Monday, May 4, 2020

Prevention vs. Treatment - The Debate that Shapes Healthcare as We Know It

“An ounce of prevention is worth a pound of cure,” Benjamin Franklin once said addressing fire safety.  In the nearly three centuries since, his quote has become synonymous with a philosophical battle being waged in modern healthcare: preventing vs. treating sickness.  Though little disagreement exists in the statement that “keeping a well person healthy is easier than getting a sick person well,” the clear winner in the on-going debate, at least in terms of which dominates our current system, is the treatment camp.  Of the $2.2 trillion spent on healthcare in the United States each year, $1.6 trillion is spent treating consistent examples of poor health; and treatment as the focal point of healthcare has been a catastrophe, as reflected by poor outcomes despite irrational spending. 

One of the primary efforts at fire prevention implemented in the 20th century aimed to install a smoke detector in every house, offering homeowners a warning sign; the strategy has proven incredibly effective.  During that same period, the population has been conditioned to ignore the equivalent warning signs in their bodies, treating the symptoms of fire-like circumstances while remaining largely unaware of the underlying, slow-burning ruin.  “When you hear the smoke detector going off, find it, knock it off the ceiling, and move on with your day,” a hypothetical fire prevention seminar sponsored by modern American healthcare might teach.  Clearly, healthcare should be following the lead of fire safety, not the other way around. 

Our current “health” system has its priorities backwards.  The number one reason why people eat well in the United States is to lose weight and the leading prompt for restoring previously lost structural balance is chronic pain; being overweight and in chronic pain are effects of becoming unhealthy, like fires, and proper nutrition and structural realignment – items on the list of things we fundamentally need in order to maintain good health – are presently used as treatments to put them out.  That has to change. 

It is unlikely to change anytime soon, though.  Nearly all manners of forward-thinking in healthcare are directed toward innovations in treatment, with one particularly noteworthy exception. Among the latest and greatest treatments in the 21st century is stem-cell therapy, which is an intriguing concept that has rapidly expanded its footprint and repute.  Stem-cells are like blank tiles in Scrabble, capable of becoming any cell type that our bodies need them to be, and they are a key facet in the constant and automatic natural regeneration that takes place inside our bodies all the time; stem-cell therapy, then, aims to extract stem-cells and place them where damage has accumulated most on account of injury or breakdown.  Plenty of controversy surrounds the concept, from the source of the stem-cells to the long-term safety of manipulating something as delicate as a living cell; the therapy also falls beyond the orthodox bubble, threatening to disrupt the disease management system status quo and thus generally costing, for a series of treatments, what the average household in America spends on healthcare all year.  Nevertheless, stem-cell treatments are quietly developing a solid reputation for their benefits, and even an opponent of the therapy would have to admit that it makes far more sense to try and channel the body’s innate capacity to repair itself than to stick with the tired idea of chemical introduction to disrupt biochemistry, the hallmark premise of conventional pharmaceutics. 

Still, even if the proliferation of the above becomes a pillar for healthcare modernization in the coming decade or beyond, that it will simultaneously serve to push us collectively further down the rabbit-hole of operating healthcare out of the reactive realm, focusing attention not on the efficacy of preventing disease and breakdown, but on what to do once already broken down and in a diseased state, is concerning.

It is in our nature to want to understand and to want to solve problems, but perhaps the best understanding we could ever reach is that most health problems are caused by losing a game of percentages; more stress than stress management skills, consistent interference within the body’s internal communication network (like putting a dimmer switch on innate functional capacity) minus the tools to eliminate the distortion, and a lifestyle described as sedentary instead of physically active exemplify how abnormal begins to overtake normal, making poor health an inevitability, the end result primarily of a long-term process of degradation rather than the by-product of bad luck or otherwise.  To win the game of percentages, we have to put in the necessary effort; and victory is but a drastic mindset shift away.

Health is not something that can be manufactured; like wealth, it must be earned and continually maintained.  Prevention of sickness alludes to well-being, the maintenance of which – in accordance with a broader definition of health inclusive of the various aforementioned foundational pieces (function, structural balance, nutrition, stress management, and exercise) – signifies a state of wellness strong enough to dramatically reduce the need for treatment protocols. 

In order to adopt a more preventative approach, we would need to put the responsibility for health back in the hands of the people, whose own roles have been preposterously marginalized; part of the process to achieve that cultural shift would involve teaching people that they can and should trust that their bodies will adapt and react as designed if given the support required to do so optimally.  When a baby is born, the phrase “it’s a miracle” is often expressed – and it is indeed miraculous – but the miracle of life continues until we expire and we have far more control over our health during the time in between the beginning and end than has been let on during the medicalization of healthcare over the past forty some odd years. 

Interesting, is it not, that the gold standard for contemporary preventative care mirrors a process that routinely takes place every single day of our lives, that being exposure to traces of microscopic foreign invaders that engage our immune systems into action, building immunity to a plethora of bacteria and viruses.  Basic sciences, biology and physiology specifically, teach that the strength of the immune system, a reflection of health, determines both the degree of exposure and the ability to eradicate invaders.  However, generations of people now believe that laboratory science is more important to immunity than the very immune system that, by comparative ratio of elephant to ant, constantly eliminates disease without artificial assistance. 

By no means, though, does advocating for a preventative model to take the reins of healthcare suggest that treatments are not necessary or that innovations like stem-cell therapy should not still be a major part of the system at large, but the pendulum has currently swung about as far toward the treatment-based model as it can and nothing is likely to change about the state of American healthcare until the pendulum swings significantly in the direction of prevention. 

If we took Franklin’s quote literally – if an ounce of prevention was worth exactly a pound of cure – then we would stand to save over $20 trillion were we to dramatically revamp our healthcare system and focus it on prevention.  So, with that in mind, let the debate resume...

Thinking good things for you, as always,

-Dr. Chad

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