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Fixin' Healthcare

Friday, September 14, 2007

If Health Is The Goal, You Should Have Said So

Do we really know what makes us healthy? Gary Taubes asks the $64 question but he cannot provide the answer. Perhaps, as he suggests, the reason the question goes begging is the complex nature of biomedical research and the great difficulty drawing conclusions from the data. "[hormone replacement therapy] is a particularly glaring example of the difficulties of trying to establish reliable knowledge in any scientific field with research tools (epidemiology) that themselves may be unreliable."

Welcome to the real world and it is not limited to epidemiology. There are more biases than you can shake a stick at and the most sophisticated research tools are like stone cutting when compared to the mind numbing complexity of the human body. And, that body has to interact with the equally complex environment, which includes the society of other human beings.

There are days when it would be easy enough to conclude that biomedical research has little to do with the real world. Mr. Taubes comments on the limitations and drawbacks of clinical trials for drugs, and he is talking only about the scientific aspects of the studies. It has long since passed the point where clinical trials define the conditions of drug utilization in daily practice. In addition to the patient, the family and the doctor, there are insurance companies, Wall Street, marketing departments, newspaper editors, politicians and courts who are factors in that arena.

Should you ask your doctor if drug X is right for you? Is it the right question? Mr. Taubes asks a good question that doesn't get asked often enough. And, when it is asked, it is usually with an answer in mind. Think about it. Do we really know what makes us healthy? Also, it might be helpful to consider to whom that question should be put. I can see the usual suspects proposing health insurance as the answer.

Socio-economic status and level of education in all probability have more influence upon achieving and maintaining optimum health status than does medical care. School systems lament that they are asked to shoulder too many of society's problems but they may be the health care system as contrasted to the medical care system. One (health care) develops the conditions for optimum health (whatever they are) and the other (medical care) diagnoses and treats illness and disease.

Interestingly, the origins of the current epidemic of obesity and chronic diseases could be traced back to the time when Allan Bloom saw the beginning of "The Closing of the American Mind". Is that a stretch? Perhaps, but we should think about it. If health insurance means medical care for everyone, God help us. Of course, I'm just playing with your fears. How could anyone say the United States is a society oriented to sickness?

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