{"id":163,"date":"2015-01-17T14:29:42","date_gmt":"2015-01-17T21:29:42","guid":{"rendered":"http:\/\/www.fetzers.org\/?page_id=163"},"modified":"2015-01-17T14:29:42","modified_gmt":"2015-01-17T21:29:42","slug":"approach-to-health-care","status":"publish","type":"page","link":"https:\/\/www.fetzers.org\/?page_id=163","title":{"rendered":"Approach to Health Care"},"content":{"rendered":"

From Daily Beast<\/a><\/p>\n

\n

GOOD MEDICINE<\/h3>\n
06.12.14<\/span><\/div>\n

Clinton Doc: This Is How We\u2019ll Fix Health Care<\/h1>\n<\/header>\n
Americans are sicker and taking more pills than ever, and our doctors are miserable. But not all is lost. Here\u2019s how we can fix it.<\/div>\n
If you happen to walk onto a medical ward and see a dead-eyed nursing assistant shoveling spoonfuls of pills into an elderly patient\u2019s dry mouth, you might begin to get an idea of what\u2019s wrong with our medical system. It\u2019s a sight so commonplace that one young nurse turned to me recently and said, \u201cI feel like they\u2019re kept alive just to shove pills into them.\u201d<\/p>\n

But it\u2019s not just the elderly. We\u2019re all shoveling pills alarming rate. While Americans make up 5 percent of the population, we consume 75 percent of the world\u2019s pharmaceuticals,\u00a0The Daily Beast<\/a><\/i>\u00a0recently reported, and 7 out of 10 of us take\u00a0prescription medicines<\/a>. We take more pills than other industrialized countries, and yet we have\u00a0worse health outcomes<\/a>. With an approach like this, many people predict that health reform will fail simply because this medical model is so broken\u2014expanding it will do nothing but explode the cost of care.<\/p>\n

A lot of patients are fed up with being plied with pharmaceuticals and are turning to alternative practitioners. But many conventional doctors are also fed up and are jumping on the \u201calt med\u201d bandwagon. Unfortunately, a lot of alternative medicine is indeed deeply unscientific, and deserves to be treated with skepticism.\u00a0But there is a little known group of doctors who are taking a \u201cfunctional\u201d approach to the patient\u2014by using basic science to seek out and correct the root cause of disease.<\/p>\n

This kind of approach could revolutionize the way we treat some of the most common medical problems\u2014and save money in the process. Take, for example, irritable bowel syndrome (IBS), a condition that affects some\u00a015 percent of Americans<\/a>. Instead of initiating the usual protocol of trying a series of medicines, functional practitioners would look for food triggers first.\u00a0It seems logical, but shockingly this is not the standard-of-care. While much of the reasoning behind this \u201cfunctional\u201d medicine is sound, critics malign it as\u00a0\u201dQuackademic medicine\u201d<\/a>.<\/p>\n

Mark Hyman, MD, best-selling author, and current chair of the\u00a0Institute of Functional Medicine<\/a>, sees it as anything but quackery. \u201cThe outcomes in Functional Medicine are much more dramatic and much faster than conventional treatments, like days to weeks, and [it] gets to the root cause\u2014it doesn\u2019t just suppress symptoms,\u201d Dr. Hyman,\u00a0who also consults Bill and Hillary Clinton<\/a>, told\u00a0The Daily Beast<\/i>. \u201cThat\u2019s what we\u2019re proving for inflammatory bowel disease, migraines, asthma, and things like autoimmune disease, gut issues, type 2 diabetes\u2014all reverse very quickly\u2026 [for example], normal glucose in three days, whole body psoriasis gone in three weeks. Those results just don\u2019t happen with drugs.\u201d<\/p>\n

Dr. Marcia Angell, after seeing the influence pharmaceutical money had on science during her two decades as the editor of the\u00a0New England Journal of Medicine<\/i>\u00a0concluded<\/a>, \u201cIt is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.\u201d\u00a0 She\u2019s not the only respected establishment voice sounding the alarm. Dr. John Ioannides concluded much the same thing, as was highlighted in\u00a0The Atlantic<\/i>\u00a0article \u201cL<\/a><\/a>ies, Damn Lies and Medical Science.\u201d Even the casual observer has to be aware of the pharmaceutical scandals involving recalls of pills like\u00a0Vioxx.<\/a><\/p>\n

Now, preventive protocols\u2014like mammograms, colonoscopies, and Prostate-Specific Antigen tests\u2014are being questioned. (And that\u2019s the stuff we are supposed to be doing right!) But for years, many independent-minded doctors have been calling preventive protocols \u201cdisease mongering,\u201d claiming the medical system has been doing little more than\u00a0beating the bushes for business<\/a>. Suffice it to say that many dedicated doctors feel there\u2019s enough evidence that our entire approach is not only expensive but also corrupt\u2014and we shouldn\u2019t be expanding it, we should be dismantling it.<\/p>\n

Of course, there will be formidable opposition from our own medical leadership who won\u2019t be likely to reverse themselves on the protocols they\u2019ve created. How can they? They call the guidelines they set in place \u201cevidence based medicine\u201d (EBM), even though, as we\u2019ve seen in many cases, the evidence is pretty thin\u2014and possibly even fraudulent. But it\u2019s a brilliant strategy for controlling not just how practicing physicians think, but also what they do and say. After all, what doctor is willing to speak out against \u201cevidence\u201d?<\/p>\n

Yet at its heart, all science begins with careful observation. You could say that science should begin in the exam room\u2014not end there\u2014because no one has a more vested interest in the patient getting well than a clinician and the patient.\u00a0It was, after all, in the offices of Dr. Barry Marshall\u2014an obscure Australian Internist who was desperate to understand why his stomach ulcer patients were failing to respond to conventional therapy\u2014that the ulcer-causing bacterium\u00a0H. pylori<\/i>\u00a0was discovered<\/a>.<\/p>\n

Marshall single-handedly reset our understanding of how ulcers are created, and won a Nobel Prize for his efforts. But now that it\u2019s been decided that the only acceptable medical evidence comes out of a boardroom, observations and patients\u2019 experiences are condemned as anecdote, and reasonable working theories dismissed as \u201cwoo.\u201d<\/p>\n

This has had an exceptionally negative effect on the practice of medicine and is particularly hard on our patients, who don\u2019t feel listened to. It\u2019s all exacerbated, of course, by the increasingly short doctor visit. Indeed, it was the embrace of evidence-based dogma that facilitated the creation of the 10-minute encounter. Why not? If we think we already know everything that is knowable, it shouldn\u2019t take more than 10 minutes to deal with anyone.<\/p>\n

Good science will always be relevant to the practice of medicine, but we\u2019ve found we can\u2019t trust \u201cthe science,\u201d we can\u2019t even trust the experts. The healing arts will be advanced not by the big science of pharmaceutical companies, but by the \u201clittle science\u201d of the exam room\u2014and through accepting that the patient will always be part mystery\u2014beautiful and complicated\u2014that a good physician will be alert and responsive to. It\u2019s precisely this \u201clittle science\u201d of the patient encounter that Dr. Hyman wants to capture. Today, he is working with the Cleveland Clinic to develop a Functional Medicine Institute to demonstrate how well the approach can work.<\/p>\n

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The healing arts will be advanced not by the big science of pharmaceutical companies, but by the \u201clittle science\u201d of the exam room\u2014and through accepting that the patient will always be part mystery<\/div>\n<\/div>\n<\/div>\n<\/blockquote>\n

Critics of Functional Medicine claim that they too are interested in curing, not palliating disease. This may be true for infectious disease and cancer treatment, but it is demonstrably false for disorders like autoimmune disease that are on the upswing\u2014and for which the conventional response is still, \u201cWe don\u2019t know why patients have it.\u201d<\/p>\n

To be sure, Functional Medicine or related fields like Lifestyle Medicine may not have all the answers. But by addressing lifestyle issues first, physicians can help patients implement enduring low-cost fixes\u2014and conventional medical leadership would do well to implement them into their protocols. In an era where we are pouring patients into the system, lowering physician pay, and increasing time pressures, without rethinking our entire approach we will do little to control costs or improve the nation\u2019s health. (And I\u2019m not just saying that to be provocative. Studies have shown that access to traditional care does\u00a0little to improve population health<\/a>.)<\/p>\n

We\u2019ll need to change the kind of medicine we practice to do that, and that will take some doing. Powerful forces\u2014the pharmaceutical industry and an entrenched medical leadership come to mind\u2014will want to keep things exactly as they are, while conveniently blaming individual physicians for the failure of the system they created\u2014and calling anyone who steps out of line a \u201cquack.\u201d<\/p>\n

Even with the backing of the Clintons, Dr. Hyman knows what he\u2019s up against. But, in the face of all that, he thinks he can turn the tide. \u201cIf we can show that we have better outcomes and it\u2019s cheaper to take a functional approach,\u201d Dr. Hyman said, \u201cin the end, the doctors who adopt this model\u2014and their patients\u2014they will be the ones who win.\u201d<\/p>\n<\/section>\n","protected":false},"excerpt":{"rendered":"

From Daily Beast GOOD MEDICINE 06.12.14 Clinton Doc: This Is How We\u2019ll Fix Health Care Americans are sicker and taking more pills than ever, and our doctors are miserable. But not all is lost. Here\u2019s how we can fix it. If you happen to walk onto a medical ward and see a dead-eyed nursing assistant […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-163","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.fetzers.org\/index.php?rest_route=\/wp\/v2\/pages\/163","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fetzers.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.fetzers.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.fetzers.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fetzers.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=163"}],"version-history":[{"count":1,"href":"https:\/\/www.fetzers.org\/index.php?rest_route=\/wp\/v2\/pages\/163\/revisions"}],"predecessor-version":[{"id":164,"href":"https:\/\/www.fetzers.org\/index.php?rest_route=\/wp\/v2\/pages\/163\/revisions\/164"}],"wp:attachment":[{"href":"https:\/\/www.fetzers.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}