You know what the big killers were at the turn of the century? Back in the 1900s, the main plague was infectious disease. The infant mortality was huge (100 in 1000 live births in 1900, and 6-8 women per 1000 died in pregnancy related complications like bleeding and infections well). There were pandemics of disease which wiped out millions and millions of people, the most notable was the 1918-1919 influenza pandemic.
Modern medicine has been very effective at treating infectious disease as a cause of both morbidity and mortality through vaccinations, the development of antibiotics, and also through to the advent of things such as indoor plumbing and water sanitation and general sanitation. As a result, the reduction of infectious disease as a cause of death is one the major reasons we have seven billion people in the world.
But now it seems now we have a new health crisis with chronic disease in this country (and more and more the rest of the world) which I have talked about in the blog before. People are certainly living longer and our lives are certainly much less full of hardship and danger, but there is still a question, as I see it, as to if we, as a society, are living well. Note: there is a difference between being well off and living well.
The rise of obesity, type 2 diabetes, metabolic syndrome, heart disease, and other chronic illnesses such as joint pain/arthritis are skyrocketing. Some people think this is a natural consequence of aging and cannot be avoided. I personally think that it is wrong and that these situations can and must be addressed if for no other reason than the amount of debt is will create without an effective solution. At this point, modern medicine has not adapted to the challenge, as far as I can see, but the question is why? At his point, I believe it has to do with having, essentially, a wrong paradigm. Let me explain.
The current, dominant paradigm of rescue care in modern medicine is very effective when treating something like infectious disease because we know for instance, that the flu is caused by influenza virus and we also know that polio is caused by the polio virus and likewise strep infections are caused by streptococcus and staphylococcus infectious are caused by staphylococcus. Actually, as far as infectious disease goes, we can link the disease to one problem and if we address that problem aggressively, then we will be able to treat it.
For instance, look at our current success with HIV. In 1980, it was a uniformly fatal disease. Today, if you have HIV, you can be treated and expect to live indefinitely with the proper medications. Soon there will probably a vaccine to treat HIV. In addition, prevention measures are more effective because they focus on methods to prevent HIV transmission which are easily definable and easily understood and in most cases, easily enacted.
But chronic diseases like diabetes, specifically type II diabetes, are a different animal, so to speak, and the same logic just cannot be easily applied. Unlike an infectious disease, a disease like type II diabetes has many causative agents that act over time to produce the disease. Though diet is perhaps the most important of these, there are other issues involved which influence diet and the choice of foods heavily. Once again, let me explain this a bit further.
The way I look at the development chronic disease is in terms of sitting on a three-legged stool. If you think of a three-legged stool, the stool will tip over if it doesn’t have one of those legs, and you will not be able to sit on it. Likewise, if the legs are too short, you will not sit comfortably. If the legs are too high, you will not sit comfortably either. The legs have to be balanced at the right height for you to sit comfortably.
In the same way, the maintenance of your health and the prevention of chronic disease depends on three legs as follows:
- Diet and nutrition.
- Stress management.
Let me talk about these a little individually and discuss where modern medicine needs to improve as I see it.
Diet and Nutrition: This is perhaps the most important thing that we can address in order to address chronic disease. What we eat has a lot to do with how healthy we are. I personally have expanded my practice to include this as much as I can and I blog regularly about it. But the sad fact is that modern medicine and modern medical doctors do not learn a lot about nutrition, or do not care a lot about nutrition. Either they consider it a soft science or they simply are not remunerated for it, so there is no incentive to play to be a nutritional guide for patients or to include nutrition teaching in their practice. Nutrition will have to be discussed in the future as they are cornerstone of preventing disease and maintaining health.
Lifestyle. Obviously, we all know that you are not supposed to smoke or drink in excess or engage in harmful and dangerous behaviors. Exercise is also another aspect of lifestyle, but it is not focused on by doctors for some of the same reasons I have mentioned in regards to nutrition. We have a health club industry that is booming in this country. More people belong to health clubs than ever before. But here are a lot of misconceptions about what exercise means and what it does for people. As I see it, there is a deep discord in our society about why we should exercise and why we actually do. Exercise, it seems to me, should be a fun way is to build strength and energy as well as a sense of wellness and optimism in the world rather than a self punishing act that is used to make yourself skinny or muscular so you can look good. Though you can look good with the help of exercise, this is a side benefit, and can’t always be achieved. (I certainly have given up on GI Joe abs a long time ago). If you try to excessively exercise to achieve that look, often you create a level of metabolic stress that is bad for you, makes you hungry, and results in injury and pain.
The main benefit of proper exercise is that your body functions better and it relieves stress as well. Unfortunately, in our society we have a no-pain no-gain mentality and that needs to be addressed On my block, for instance, that are endless joggers (many of them don’t look like they are having any fun if you look at their grimacing faces) and they seem work themselves to the bone thinking that is healthy, when all it does is increases cortisol levels, make you more hungry, and make you burn calories at a much slower pace because all this stress signals your body that you need to slows down your metabolism and conserve energy. Exercise should be fun and something you want to, and if it hurts to do something, you should not feel guilty or that it’s a bad choice quitting and resting or doing something else.
Stress management. Stress management as I‘ve said has a lot to do with exercise but in a greater sense, stress management has everything to do with your relationship with the world—a sense of meaning and belonging at your job and with your family at home. Do you like your job? Are you overworked? Maybe it’s time for you to start looking for a new job or change your habits? We are only here for a short time, so we should not allow ourselves to suffer at a job we simply cannot tolerate. Too many of us do, though forgetting that we are extremely adaptable creatures and thrive on changes as much as we fear it. Humans would not be here for as long as they have, successfully inhabiting all corners of the globe as a result, if they didn’t embrace change at some level.
Likewise, if you have a job that you enjoy that is stressful, then take breaks, takes walks, clear your mind, and engage yourself with things like meditation and yoga– which are important stress relievers– and if you are religious, prayer plays an important part too in this equation. You have an inner life which is important. You should honor it and sanctify it the best way you can.
Also, it is important to focus on your family life, specifically the interactions with the people that you love because if these are disjointed and you are an insular person, you will suffer because of it. We are a social animal, and the reason why we survive and we have done so well as a species is because our ability to cooperate and to be connective. This is important, and we forget this because things like technology or cars and our jobs, etc, etc, isolate us on a daily basis. So turn off the TV, throw away your Blackberry for a while, be unreachable on the cell phone, and spend sometime with your family, just playing, just enjoying time together, reading together, taking a walk together in the forest with no particular place to go.
I think these are the three elements that can be integrated to help prevent disease and maintain a healthy lifestyle.
I think there is also a final element that needs to be addressed, which is a sine qua non that allows you to choose to be in charge of your health and your destiny and that is patient motivation. In the modern medical system that treats the symptoms of diseases, the patient is incentivized to not care about their health. The doctor will take care of it. You take a pill and you get better, but that is a passive way healing. Although it is very important if you have a pneumonia, as we cannot expect you to be actively involved in your care, it is important to note that the same rules can’t and don’t apply when we are talking about preventing and treating chronic disease and maintaining your health.
An active relationship must be developed between the patient and the doctor which needs to be informed and motivated from both ends of the equation to serve each others’ interests, to serve each other as best as possible. It is ultimately symbiotic (doctors benefit as well, I can attest) and promotes an ecology of health.
Bridging this disconnect of treating chronic disease will be one of the great challenges of our health in the next years. It will take a significant paradigm shift and it will not be easy, but it will be vital. We already spent 20% of our gross domestic product on healthcare which in my view, is too much and is a hallmark, not as a healthy society but of a sick and possibly unstable society.
I hope we can promote more dialogue and more efforts to prevent disease and maintain health in the years to come; otherwise, both our health and pocketbooks will suffer in the future.