Healthcare vs. Disease Management | Chris Kresser

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.

  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.
  1. Thanks, Christian, for the response.

    You are correct, of course, but you must be considerably younger, bolder, more hopeful and empowered than I, as I am pretty switched off from trying to save the masses in great handfuls. 

    The story goes that Jesus tried that two thousand years ago, and to this day, not even his most devout followers seem to understand his message.  I trust that is not true for his namesakes like yourself.

    Saving ourselves may yet prove to be our greatest contribution to the race, to the collective, and to the masses.

    My experience has led me to believe that the human mind is one of the most impenetrable barriers in existence.  It seems to have been engineered by the great creative force itself to resist all but that lovely music from the pipes of Pan.



  2. John, corporations are made up of people, don’t forget that.
    Corporations, consumers, and shareholders, are in the game together. There is no pied piper -there is only us (the people).
    People are also responsible for the type of government that they get. Americans have wanted an increasingly fascist, more paternalistic, more controlling state, and they got it.
    I agree with the rest of your comment. We who dissent have to teach the others while also saving ourselves. It’s going to be a fight of epic proportions.
    The new USDA guidelines show that the gloves are coming off as far as the thugs are concerned. The implicit message is “We don’t care about the facts and neither should you. Eat our corn, soy, and wheat, or else… ”

  3. I hear you, Christian, but isn’t that a bit like saying the kids were at fault and so the pied piper should be forgiven.
    I like Cindy Black’s posting.  That change of attitude and the daily and constant vigilance is what it will take to turn the culture around painlessly.  Without it, the culture will be self eliminating.  The latter is more likely to be the outcome.

    The real challenge will be to save ourselves as individuals, whatever our station or situation.



  4. Re profits as a cause of the problem:
    I don’t think that the profit motive is the problem. One of the essential features of life itself is to take in more than what’s taken out. Same goes for an individual making a living, or a corporation attempting to provide value back to its investors by making products that people want to buy.
    The problem in the area of healthcare is that the corporate interest isn’t aligned with what’s health promoting for its customers. However this is not an inherent effect of profit-seeking, which is only natural, proper, and moral.
    The core reason for today’s problems is that the American public, out of ignorance, intellectual confusion, and distracted by other priorities, have not demanded anything better than disease-management from the medical profession and industry.
    For most of the 20th century Americans in general have wanted to do whatever they feel like to their bodies (including eating junk that no one else in the world would even consider food) and then pop a few pills to fix problems as they come up.
    They got exactly what they wanted. And this with the same precision and efficiency as they get iPods and flat screen televisions provided by extremely productive corporations.
    Furthermore, the medical profession has out of ignorance of basic proper medical principles (such as the necessity of a holistic approach) been applying a reckless engineering approach to the practice of medicine. Not only dubious pharmaceuticals have played a role here. At root, it’s the entire philosophy of trying to fix things in the body as if it were a machine.
    The situation is made vastly worse by the the government attempting to regulate alternative medicine out of business to the advantage of big pharma, and by attempting to make the practice of medicine exclusive to those who have been trained according to conventional, deeply flawed methods.
    What needs to happen is a grassroots revolution among Americans such that the people begin to demand proper wellness care.
    Let’s continue educating people!

  5. I appreciate the call to health care, and the stumbling blocks to it that you have pointed out so well in this post.  I would add that in addition to providers making this change in attitude, consumers also need to work on changing their approach to health, medicine and wellness.
    I have been immersed in holistic health as both a provider and a consumer for 20 years- and I still need to remind myself to pay attention to what is right, to wellness, harmony and ease.  I think those of us raised in the midst of the disease management mindset need to pay particular attention to how we are thinking everyday in order to be a part of the change you are calling for.

  6. Interesting. Direct-to-consumer drug advertising does seem useless and counter-productive and possibly harmful. What countries would you rank as being closest to practicing “wellness care?”

  7. Other industrialized countries aren’t necessarily practicing “wellness care”, as I defined it.  But they tend to be a bit less drug crazy and a bit more open to other methods of care.  For example, herbal medicine is often prescribed by MDs in Europe.  The US and New Zealand are the only two countries in the world that allow direct-to-consumer drug advertising, and that makes a huge difference.

  8. So do other countries that rank better in health care and infant mortality (like Sweden and Iceland) practice evidence-based medicine and the “wellness care” side of that table? How do they do things differently in those places?

  9. Thank you for all the wonderful info you provide on the Healthy Skeptic Blog.  I have shared the videos and certain articles with many of my family members and friends.  May your readership grow a hundred fold.  Keep up the great work!

  10. Tom,

    Where did I say wellness care happens in other countries?

    Big Pharms’s influence is indeed global, and many other industrialized countries have the same problems we do.  We just have more of them.

  11. I agree that I’d like to get what we pay for. But it’s too facile to use this recent report to claim by implication that the other countries studied do “wellness care” better than the US. Big Pharma operates in other countries. Medical literature and conventional wisdom travels around the world. Where is the evidence that these other countries do wellness care significantly better, *and* that this leads to better outcomes and longer life expectancies?

    From what I know (not that much!), the other countries have better access to medical care for more people, better and cheaper medical records, in some cases non-profit medical insurance, and so forth. IOW, lower administrative costs, more effective and efficient records, and more widespread access to care seem to be the big differences.

    If anyone has good information that wellness care is being done better in the studied countries and that it is effective, well, quick, let us know – that would be great news!

  12. @James: I think Chris, like most of us, would like it to be the case that we are getting what we’re paying for. 

  13. I agree with the thrust of your article, but one needs to exercise care when comparing health across countries.  There are three great examples of how this can be problematic:

    Life expectancy:  The US has a very high rate of auto-related deaths, since we all drive everywhere. This lowers life expectancy, but has nothing to do with the health-care system.

    Infant Mortality: The US counts infant deaths more rigorously than a lot of European countries do, which makes us look worse and them look better.  If we count a death, and they don’t count it at all, it makes our life expectancy worse, and our infant mortality worse, while not actually reflecting relative quality of care.

    Survival rates:  The US has the best cancer-survival rates in the world, which reflects that our health-care system is pretty good at treating you once you get sick, it just doesn’t do well at keeping you healthy.

    Keep up the good work, and make sure you pass those boards! 😉

  14. We don’t even have disease management. We have a system in which the food, pharma and medical industry are optimizing their profits. First they breed patients by feeding unhealthy food. After this they sell these patients the drugs and medical “care” to keep them sick but alive. When the patient is worn out, a last expensive surgery, chemotherapy or hospitalization will be “given” before he is allowed to go to the happy hunting grounds. The strange thing is that almost nobody seems to be aware. Humans are lead to the slaughtering-table more easily than lambs.