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Healthcare vs. Disease Management


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In a recent post, The Myth of Evidence Based Medicine, I explained that conventional medicine is based not on evidence, but on profit.

So how’s this working out for us?

The U.S. spends far more than any other country in the world on healthcare – a whopping $2 trillion per year. 1

Considering this enormous expenditure, we should have the best medicine in the world. We should be reversing disease, preventing disease, and doing minimal harm.

But that’s not what’s happening at all. The U.S. ranks just 34th in the world in life expectancy and 29th for infant mortality. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from bottom) for 16 available health indicators. 2

Even worse, a study published a few years back in JAMA suggested that medical care may be the leading cause of death in the US. (For more on this, read my article The Failure of U.S. Healthcare).

Yes, you read that right. Medical care kills more people than heart disease, strokes or cancer.

How can it be that we spend nearly 16% of our GDP on healthcare, but have one of the worst health care systems in the industrial world?

The answer, in short, is that we don’t have healthcare in the U.S.. We have disease management. And there’s a world of difference between the two:


Wellness care is what we need. Disease management is what we have.

Wellness care would save insurance companies billions of dollars each year. But it would devastate the bottom lines of the pharmaceutical industry.

Wellness care is what I will offer my patients. And it’s the vision I have for what medicine could be here in the U.S. and elsewhere.

I’m just not holding my breath. Until we can lessen the influence of Big Pharma, disease management will rule.

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  1. Park, A. America’s Health Check Up. 11/20/2008. Time Magazine Online.
  2. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998.
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  1. Indeed, “disease managment” is far more apposite than ‘healthcare’. This applies thoughout the Western world (and beyond, but the real profits are to be made in ‘developed’ nations, obviously). Since this IS manifestly the case, it follows that more disease = more profits. Statins are a pharmaceutical manufacturer’s wet-dream – they actually poison people SLOWLY and create more illness, over a period of many years, which creates a demand for MORE “medicines” AKA drugs. But the very fact that the poisoning is so slow and inisiduous, the symptoms resulting from the cellular distruption they cause so diverse, allows a high degree of “plausible deniability” through statistical manipulation by “experts” (paid handsomely to carry out their ‘studies’). Of note was the time one of the biggest of the big Pharmas got it spectactuarly (and horrifically) wrong – Bayer with their own patented statin ‘Baycol’, withdrawn hurredly in 2001 after it was shown to have been killing people (via muscle wastage) in a matter of months after commencement of their prescriptions. Many people might be surprised that they they’ve never heard about this, and the almost complete silence in the MSM – they shouldn’t be.

  2. It is the ‘monkey’ in us that keeps us from being healthy.  We play follow the leader and the leader can’t help himself from putting on a silly hat and thinking he is now god.

    If you want to understand the primal conditions that make this true, the story of Capt. Cook is a good model.  The residents of the Hawaiian Islands had this tradition that a white god would come some day, so when Cook turned up, pink though he may well have been, they worshiped him. 

    He was only too willing to avail himself and his crew of their favours, pigs, yams, sex, labour to repair his ship etc.    However, when the natives discovered his Achilles Heel, that he was just a mortal man, same as themselves, one of them put a spear through him and his god status was sent packing.

    A similar thing happened with midwives, or maternity nurses, or witches, as they evolved to be.  You can see that same monkey-mindedness at work in this case with a multitude of people.

    Now progress that throughout a society to the entire world, and you can see that the monkeys are following the Dr. WHO (World Health Organisation) which is run by other monkeys with cute hats (flat tops and tassles), and when sufficient of the public wake up to their frailties the spears will come out again.

    Now just who is responsible for all that is rather difficult to determine, but after Cooks death, there was not much more story to record.   After the witch trials, we simply switched to male leaders, and after the next purge there will be only a few tribal customs survive (if that even, if nuclear war breaks out).

    So I blame the guy who invented monkeys.   He must have wanted it this way.  Or was he a she?  Or was IT an insect?

    What is here now is for us to sort out and few there be who want to walk the narrow pathway.   When those who want the easy life are gone, we will start all over again: Hopoefully!

    But old age and treachery will beat youth and innocence every time!



  3. In your post you say:

    “Considering this enormous expenditure, we should have the best medicine in the world. We should be reversing disease, preventing disease, and doing minimal harm.”

    You didn’t say:
    “Considering this enormous expenditure, we must have the unhealthiest lifestyles on the planet.”

    “Considering this enormous expenditure, there must be something contaminating our water supply that’s making us all sick.”

    etc, etc..

    The fact that you conclude that higher costs should lead to healthier population and means we have “one of the worst healthcare systems in the world” reflects a bias in your interpretation of this data.  You could be right, but there are multiple alternative hypotheses that could account for the statistics.  You focus on one and then use it to support your argument.  (incidentally, it’s this kind of sloppy logic and biased data analysis that is the very reason the nutrition experts wrongly advocate a “low fat, high carb” diet!) 

    And you say:
    “It’s disingenuous to use smoking and substance abuse as examples.  Everyone knows those activities are harmful.  But what about diet?”

    That’s my point!  Everbody knows smoking is bad – and millions still smoke!  And they’ll get sick, and cost the health care system billions of dollars.  Our problem is not education, it’s compliance.  The people who are involved enough in their own health to come to a wellness doctor, care about preventitive health, follow the recommendations of their doctor, etc. are by and large not the ones who are getting sick from lifestyle related illnesses.  A 20 year old chain smoker who has been raised in poverty and a steady diet of processed junk isn’t poring over epidemiological studies on the internet trying to figure out proper macronutrient ratios.  The ones are that involved in their health are not the ones driving up costs.

    Also, most of the countries that beat us in overall health make the same dietary recommendations that US docs do, prescribe the exact same medications, etc.  That patient you mention with the high blood glucose will be given the same meds, the same diet guidelines in Sweden as they would here in the US.  Yet the Swedes are much healthier.  But our health cares system is “one of the worst in the world”, and theirs one of the best??

  4. You must not have read my reply.  Once again, I’m not “pointing the arrow of causation in one direction”.  I clearly said that the fault is shared amongst patients, healthcare providers, insurance companies, drug companies (and I would add legislators).

    Nor did I say the whole point of the healthcare system is to keep people from getting sick. I’m not sure where you’re coming up with this stuff.  I said that when people do get sick, as in the case of the diabetic person I mentioned above, they should get a treatment that is backed by the latest evidence and that actually helps – not harms – them.

    I also disagree strenuously that healthcare providers don’t have a responsibility to help their patients stay healthy.  The idea that they should just wait until people get sick and then treat them is shortsighted and one of the primary reasons our healthcare (or rather, disease-care) system is so inefficient, expensive and ineffective.

    Countless studies have shown the value and cost-effectiveness of preventative medicine. It’s a complete no-brainer.

    Your viewpoint is privileged.  It assumes that all people have the same access to resources, education and time and the same ability to discern good from bad information.  I know plenty of highly intelligent people that are very motivated to live a healthy lifestyle.  They do their own research, but there’s so much contradictory information out there they look to some.

    It’s disingenuous to use smoking and substance abuse as examples.  Everyone knows those activities are harmful.  But what about diet?  For decades we were told that eating a low-fat, high-carb diet was “healthy” and that a diet high in saturated fat and cholesterol caused heart disease.  Now research clearly shows that low-fat, high-carb diets contribute to cardiovascular disease, obesity and metabolic syndrome (among other things), and that saturated fat and cholesterol don’t cause heart disease.  Most people – even well-educated, “health-conscious” people still aren’t aware of this.  Why?  Because our healthcare system is hopelessly in the grip of drug companies that have a vested interest in selling people drugs – regardless of whether they’re beneficial or not.

    I could go on, but I have a feeling there’s not much point.  We’ll just have to agree to disagree.

  5. If everybody in our country stopped smoking today, we’d have the healthiest country on the planet in 5 to 10 years, and costs would plummet.  Should we then pat ourselves on the back and say what a marvelous health care system we have?  

    My point is that to look at our health care costs and point the arrow of causation in one direction is misleading.  You could hypothesize that one potential cause of our poor health despite high costs is that our health care delivery systems are worse, just as you could hypothesize that there’s an as yet unrecognized environmental toxin we’ve all been exposed to, or that we’re the laziest population on the planet. etc.  To rail against our health care system because of these statistics is just hand waving propaganda.  There are lots of problems with our health care system, and we need to have honest discussions about how to fix them.

    And I disagree entirely that the whole purpose of the healthcare system is to keep people from getting sick.  The system is there to take care of me if I have a massive heart attack, or Dengue fever, or Guillain Barre syndrome.  Preventing lifestyle related illness is our responsibility.  If you reach adulthood not knowing that smoking, substance abuse, a diet based on processed foods, sedentary behavior, etc. are going to make you sick, then that’s fault of our culture and our educational system.  And I’d contend that the vast majority of the population know these things, but choose to act differently.  And I would hypothesize that that’s why we’re so sick.

  6. Chris,

    Why do you automatically blame our health care system for our problems?  Our health care system is there to provide care when we’re sick .  And the US populaion is sick because it doesn’t take care of itself.  And smoking, lack of exercise, poor nutrition, etc. are the causes of a population that’s sick.  Sick people need more medical care – hence higher health care expenses.

    Everybody knows what they should be doing to be healthy – I don’t need a “wellness doctor” to tell me these things.  That’s ridiculous – this is 2010 for crying out loud!  A doctor can tell a patient 30 times to stop smoking, give them every tool at their disposal, and yet they continue to smoke and get lung cancer.  By your logic this is the fault of the doctor?  WTF?!!

    • Settle down, Bob. Where did I say I blame the health care system exclusively for our problems? Obviously I believe people need to take responsibility for their own health. That’s the entire purpose of this blog. But that doesn’t mean drug companies, insurance companies and health care providers don’t have a moral and ethical obligation to provide a high standard of care to patients. The failure of our system isn’t all the fault of the individual. There are plenty of sick people trying to get the care they need but aren’t able to. Imagine someone with blood sugar problems that goes to the doctor. They’ll get put on drugs and told to follow a low-fat, high carb diet. That is the fault of the healthcare system, not the patient. Not all patients have the education, inclination or confidence to find their own solutions. That’s the whole purpose of having a healthcare system in the first place, rather than just letting everyone do it themselves.