Evidence based medicine vs preventive care...
The type of medicine we have today is called Allopathic medicine or sometimes referred to as "evidence based medicine" or EBM. The basic approach is to diagnose illness and treat it with medication. There is minimal intent towards prevention or eliminate the true cause(s) of the illness. EBM has been around for about 50 years as part of Allopathic medicine system and supported greatly by Big Pharma. EBM sounds good - "It is the conscientious, explicit and judicious use of best evidence in making the decisions about the care of individual patients." What is missing is - the process that is used and rigor of approach. Do we look at root cause and eliminate it or do we look at nutrition as an key form of prevention? No, to both as EBM is focused on treatment of disease using medicine aka drugs to improve the condition using very strict protocols. EBM has certainly not improved our health care outcomes by any measure in the last 30 years. Doctors are very limited in what they can do to help solve health problems for people. EBM is term used primarily for pharmaceutical trials and results.
Doctors are trained to treat illness but do not cure or work on preventing illness. In a way, our system is a "sick care" system. As a result, the design of the current health care system to treat versus cure disease, we have ended up with more chronic illness than ever before and spend more money than other countries. As Americans, we are enamored with high tech and spend lavishly on the "latest and greatest" equipment regardless of whether the new device has been tested to be better than the existing device. Even with drugs, we assume if it is new it is better than the generic and therefore we need the new drug. Sometimes new drugs come out like "the purple pill" ( Nexium) which is a reformulation of the older and now generic Prilosec. The current health care system is flawed in that it makes no attempt to stop disease in its tracks and is focused on profits vs customer care.
According to the CDC most of the chronic diseases we have today are preventable.
The CDC claims that chronic diseases and conditions like heart disease, stroke , obesity, diabetes type 2, arthritis, Alzheimer's and high blood pressure are preventable. There are several cancers like lung cancer, melanoma prostate and breast cancer that can be prevented. Also according to the CDC 70% of all deaths are chronic disease and 85% of all our health care costs are associated with preventable diseases. Lets review some of the diseases an conditions that are preventable. These diseases below constitute most of our deaths and most of our health costs, all disease below are expected to increase versus decrease.
1. Heart disease, the #1 killer of Americans is preventable and the prevalence of heart disease in the last15 years is increasing. Stroke is also preventable, now the #5 killer since it has been passed by Alzheimer's.
2. Alzheimer's disease (AD) is preventable . It has increased 100X in the last 30 years and is now the #4 killer of Americans just behind "death by healthcare". One half of Americans over 85 have Alzheimer's today and that percentage will increase. This disease is not caused by aging. The Mayo clinic website states AD is caused by lifestyle and environmental factors. Japan and other major nations have a 4-10X lower death rate from AD than we do. It is the most costly of all diseases and is not caused by genetic changes.
3. Type 2 diabetes or Adult onset diabetes is preventable. This disease has increased 4X in the last 30 years. The average age of diagnosis is now 37 and dropping. Diabetes is the leading cause of kidney failure and linked to heart disease as well.
4. Obesity has increased 3x in the last 20 years. Almost eighty percent of obese people end up getting type 2 diabetes and heart disease. This disease is preventable by lifestyle changes like diet changes and exercise. Over 67% of all Americans are either overweight or obese.
5. Arthritis is the most crippling of all diseases and is preventable by lifestyle changes. The CDC claims 54 million people have arthritis today. This disease ends up with expensive knee or hip replacement surgeries.
6. Lung cancer and melanoma are cancers that are preventable Lung cancer is cause by 3 things. Eighty percent of lung cancer is caused by smoking. The remaining 20 % is caused by Radon and asbestos both of which are environmental issues that can be prevented.
7. High blood pressure is a condition that is preventable as well. Almost 67% of all seniors have high blood pressure. That number could be higher since some people do not even know if they have hypertension. In other countries like France, Japan, UK, and Canada the deaths from hypertension for high blood pressure are 2-4 X lower.
8. Breast and prostate cancer are mostly preventable according to the CDC as well. By exercising more we reduce our breast cancer risk by over 25%. Both types of cancer appear to caused by environmental, poor diet/nutrition and lack of exercise. In Japan and India, the breast and prostate cancer death rate is less than half of the USA according to the WHO. Note the impact of Vitamin D3 on breast cancer in last post.
So given the above facts, why isn't prevention being applied?
1. Doctors are not trained in nutrition and prevention techniques to help their patients.
2. We (patients) want quick solutions to problems and drugs appear to be a fast way to resolving symptoms. We also rely on our doctors to solve our problems. We are too dependent on their care and do not know the doctors can not help us get healthy.
3. Drug companies don't want people using prevention because it would have large impact on their bottom line since prevention requires nutrition and other means to eliminate the cause(s). Prevention would reduce the need for drugs, hospital surgeries etc.
4. Our government agencies like the FDA ,medical associations like the AMA are not supportive of more nutritious foods and supplements. It does not fit in the "envelope" of EBM. The FDA does not allow the use of supplements to be used for the prevention of disease even though studies can show they prevent, slow down or reverse a disease! The FDA is not a scientifically based and impartial organization that makes decisions based on data. It is linked to Big Pharma and the medical organizations who do not want change.
5. We don't know enough about prevention ourselves and are confused by advertisements and government policies that have been harmed our health more than helped. So there are many reasons why prevention through nutrition and supplementation have not played out.
The most important reasons for the dilemma is we have no incentives for prevention and it is hard to change our diet and people perceive it might cost more money. Fundamentally, we do what we do because what is done to us. This means independent of whether we were capable to prevent disease we don't personally have the interest or will to do it. The consequences of bad health are decades away for a 20 or 30 year old person. They are in the prime of their life, feel good and like their lifestyle and diet. The idea of eating healthy, avoiding toxins and exercising more just doesn't cut it with them because if they do not see negative consequences right away. For younger people, it is all about immediate satisfaction and the negative consequences 10 years down the road - they just don't care. Unless the financial burden is high enough. What the 20/30 years olds don't know is plaque is already starting to build up in their arteries.
Edison quote in 1902. "The doctor of the future will give no medicine, but will educate this patients in the care of the human frame, in diet and in the cause and prevention of disease."
Edison was on target over 100 years ago, but our health care community is no closer to a desired future than they were 100 years ago. But there is hope, prevention does start with you and you can decide to change your approach to leading a healthier and better life.
It starts with the need to change, then accountability, then knowledge, skill and will.