Wow, from the responses to my last blog, it seems like healthcare is second only to religion in inciting active debate!  One of you even told me to save the commentary and stick to practicing medicine!

Thanks to all who contributed to the conversation.

Some said I didn't value Michaels Moore's attempt to highlight the problems with our health care system.  And some may have misinterpreted my criticism of a country and an economy that thrives like a parasite on the sickness and obesity of it citizens as a cynical call to profit from helping people create health.

What really I believe is that there should be an economy of products and services (healthy food, activities, etc.) that promote rather than destroy health.

So let me clarify.

I applaud Michael Moore for opening the debate on health care.  And I do believe that you can assess the nature of a society by how it cares for the young, the sick and the elderly (all of which we fail at miserably in America), and I do believe that health care should be a right of citizenship, not a privilege of the wealthy.

And the solution may even be a single payer system (though that is certainly only one of a number of possible options).

But my main beef with Michael Moore is that he MISSES the chance to question the very foundation of how we practice medicine - from symptom-based disease oriented care to systems based care based on the true causes of disease.

Let me explain more now...

You don't build a new house on a rotten foundation. 

So why would we create a new way of paying for healthcare, when the very healthcare we are paying for is the WRONG type of care?

Last week I reviewed Michael Moore's new movie "Sicko" and explained why we need to look at the bigger ecosystem of people, companies, and government involved in healthcare and get everybody's incentives aligned. 

Today, I'd like to delve further into this issue.

We have to all profit from our citizens becoming healthy.

When we have four health insurance lobbyists for every congressperson, or have a CEO of a health insurance company paid $1.8 billion a year, there is something seriously wrong with incentives.

Now, when I researched how much our government does spend on healthcare, I realized that they are the single biggest payer for healthcare.  So we almost already have a government-run system. 

What's the difference?

Bureaucracy and administration consume nearly a third of healthcare expenditures in the US, whereas Canada's single payer system has only 1 percent administrative overhead.

This does not include indirect costs such as agricultural and food industry policies and subsidies and tax deductions that encourage corporations to promote disease and not health.

But the silver lining in this startling fact offers hope.  

If government leaders can leverage that financial burden into wholesale disruptive innovations that produce quality and value, then we might have a chance.

We cannot afford a patchwork quilt of minor tweaks and adjustments aimed at reducing symptoms but not curing our seriously diseased and broken system.

Political candidates speak of containing healthcare costs; shifting costs between payers, employers, and patients; reducing errors; implementing software solutions; and improving efficiency.

But these many only help temporarily relieve the pressure on the system -- ignoring the real issues.

Something else about healthcare needs to change.

The RIGHT question is: How do we adopt a MAJOR shift in our scientific approach to illness from reductionism (treating symptoms and diseases) to systems biology (treating causes and creating health)?

And how do we change the way we deliver that care?

We have to think beyond just the patient in the exam room and his or her doctor simply dispensing prescriptions for diseases and symptoms.  We have to include in that room all the potential influences on health.

Just as we ask, "What is the real cost to society of cigarette smoking?" we should ask, "What are the real, long-term costs of a nation of overfed and undernourished citizens with total access to goods and services that have been clearly shown to create disease and increase costs?"

How do we address the fact that it is hard to find health-promoting foods, activities, products, and services in America?

What is the true cost in lost dollars, productivity, health, and well-being from a large serving of trans fat-soaked French fries or a 48-oz soda consumed three times a week for a decade or more?

What is the cost of cities and communities designed around cars rather than human beings?

What is the impact on our bodies of decreased fitness and progressive muscle loss that results from our car- and computer-addicted population and that is linked to every known degenerative disease?

That's a lot of questions -- and there's no one quick answer.

There is just no magic pill to cure our diseased healthcare ecosystem.

There are opportunities, challenges, and obstacles that must be overcome to move from our ordinary thinking about change toward extraordinary thinking -- out of which a new, thriving sustainable ecosystem of healthcare can emerge and function.

Now let's take a deeper look at the beliefs and assumptions that control the way medicine is practiced.

The latest high ground of doctors is the demand for evidence-based medicine -- that is, only doing things that have been proven in research. 

But even that is a problem because many practices in medicine are handed down through lore and apprenticeship. More than half of our treatments have never been subject to the standards of research we want.

We ask for randomized controlled trials as the gold standard methodology to tell us whether a treatment is good or bad.  But looking at one drug for one disease while ignoring all the other factors that affect health falls short in assessing real people with multiple chronic complex conditions.

The Institute of Medicine's 2001 report on the lack of quality in our healthcare system describes in detail our limited capacity and dismal failure to translate and incorporate rapid advances in medical thinking and science into clinical practice that would lead to improved quality and value.

It also highlights the current well-documented rampant overuse of ineffective treatments, under-use of proven therapies, and misuse of existing practices.

What was not addressed directly but only hinted at was the need for reinventing healthcare based on emerging principles of systems biology, functional medicine, health promotion, and prevention.

THAT is the answer to the disturbing lack of quality in our healthcare system.

It is what I write and speak about.  Get to the root of the problems, to the causes in individuals and in society -- and then we have a chance.

Conventional medical thinking and care is organized into separate scientific or clinical silos (known as specialties).

These become less useful as we understand the real and common causes, mechanisms, imbalances and networks of how dysfunction leads to illness.

Our methods of research and standards of evidence-based medicine must be reexamined. They have serious limitations, and should not held up as the gold standard for medical decision-making.

Let's look at the real people who walk into a doctor's office -- not the statistics in a study!

So many doctors use one drug for only one disease, when the average patient has three or chronic problems. In fact, 12 percent of Americans older than age 65 take 10 medications and 23 percent take at least five medications.

And the top sellers are all medications used to treat lifestyle diseases, like statins, acid blockers, antidepressants, and blood pressure drugs.

Disease occurs in clusters because there are common interlocking mechanisms at the root of all disease -- The 7 Keys to UltraWellness I've talked about before. 

==>  But medicine ignores this obvious fact.

Research and treatment methods are designed for single diseases and ignore the complex biological web of functional disturbances that give rise to that problem. This type of care presumes that clinical medicine is a pure science, which it is not.

We have to use different ways of looking at chronic disease.  We have to adopt new ways of thinking about how all the problems and symptoms a patient has are connected.

We need to think of helping people within a whole ecosystem of healthcare, not just the one-on-one, 8-minute office visit. 

We need to use healthcare teams and group education on lifestyle, nutrition, exercise, and stress reduction to help people deal with the causes of their problems.

We need to change research by getting funding for what might work best, not what might make a company the most money. We currently embrace the latest drug or procedure without really looking at how it compares to the old drugs or an integrated lifestyle solution.

We need to rethink the use of placebos (fake pills) as the comparison group for new treatments.  We should see how treatments compare to complete lifestyle and systems approaches, including diet, exercise, stress reduction, and cognitive therapies.

When drugs have been compared to these approaches, the drugs usually do worse!

It took 264 years from the discovery that lemon juice could prevent scurvy until the British navy adopted a prevention policy. We don't want to have to wait that long to take advantage of new scientific discoveries.

Innovations in medicine (and in general) are slow to be adopted, especially if they are as complex as systems biology and medicine. (9)

Even in the context of reductionist medicine, the spread of innovations is dangerously slow.

Only 1 in 5 elderly patients with myocardial infarction receives current accepted standards of care to prevent recurrence. (10)

The fact that 45 percent of patients do not receive recommended care measured with 439 indicators of quality of care for 30 different health conditions and prevention should be cause for alarm and a self-critical analysis of the reasons for this failure. (11)

So what are we to do?

I find myself practically and literally at the interface of all the changes in medicine over the last half century.

This has been a subject of great interest to me as I have moved through various roles in my life.

These include family and emergency room doctor, practitioner of systems and functional medicine, chronically ill patient, advocate for sick parents and children, business owner and payer for employee healthcare, professional and consumer educator, interpreter, and synthesizer of health information, researcher, practice manager, and electronic health record purchaser and user.

The main question we face today is:  How can we find a way to reinvent healthcare practices to accommodate the changes in science, the advance of information technology, and the shift toward patient-directed and patient-centered healthcare?

How do we match the changing content of science to a reengineered healthcare delivery system at all levels within the system? 

In other words, how can we change the type of practice and the way it is practiced?

These questions are the real questions we need to be asking.  They are essential to our collective survival and renewal in a desperately outdated, flawed, expensive, and misaligned healthcare system.

These questions and concerns form only the starting point for conversation and debate.

We should take as our guiding principle the need to change from ordinary to extraordinary thinking.

We all need to look very carefully at how our current thinking leads to actions and results that may not reflect our common unspoken goal -- to create a sustainable healthcare system and society so that our children and their children can thrive for generations to come. 

Please let me know your thoughts and ideas on how we might change things.

And forward this blog and last week's to your congressmen and senators and to the political candidates who are seeking solutions to our healthcare problem.

There is another way -- but we all have to work together, and we have to demand something different.

Now I'd like to hear from you...

Do you think I should save the commentary and stick to practicing medicine?

Do you have any personal stories of how our healthcare system is broken?

Do you think that our healthcare system is broken?

What ideas do you have for fixing it?

Do you believe that these changes can occur?

Please click on the Add a Comment button below to share your thoughts.

To your good health,

Mark Hyman, M.D.

==> http://www.ultrawellness.com/blog

REFERENCES

1. Porter ME, Teisberg EO. How physicians can change the future of healthcare. JAMA. 2007;297(10):1103-1011.

2. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.

3. Herbert MR. Autism: A brain disorder, or a disorder that affects the brain? Clinical Neuropsychiatry. 2005;2(6):354-379.

4. Holman H. Chronic disease-the need for a new clinical education. JAMA. 2004;292(9):1057-1059.

5. Williams R. Biochemical Individuality. New York: John Wiley and Sons; 1956.

6. Daubenmier JJ, Weidner G, Sumner MD, et al. The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program. Ann Behav Med. 2007;33(1):57-68.

7. Jenkins DJ, Kendall CW, Marchie A, et al. Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr. 2005;81(2):380-387. yyy

8. Rogers EM. Diffusion of Innovations. 5th ed. Northampton, Mass: Free Press; 2003.

9. Berwick DM. Disseminating innovations in healthcare. JAMA. 2003;289(15):1969-1975.

10. Soumerai SB, McLaughlin TJ, Gurwitz JH, et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA. 1998;279(17):1358-1363.

11. McGlynn EA, Asch SM, Adams J, et al. The quality of healthcare delivered to adults in the United States. N Engl J Med. 2003;348(26):2635-2645.

12. Herrick D. Why employer-based health insurance is unraveling. Consumer Driven Health Care web site. November 01, 2005. Available at: http://cdhc.ncpa.org/commentaries/why-employer-based-health-insurance-is-unraveling. Accessed June 5, 2007.