For All the Wrong Reasons

I know I should be positive and optimistic in an attempt to raise spirits. Identifying problems may not move things in the right direction and there is likelihood everyone will be upset with the process. But I cannot get the proposed government drug development center out of my mind and I have no other suggestion than to cease and desist with the development of such a center and put the attention, if not the resources, on changing behavior to improve health status.

The government is not immune from the same scientific limitations and market forces that impact the pharmaceutical companies. There is good reason the flow of new, effective and safe drugs has slowed over the last fifteen years. The lack of useful products from the genome project is a good example. Even after billions of dollars are spent the pharmaceutical companies cannot achieve a fraction of what healthy lifestyle can do to improve health status.

But the government is committed to the pharmaceutical industry for reasons of economic development and Dr. Collins is committed to the principles of the genome project. I sympathize with their positions but not for reasons of health.

The Best and the Worst

America eats the best and the worst diet in the world. There is more good food available than anywhere else but every community of any size is surrounded by junk food. Perhaps Americans are justified to worry about their diet and health status because the result is a population with a high incidence of chronic diseases. Whether in hope or desperation the country turns to medical care and nutritional supplements for help. But neither source solves the problems. The options are narrowing down to a diet consisting of whole foods primarily from plant sources, avoiding highly processed food and increasing physical activity. There are good reasons to reduce food from animal sources.

Do We Really, REALLY Need This?

The pharmaceutical industry estimates it invested $45.8 billion in research in 2009. But the drug industry's productivity has been declining for 15 years with no signs of improving. Concern about this situation has prompted the government to start a billion dollar drug development center to help create medicines.

The American public has a unique relationship with drugs. No nation comes close to the U.S. for the utilization of prescribed medications or the incidence of drug abuse and drug addiction. People with at least one prescription increased from 67 percent to 74 percent of the population and the number of prescriptions annually per person rose from 10.8 to 14.3 between 2000 and 2006. More than a quarter of U.S. children and teens are taking a medication on a regular basis and nearly 7 percent are on two or more drugs. The Congressional Budget Office estimates that $235.4 billion was spent on prescription drugs in 2008.

Advancement in science applied to pharmaceuticals creates large numbers of drugs that increasingly target specific aspects of metabolism. Drugs are the cornerstone for therapy in the medical care system. It is not unusual for patients to consume multiple drugs for a variety of unrelated complaints and health problems. Chronic diseases are more prevalent and severe, and nationally assembled panels of experts often recommend therapy with multiple drugs simultaneously directed at different aspects of these complex health disorders. Chronic diseases can be controlled but not cured by drugs.

Strict rules for safety and efficacy apply to development and testing of drugs. Clinical trials are the best tool available to comply with these rules but they are not perfect. All drugs have side effects, some of them dangerous and unexpected. It is difficult to account for biological variability, biological adaptability and behavioral uncertainty. Some drugs are used for longer periods of time or higher doses or under different conditions than are evaluated in clinical trials. Every possible drug combination utilized in medical practice cannot be evaluated by clinical trials. Even with the use of approved medications and correct medication procedures, many people die every year from unintended reactions to the medication.

Drugs are major legal and illegal economic enterprises in the U.S. Considered in its totality, which includes side effects, multiple drug interactions, incorrect and inappropriate utilization and propagating a social and individual mind-set for sickness, drug therapy might have as much negative influence as benefit upon health. Improving health status of the U.S. population and decreasing medical care cost could be accomplished by decreasing drug utilization. I am not confident society or the body politic is willing or capable of even attempting to comprehend that concept.

All Of Me

Biomedical research, medical practice and commercial application of medical technology have focused upon ever smaller and more refined parts of the whole. An organ system, a hormone, a protein, an enzyme, a chemical, a gene, a vitamin, a mineral, protein, fat, carbohydrate are examined, isolated and pursued in a linear fashion. But the whole organism is an immensely complex interactive network and it becomes ever more evident that the whole is greater than the sum of its parts. Further, science has barely scratched the surface of knowledge about any of the parts.

Medical care suffers from incomplete knowledge about every specialty component of the field plus lack of appreciation and knowledge about the whole organism. To further complicate the situation, medical care is but a component of health, and a small one at that, which has become overstressed to the detriment of health status and the economy of the nation. It is not time to make peace with disease but it is time to organize health care with the priority upon the person, the community, maintenance of optimum health status and prevention of disease.

War Without Victory

Medical care continues to increase in complexity as measured by the variety and highly technical nature of the services, as well as by the size and fragmentation of the medical care system. By default people come to rely upon health care professionals who are expert in one or another selected aspect of medical care. Medical care professionals do not always relieve sickness or cure disease and their limited time with the patient is consumed with attention to the sickness and disease. Broader consideration of health during the throes of illness may seem misplaced. Secondary and primary prevention are discussions for a later date, if at all.

But any discussion of disease or health between patients and health care providers takes time that is not built into how the medical care system functions and patients often are not prepared to grasp the nature of what they are hearing. Even if such discussions were to transpire, and I am not saying that they don't in some cases, the effort is insufficient to provide insight to patients about the manner and means to achieve optimum health status. That is a more involved process spanning much of a lifetime.

Perhaps it is unreasonable to expect providers of medical care to venture into the value systems, beliefs and philosophy of achieving and maintaining optimum health status. That is not what medical care professionals are asked to when diagnosing and treating illness, disease, injury and disability. Medical care functions with a philosophy best described as "find and fix". It is rooted in the same mind-set as "search and destroy" and "shock and awe". These are aggressive, confident attitudes based upon belief in the superiority of technology and overwhelming resources to achieve victory. For medical care the victory is over disease.

In Search of Health

I come to praise medical care, not to defend it. The praise is justified for providing relief of pain and suffering, for saving lives of the injured, for rehabilitation of the sick and disabled, for amelioration of chronic disease processes, for participating in the increase of life expectancy and for expanding the boundaries of knowledge for the biomedical sciences. But medical care suffers from an excess of praise. Praise originates with expectations, fuels expectations and arouses pride in the recipient. Pride clouds vision and forsakes purpose to yield enterprise that is not always of use or capable of providing relief to the sick.

People expect many things from medical care, sickness has a way of doing that. The expectations for medical care have teetered on the balance between hope and wishful thinking and ranged as far as explaining and relieving every complaint, ailment and human problem to delaying death. Expectations create demand and there is no defense against expectations and demands for outcomes beyond the capabilities of medical care. Nor is there an acceptable rationale for failing to learn and live the lifestyles that shape and support the pathways to good health.

My heart is in sympathy with medical care. But medical care is not everything in health. It is not most of health or the first thing in health; it is the last thing when health fails; it is the response to illness, disease, injury and disability. America expects more, but must learn to achieve it. Good health is a blessing, which like all blessings must be earned everyday.

The status of health in a society starts with the mind-set of the individual members. That mind-set can be directed toward health or sickness by the values and beliefs prevalent in the society, by what the society teaches and how the society behaves and utilizes resources. Good health may be the object of desire but if it is overwhelmed by fear of sickness then medical care becomes more than a process, it becomes a goal. When medical care is a goal achieving it creates a sense of security, which is not always justified and misleads people in their understanding about health.

There are many reasons for failing to understand the differences between health and sickness or health care and medical care. The greatest failing is insufficient personal thought about health in the absence of sickness. Many people don't think much about health and sickness until a problem arises. Sickness is an emotionally charged situation when thinking clearly is difficult. Even the most careful and rational of thinkers can be overwhelmed by sickness. Almost everyone expects medical care to develop the capability to cure illness, disease and disability. When this is the mind-set that dominates thinking about health, it increases the amount and intensity of medical care, diverts attention from the active pursuit of healthy lifestyles and negatively influences health status.