Suffering from headaches and depression? Don’t let your doctor put you on Prozac; instead, look for the underlying causes.
Maybe there are problems at work or at home that you can solve.
High cholesterol? Try the Mediterranean diet, with a glass of red wine a day. And if you really need to take statins, drink green tea to counteract the harmful side effects.
The best way to win the “war on cancer”? Eat healthy, exercise and develop an active social life.
An increasing number of physicians are realizing that this type of approach—geared to prevention and a conservative use of medications and technology—not only increases patients’ vitality but saves lots of money. In the debate over health care reform, one group of doctors and researchers would like to change more than just how health care costs are covered. They believe—in the words of Dean Ornish, founder and chairman of the Preventive Medicine Research Institute in Sausalito, California—that it is time to “change not only who is covered but also what is covered.” With that insight as a starting point, they hope to inspire President Obama to take a different approach to health care.
Ornish and other critics of the current system claim that a great deal of Western medicine is too often ineffective and sometimes even harmful. There is an overemphasis, they say, on treating symptoms and on the idea that caring for your health is primarily the responsibility of medical experts rather than of individuals themselves. Zhaoming Chen, chairman of the American Association of Integrative Medicine (AAIM), describes the way things currently work as sick: “We only treat the disease after it occurs.” The figures bear him out: 95 cents out of every dollar spent on health care is spent on treating illness. “The best way to reduce the costs is prevention,” he says.
The emphasis on prevention is a crucial element in “integrative medicine,” a practice that combines the best of Western health care with alternative or complementary healing methods employed when conventional therapies are ineffective. Integrative medicine puts the patient, not the doctor or the insurance company, at the center of attention, and it puts the focus on the sources of illness not the symptoms. As it becomes more likely that health care reform will not result in any drastic changes, integrative health offers simple, effective and cost-effective solutions for much of what ails both patients and the delivery of medical care.
The litany of health care problems is by now pretty familiar. Costs are escalating, along with the instances of conditions like cancer, diabetes and heart disease. The U.S. ranks 37th in the quality of its health care system, according to a 2000 World Health Organization report, despite spending twice as much per person as any other developed country. Some 48 million Americans, 16 percent of the population, don’t have insurance; a lot of those who have it discover, when they become ill, that they don’t have enough. Earlier this year, the American Journal of Medicine published a study showing that illness and medical bills contribute to more than half of all personal bankruptcies—a portion that’s increasing fast. Of the cases studied, three-quarters involved individuals with health insurance, most of whom were well-educated, owned their own homes and had decent jobs.
Daniel Dunphy, a doctor with the San Francisco Preventive Medical Group, an integrative clinic where both conventional and alternative therapies are prescribed, shakes his head at the statistics. He believes that whatever reform is eventually passed, it will not bring about the necessary fundamental changes. “What we now have is not a health care system; it’s a medical delivery system,” Dunphy says, referring to the tendency of doctors to prescribe pills or refer patients to specialists whether they need it or not. “And we’re even bad at that. We give medical care to people who don’t need it. And when people do need medical care, we don’t give it to them. But if we do, we do everything we can to avoid reimbursing them.”
The exclusion of “pre-existing conditions” from coverage has long been a point of contention between insurers and consumers. Less well publicized is the fact that tests, interventions and procedures for which there is no sound medical basis account for around 30 percent of all medical expenditures, according to a statement from last year’s Health Reform Summit convened by the U.S. Senate Committee on Finance.
In a recent article on the New England Journal of Medicine website, Robert A. Levine, clinical professor of laboratory medicine at Yale University, blames unnecessary care on “perverse incentives” that reward doctors for every procedure: a prescription for medicine, a referral for a test, or an operation. “Even if all physicians were highly ethical and ordered only tests and treatments they deemed truly important,” Levine wrote, “it would take saints not to have their judgment skewed in favor of decisions that will provide them with financial rewards.”
Health care costs are continually rising but people are not getting any healthier. Any reform that does not address this fact will fail. So here is Ode’s five-point prescription for the future of health care, a prescription that applies the tenets of integrative medicine to make health care simpler, more effective and more affordable.
1. Prevention is better than cure
Dunphy draws an iceberg in the air with his index fingers. “What we see in Western medicine is only the tip of the iceberg,” he explains, referring to the symptoms that are treated with pills and technology. “What we don’t see is all that’s underneath the surface, which is what is leading us to disease and away from it. This is where chronic illnesses occur.” And it is these illnesses—cancer, diabetes, heart disease—that account for a large chunk of health care spending. If we can prevent these illnesses, Dunphy argues, we can avoid a great deal of suffering—and save a great deal of money.
Around half of all American adults have a chronic illness, according to The Partnership, a John Hopkins University-led initiative to improve care for Americans with chronic health conditions. Preventive Medicine Research’s Ornish claims that three-quarters of the more than $2 trillion spent last year on health care went to cover these conditions, among which he also includes obesity. “All of these can be not only prevented but even reversed through diet and lifestyle intervention,” he says. “It just seems so obvious to me that this is where we should be putting our focus.”
AAIM’s Chen agrees: “If we do not reduce the incidence of chronic diseases and change our lifestyles, we are not going to reduce the costs.” He points to a recent Archives of Internal Medicine study of over 20,000 Germans, which found that non-smokers who maintain a healthy weight, healthy diet and exercise 30 minutes a day lower their risk of developing diabetes by 93 percent, heart attack by 81 percent, stroke by 50 percent and cancer by 36 percent, compared to people who haven’t integrated any of these factors into their lives. According to Chen, doctors should explicitly discuss lifestyle choices with their patients, including everything from learning to better handle stress to exercising more and enhancing social contacts.
There is, however, a long way to go before prevention is on the agenda. While prevention is indeed better than cure, we tend to reward those who find solutions for existing problems rather than those who ensure that those problems don’t occur. The system is even designed to reward insurance and pharmaceutical companies when they treat a disease instead of preventing it. Plus, by definition, the benefits of prevention won’t show up for decades, or even generations. “It’s hard for Congress to engage in a comprehensive integrative health approach because the savings will only be visible many years later,” says William Novelli, a professor at Georgetown University’s McDonough School of Business and the former CEO of AARP, the consumer group for older people. “That’s an artificial barrier we need to cross.”
But, according to Ornish, there’s an even greater challenge: Prevention just ain’t sexy. “Prevention is boring,” he says. “We need to focus on living better. [If you have a healthy lifestyle,] you’re likely to look better, feel better, lose weight and gain health, as well as to smell better, taste better and love better.” What’s not to like?
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