What does this mean for the average person?  Let’s face it.  Medications are overpriced.  You know it, I know it, we all know it.  Is Niaspan really worth it’s suggested cost of nearly $100 per month…or can you just get a similar effect by taking over-the-counter slow-release niacin for a fraction of the cost?  Or is Lovaza really worth it’s hefty price tag in comparison to over-the-counter fish oil capsules?

Think about it.  The pharmaceutical choices we have for patients are nothing more than drugs categorized into broad “classes” of medications used to treat various disease processes.  For instance, there are at least 4 different statin drugs out on the market to treat your cholesterol.  Why do we even need this many?  Is it because everyone is different, therefore, we should have a variety of drugs in a “class” to choose from in order to “customize” our treatments for individual people?

The answer to that question is an emphatic “NO”.  We all know that in order to survive in the world of free-market capitalism you have to make a profit– a bottom line.  With that in mind, you can see where this is all leading.  One drug is developed as a pioneer of a “new class” of drugs and then other pharmaceutical drug companies add their own molecular side-chain to the basic molecular structure and then patent that molecule and call it “their own”.  Thus, with the rights to that particular molecular structure, they can market it without much competition; that is, until their patent runs out and the molecular structure can then be copied; in essence, making the drug a “generic”.

What happens then?  No significant profit can be made because other chemists and molecular biologists can mass produce the molecule in their own laboratories.  With so many chemists getting in on the mass duplication, competition can now occur from many labs, thus, driving down the cost of the molecule or drug significantly.

Think about it.  With all the “pomp and circumstance” of our major “blockbuster” drugs out there on the market, many of them are not really new or “novel” ideas.  A lot of them are either enantiomers, isomers, Levo- or Dextro- configurations of one another.  In essence, they are “copy-cats” of one another, each with their own chemically distinct and subtle, might I add, differences.

This all leads me to one question.  If we are coming out with only copy-cat drugs of one another, then are the research and development departments of these drug companies actually coming up with “new” ideas?  Indeed, the drug might be marketed under a different name and sold to the public as “new”, but the creative ingenuity isn’t there.  Why don’t research and development departments actually spend money and invest in novel new ideas and new classes of drugs, rather than just adding another drug to an already existing class of medication.  In part, it is because of profit.

Unfortunately, this hurts patients–in their pockets and in terms of their health.  When a patient can’t get a medication because the insurance company won’t cover it, the reason is primarily because of the cost.  If pharmaceutical industry personnel claim their drug is really the “best on the market” then why do they make it nearly impossible for people to get it–i.e. why do they make their consumers go “bankrupt” in the process???

Never made sense to me.  Never will.

People downplay the ability of others to break free from old habits and change.  Let’s admit it, lifestyle changes are easily spoken of, but quite often, hard to initiate.

In this series of posts I will tackle the dilemma of change and the steps in the process that can lead one to successful lifestyle interventions.

“I know I should” is the motto of people willing to change, but not yet quite ready to take that first step.  People in this stage need accurate information and they need KNOWLEDGE!  Of course, this is where we, as physicians, come in.

Unfortunately, it seems as if our training doesn’t equip us with all the right tools to impart such knowledge to our patients.  This is when we have to put our minds to the test and continue to go “outside of the box”.  There is so much more out there to learn than what we think we already know.

Lifestyle modifications are important in the overall success of true health.  In order to combat chronic disease, we must show our patients that living healthily is worth it.  I believe that it starts with, in part, basic nutrition principles. 

Nobody wants to go buy a brand-new $75,000 Mercedes-Benz and immediately start filling the gas tank with sugar, do they?  Unless you don’t care about the investment you’ve just made, anyone who would do such a thing would be considered foolish.

So, then, why would anyone in their right mind go out and destroy themselves by putting junk into their bodies?  Especially, if they were given the knowledge about healthy alternatives.  I know why!  Because it tastes good!  Unfortunately, we have to help our patients overcome this mindset.   They must be taught to start valuing themselves over the tasty (but unhealthy) foodstuffs they are putting into their bodies. 

We can help our patients see that they need to change by promoting the benefits of healthy living.  To be free from diseases before they happen is the ultimate goal of healthy living.  Sure, not everyone will fit into this model.  However, we can at least encourage positive change by instilling the belief that people should alter their attitudes towards healthy living because they are worth it.

If we are ever to help modify this country’s great health care debate, cut soaring health care costs, and climb to the top of the list in effective health care, world-wide, then we need to place a priority on how we define what it means to have health and be healthy.

Remember…the first step in lifestyle change is…”I know I should” and we’ll hear it a lot, especially when it’s too late, unless we refocus people on valuing their health over poor habits from the start.

In college I came just a few credits short of a sociology minor. I remember one of the things I learned in my education was that by observing the choices, attitudes, and mannerisms of people, we can learn about what they value. Oftentimes, one need not even speak a word to convey what they truly value in life. All you had to do was watch people. This was never more true than when for one assignment we were asked to go to the local mall, sit on one of the indoor benches, and just watch people passing by; observing their body language, speech, and overall, mannerisms and actions. You can imagine the things I saw and what it disclosed about someone.

My question is why don’t people value their health more than they actually do? We have over 300 million people living in the United States, and it seems as if we value disease more than we value health. Why is that?

Think about it. According to the CDC National Center for Health Statistics in 2005, heart disease, cancer, stroke, and diabetes all ranked within the top 10 all-cause reasons for death that year, with hypertension coming in at number 13. What does this actually reveal to us as a nation? That we don’t value our health. How can I say such a thing? Here’s why. Of the top 10 leading causes of death in 2005, arguably, 7 of them are actually preventable.

The four causes I mentioned above (heart disease, cancer, stroke, and diabetes) actually accounted for over one half of the all cause mortality that year alone! And guess what? Much of your hard earned health care dollars are spent on treating the symptoms of those diseases every single day. Why is health care so expensive? Is it because we don’t value our own health as we should in the first place?

If four of the top-ten killers of Americans can be prevented, yet we still have over fifty-percent of our population dying from such illnesses, what can be presumed? Any person can see that the majority of us place more value on other things than orienting our lifestyles in such a manner as to prevent those diseases.

How can this situation change? I believe it starts with redefining how we look at “health” care. Start integrative health principles in the form of dietary reform and nutrition, stress reduction, proper rest, and spiritual wellness. I’m not saying there is no place for pharmacologic intervention, because there certainly is, but my overall point is to avoid the need to treat symptoms by preventing them in the first place. This only comes about by initiating change, and although difficult, I believe, we will ultimately have to change because we will be forced to. If the current statistics keep going the way they are trending, despite all our advancements in scientific medicine, then we are headed for a disaster. And, unfortunately, sometimes it takes a catharsis to wake us up and realize that the way we currently are doing things isn’t working.

Prevention and education are the keys to unlocking a revolution in medicine. Sadly, it seems as if it will require a catastrophe for us to actually value them first.

What makes the difference between okay physicians, good physicians, and great physicians? Certainly it can’t be the diplomas or awards hanging on your office wall. Sure, they’re great decorative pieces and add to the flair of your office, especially if you’ve framed them nicely. However, most patients I know, never even once asked me where I went to undergraduate school. I sometimes get a few questions about where I went to medical school, but rarely does that impress or reflect upon the quality of the relationship I have with that person.

This is now the dilemma as we see a push from “relational” medicine to “performance-based” medicine. Most of this change is forced upon us by insurance companies who have largely ruined our relationships with patients by telling us that we must see a certain “quota” of patients per hour, how to bill, and/or how to prescribe medications for our patients (a terribly humiliating and frustrating experience for most educated physicians who have ever had to do a prior-authorization).

Most of the time, we, as physicians, have just accepted our passive role in this macrocosm, because, at the end of the day, we have to make a living somehow. But what is transpiring is rapid movement towards treating numbers rather than patients; treating labs more than the human being. This trend will eventually ruin and dissatisfy most people because they will be diminished to nothing more than just numerical values on a piece of paper.

But what patients want the most is an intelligent relationship with their physician. They want to be able to make a choice in their health. They want to experience a partnership with their physicians. This is why medicine is not only a science, but an art-form. Most physicians today seem to have forgotten about the art of medicine because they are hard-pressed to practice the science of medicine more often; in essence, number games.

Building quality relationships with people allows the leeway to open doors of compliance and change with people. Telling people they will die because they don’t do what you say is “old school”. If you want your patients to make intelligent decisions, empower them to think about the consequences of their decisions on their own. The process of giving people the ability to make decisions regarding their health is only humanistic in approach. The unfortunate thing I see happening is that physician-patient relationships are becoming sacrificed in the name of performance-based medicine. Sure, people will look great on paper, but will they actually be any healthier? Will they actually feel any better just because we drive their cholesterol down with a medication, while they are still obese and suffering from chronic back pain or degenerative arthritis of the knees or hips?

I’m sure we’ll all rest comfortably at night knowing that “at least I did my job today…my patients look great on paper!” The consumeristic and commercialistic mentality that we call health care delivery has got to change. Let’s turn the whole thing around and change the way we care for our patients, who are, after all, no less human than you or I.

Think about this example. In most medical schools, there is no formal instruction on proper nutrition or how it affects our health other than “don’t eat foods high in fat or high in sugar because they’re bad” or “fruits and vegetables are high in fiber and can help lower cholesterol”. However, there are countless hours devoted by professors to the teaching of pharmacology and classification of drugs in the treatment of disease. Is this not backwards thinking? If medical schools place the emphasis on drugs as “the cure” and place a diminutive value on proper nutrition, then what more can be expected from their graduates other than to prescribe medications to treat symptoms?

Why are most people frustrated with the medical system, other than the fact that they have to deal with insurance companies? It’s because as our population continues to age, they are encountering more disease processes, which in turn, are diagnosed by their physicians who prescribe medications as “cures” for their symptoms. But people still don’t feel better or get any better? Why is that the case? Why are so many people seeking out alternative or natural therapies for their health and refusing pharmaceutical drugs and procedures? It’s because they’re never truly healthy. It’s because of the assumption that most physicians make– if they “treat” patients with drugs they think they are “curing” their patients; but they are mistaken! On the contrary, they are just treating symptoms, not the person. How unfortunate and frustrating that must be for people who come to the doctor to help them get better and feel healthier!

What if you could actually prevent the symptoms from occurring in the first place? Sounds idiotic in the present day medical community because much of our medical system and teaching is focused on the secondary or even tertiary model of prevention. What that means is that we deal with the medical conditions that already exist. In some cases, we “eagerly” await for new symptoms or problems to arise so that we can diagnose them and treat the problem, thus making us feel better and justifying our own existence. However, such thinking and strategy to combat disease is backwards in approach if you want a person to be truly healthy.

What we need to do is revamp our current medical model. We need to move from the paradigm of a secondary prevention model to a primary prevention model. In essence, a shift from a disease-based model to a health-based model. We need to place an emphasis on primary prevention and healthy living; educating our patients while they are young and on into adulthood.

What if we didn’t have to suffer from diabetes, heart disease, stroke, cancer, high cholesterol, etc. In fact, if we could teach our patients how to change their lifestyles for the better rather than waiting for them to develop signs and symptoms of such diseases then we could cut back on overall health care costs. We could make people not only feel better, but BE better human beings!

While some can argue that certain illnesses may be inherited, like high cholesterol, etc., I feel that genetics plays only one part in the total equation. While genetics may load the proverbial “gun”, environmental cues and decisions we make can “pull the trigger” of that “gun” and set off a cascade of genetic susceptibility that can make it easier for us to succumb to illness. But what if you never “pulled the trigger” by living healthy from the start (i.e. choosing a healthy diet, exercise, stress reduction techniques, proper rest, etc.)?

This blog is for all of those who truly want to practice and experience the art and science of good medicine; who want to fulfill the ultimate goal of making people healthy again…not just finding disease. Our goal as physicians IS to find health; anyone can find disease.