July and October 2017 and asked a nationally representative sample of 3,004 adults in England, Scotland and Wales about their satisfaction with the NHS overall, and 1,002 people about their satisfaction with individual NHS and social care services.
In April 2016, a QualityWatch report from the Nuffield Trust and the Health Foundation, concluded the following,
"To conclude, we make five clear recommendations: 1. A new long term public health strategy is needed that not only focuses on priorities including healthy eating, sensible drinking and mental health but also seeks to address inequalities. 2. There needs to be a paradigm shift in our thinking away from merely treating ill health and towards promoting positive health. Health promoting environments are needed including health promoting schools and hospitals. etc
As patients we know that the longer we delay taking action to address a health condition, the likelihood that it becomes worse and therefore more expensive it becomes to treat. Similarly, the longer we delay facing up to and taking action on the inefficiencies, costs and brokenness of the current system, the more difficult it will become to fix things. And perhaps fixing is the wrong word. We need a new paradigm, for the present system to die, which it seems to be doing, and to be reborn.
This is not a paper about the excellent staff we have in our medical services; this is about the system they have to employ.
I maintain it is broken.
The standard model of care they have at their disposal works reasonably well for acute diseases, trauma, infection, and emergencies. I have been brilliantly dealt with and care for when needing emergency treatment. Sadly, our system, particularly I would argue the present GO system, fails miserably in the care of people with and management of chronic diseases eg diabetes, auto-immune disorders, that affect over 125 million Americans and who knows how many in Europe or the UK, let alone help people create optimal good health.
Treatment versus prevention and creation
And why do I say the present paradigm is broken??
Well, here’s one way of looking at it and I
appreciate this is simplistically put: we focus
far too much on treatment and not enough
on preventing ill-health or. more importantly,
the creation of optimal health and well-being.
The concept and importance of prevention is
nothing new. There’s a line in the
Huangdi Neijing, The first and Essential
Text of Chinese Health and Healing,
written two millennia ago in the form of a
dialogue between the Huang Di, the Yellow
Emperor, and his acupuncturist, Qi Bo, that says,
“The wise physician treats disease before it occurs.”
And in the west, we have the wisdom of Benjamin Franklin,
one of the Founding Fathers of the United States, who said,
“An ounce of prevention is worth a pound of cure.”
As practitioners, as patients, as people we know this notion
to be true so why do more people not practise it? We know
excess alcohol one evening sets the scene for headache and
nausea the next morning. It's called a hangover. So, we could
easily prevent the hangover by not drinking so much, or at all.
But even if it kills us, we prefer to party and not think about
nasty things. It's called denial.
It’s also much easier to prevent a disease like type 2 diabetes from occurring in the first place than it is to treat it once it has taken root. And it is growing within long before we get the first signs.
I always thought it could never happen to me, it just wasn’t on my radar and I guess, at the time when I was running my own hotel, it was easy to miss meals, catch up by eating left-overs, watching neither quality, content or quantity, and generally not paying too much attention to me setting the scene for diabetes. Had I known more and been more proactive I could have avoided a diabetes diagnosis.
But even once diagnosed, there was no education to encourage me to reverse the condition or create good optimal health, even with the diagnosis. I was given the treatment model. No education whatsoever and this, at the time of no internet, meant it was difficult for me in a remote Scottish community to access good resources. And the consultant assigned to me, would not (I was told she did not like to) discuss the mental, emotional, and more male implications (eg impotence, erectile dysfunction, depression effects) of diabetes. She was simply interested in treating blood glucose levels. No mention of insulin resistance.
Twenty years later, since the diagnosis, not much has changed.
So why is treatment still the focus of our “sick care” system? (I refuse to accept we have a national health service because in my 20 or so years dealing with the NHS, I never hear talk of health, only treatment and treatment of a symptom, not the addressing of the root cause of the symptom.)
In America, in 2011, Dr Steven Charlap established a unique clinic, MD Prevent - it was created with the premise that patients would be better off if doctors focused their attention more on preventing disease than simply treating it. In clinical parlance, “primary prevention” means preventing disease occurrence, while “secondary prevention” means early diagnosis and treatment of existing disease before it causes significant harm.
"Our system was predicated on integrated health, including cooking, exercise, nutritional therapy, and mindfulness meditation. Care models in the U.S. still reward treatment, though; not prevention."
It really is well worth a read for it shows you a vision of a better health care model that is possible and then outlines why there are so many human barriers to achieving it, where ultimately, the three major healthcare industry players—the providers, the payers, and the patients—all had to share some responsibility for the clinic’s failure. And here’s the crux of it.
The interventions that would have the biggest impact on preventing and reversing disease—diet, lifestyle, and behaviour change—are not sufficiently remunerative, they don’t earn money for big pharma and costs aren’t typically reimbursed by insurance companies.
Instead, they pay for drugs and surgery—modalities that are focused on suppressing symptoms and intervening well after disease has developed and in my view, guilty of making matters worse, creating serious side effects which then need other drugs to treat them, and on and on – a self-perpetuating medical money machine.
In the UK we have something that is just as bad, and a waste of resources. I recently declined surgery (to take out my gallbladder.) It is a common procedure and we are told in the west (foolishly I maintain) that we don’t really need our gallbladder (that is not the case.) And so resources are spent whipping out gallbladders from patients who just go along with custom and practice because they know no better and put their trust in the health service. When I said no, my very kind surgeon , I say kind because he really listened to me, said “It makes no difference to me whether you keep it or have it out. In America they encourage it to be removed because they can charge for it and be reimbursed. In the UK, I get paid whether it is removed or not.” So unless we as patients are aware of what is going on, inform ourselves of purpose, procedures, and possibilities, then we unwittingly collude with unscrutinised practice and custom and practice.
If we truly practiced “evidence-based” medicine, where we proceed on all the available evidence – in the case of the gallbladder we need to be told more than “you don’t need it!” - rather than “reimbursement-based” medicine, or “routine-based medicine” we could spend the majority of our money and time on essential procedures, on supporting patients in changing their attitudes to health, changing their lifestyles, their nutrition, increasing physical activity, getting more and better sleep, managing stress, reducing their exposure to technology, and making other behaviour and lifestyle changes that can prevent disease before it occurs (and even reverse it after it occurs – think diabetes, another treatment disease which we have known for many years could be reversed through nutrition).
My general practitioners are so pushed for time to even cope with the treatment approach, they don’t have time (or inclination in some cases) to talk about healing, health, and the creation of well-being but even within the constraints of time, they could still make changes to their own practice—without waiting for policy changes from on-high, whether they’re working in the conventional system, or outside it—to emphasise prevention, reversal, and creation as the guiding approach with treatment only when essential.
This shift is, to me, perhaps the most important step we need to make in transforming the medical paradigm as individual practitioners, providers, patients, and as a society, in addressing the chronic disease epidemic and pandemics which we now face and will more seriously face in future.
In countries, such as America where they have it, more health insurance is not the answer.
In the UK ploughing more money into a medical treatment model / paradigm that is not helping us get healthier is also not the answer.
Whilst we have generations of people who are ill and have conditions, treatment will often be the way. But we have generations growing up who are not yet ill and so we need to have, running alongside the treatment model, a model which is about healthy living and prevention, about focusing attention more on creating and maintaining good health than simply treating if we get ill.
We need to integrate both, with the “new” system being predicated on integrated health, honouring holistically all aspects of a human being – the mental, emotional, spiritual, soul, as well as the physical - including lifestyle issues such as nutrition, movement, exercise, self-care, self-healing, prayer, mindfulness and meditation and a health service that embraces the various modalities that support such approaches. Doctors might then prescribe meditation for stress instead of pills, qi gong to develop flexibility and calmness instead of anti depressants. We might see fewer expensive doctors and more health coaches.
And yes, at the outset, for quite a number of years, this may be hugely expensive, to have two systems running side by side, gently integrating, but eventually reaping the rewards as fewer patients have fewer needs for expensive (but not always necessary) surgery or particularly pharmaceutical drug treatment.
For years now, I have declined prescriptions for anti-depressants (sometimes prescribed for pain) and instead have trained myself and practised meditation, visualisation, breathing, and energy healing…saving our NHS the cost of medication and other treatments.
A Way Ahead
The present paradigm is so ill, it cannot be saved. It maybe has to die and then be reborn. Imagine then a paradigm, model, or system of healthcare which:
Is deeply science based.
Genuinely views each of us as individuals, as being different; genetically and biochemically unique each with our own lifestyle, biology, and history.
Has time to go exploring with patients, travelling upstream to find the cause, the blockage, the source of imbalance
Extends the definition of health to enable the patient to encompass a process of awareness, education and growth, based on patient self-responsibility.
Sees wellness as the integration and effective intercommunication of body, mind, spirit, and soul and honours that what happens within us is connected in a complicated network or web of relationships, cells speaking to cells, organs to organs, heart to mind, mind to all etc
Honours the body’s intelligence, its capacity for self-regulation, expresses itself through a dynamic balance of all the body systems, realising that something that is a problem in the brain may be originating in the gut microbiome, that arthritis may stem from a tendency to be ever critical, inflexible, unwilling to psychologically bend
Opens to health modalities outside the present conventional health realms of radiation, medication, and surgery to the best of complimentary, alternative, nutritional, homeopathic, and natural
Helps the patient understand that their attitude, that all they do, think and feel, their lifestyle, the quality of their relationships, impacts their state of health
Prevents and reverses chronic disease, instead of just managing it by medicating and treating symptoms
Genuinely enables personalised health care and its patient centred approach and treats the individual, not the disease.
Supports the normal healing mechanisms of the body, naturally, rather than attacking disease directly but, as in cancer, in attacking one part of the body, attacks the wider area
Offers a paradigm and system of working focussed less on treatment and more on creating health in which all medical staff find their work inspiring, meaningful, and rewarding
Ceases to have everything filtered through the GP, thereby creating systemic blockages, and introduces the use of health coaches, nutritionists, and other allied providers to support patients in making lasting attitudinal, belief, diet, lifestyle, and behaviour changes
Creates more over-the-counter services and products from pharmacists
Reduces the costs to staff especially in terms of raised cortisol levels and personal stress
Fundamentally realises that health is not just about trating or getting rid of disease, but a state of immense vitality.
Prevents vast costs on healthcare for governments, organisations, staff, and individuals
Unconventional Medicine Chris Kresser
Treatment Prevention Creation
The above continuum was developed by Dr John Travis and Regina Sara Ryan.
Wellness is a process, not a static state of being. You don't just get well or stay well. There are many degrees or levels of wellness, just as there are degrees of illness. But, no matter how well you are,you can always be moving towards better health. Wellness is not the absence of disease or infirmity. You can be at a neutral point, without discernible illness, yet still feel tired, confused, run down, bored, depressed, tense, anxious or even not in control of your life. Wellness is based on self-responsibility.
Conventional medicine works with the signs and symptoms of disease.
The above Wellness Continuum, Functional Integrative Medicine, extends the definition of health to encompass a process of awareness, education and growth, which is based on self-responsibility. Wellness is the integration of body, mind and spirit; all that you do, think and feel impacts your state of health.