Category Archives: Health Care Reform

What can we do to fix our health care?

The Streetlight Effect on Chronic Disease Prevention

 Once upon a time scientific thinking was a virtue…

But science as currently conceived  can also be like the tale of drunkard’s search also called the streetlight effect.

“Researchers tend to look for answers where the looking is good, rather than where the answers are likely to be hiding. (David H. Freedman, 2010)”

 Clearly it is not just science that can get stuck, but society as a whole, as the gap between scientific pursuits and their impact on societal progress  widens.  Could it be that as the gap between the rich and poor increases, so does the gap between what scientists are working on and what is truly beneficial for the common person?

The Streetlight Effect on Science

We have been ingrained with the virtues of science over the past few hundred years to the extent that many believe it can even supplant religion as the ultimate venue for seeking truth.

However, in spite of its many achievements, it’s becoming clear that science too is often like the emperor without clothing when practiced within our current economic framework.  In this framework, most scientists require funding in order to sustain themselves and their research.  Thus if the sources of funding are constrained by the wealth gap, and the motivation for research is to develop profitable products (i.e. marketable drugs and marketable behavioral interventions), we end up with a streetlight effect upon scientists that can limit the scope of the solutions they find (i.e. profitable solutions vs better but unprofitable solutions) .

Profitable vs Unprofitable Solutions to Problems

You may ask, “How can an unprofitable solution be good?”  It is all a matter of perspective.  For example, if I design a drug that a person with Alzheimer’s can take for life to reduce symptoms, I have a very profitable business.  I can patent the drug and people have to buy it from me.  There are barriers to keep people from getting the drug elsewhere or making it themselves at home.  However, if I work very hard to invent a behavioral intervention (i.e.  a lifestyle or multimodal stategy or perhaps a cognitively stimulating music / dance program) that completely prevents Alzheimer’s, and people can learn it on their own at home, I will be destined for the poor house.  Sure it is a better solution, but who in their right mind will work on it?  Who will spend good money on clinical trials and marketing for a superior but unprofitable product?

This is a huge dilemma for our society!

Unprofitable solutions are often the best for society as a whole but scientists may never seek them because of the streetlight effect.

Consider that the cost for the multi-center Diabetes Prevention Program (DPP) clinical trials has been estimated at $200 million over 10 years. This study showed that lifestyle intervention in the form of a 1 year program  consisting of 26 weekly sessions (20 sessions within the first 6 months and 6 sessions in the following 6 months) covering nutrition, weight loss, physical fitness and behavior modification was more effective than the drug Metformin, or the standard of care, for preventing pre-diabetics from becoming diabetics within 10 years.

Although it would seem that the results speak for themselves with 58% reduction in the incidence of diabetes ( up to 70% reduction for people over 60),  the justification for the DPP intervention comes not from the dramatic improvement in quality of life of the participants, but rather from demonstrated fact that insurers paying for the DPP can save on costs given the expenses associated with diabetes.

The effort to introduce prevention efforts for diabetes has been a very expensive 20 year battle that is still on going.  So where does that leave the future of prevention efforts for other chronic diseases such as heart disease, cancer, lower respiratory diseases, stroke, and Alzheimer’s?

Chronic Disease Prevention

Most people already accept that our economic system and it’s search for profitable solutions will result in the creation of environments where chronic diseases that could have been easily prevented flourish.  In this framework, things that exist in abundance become worthless. For example the air that we breathe is vital for healthy living but as of yet has little economic worth because of its abundance.

In the YouTube video, “Pay for the Air you Breathe,” the advertising agency Leavingstone in Tbilisi, Georgia  delivered the following message:  “If  we don’t care about the air we breathe, sooner or later we’ll have to pay for it.” 

What can we do to speed up the process of adopting prevention strategies as the gold standard for world health?

One thing seems certain,  we cannot afford to keep waiting for the scientific process trapped by the streetlight effect and  enormous costs / delays of RCT trials  to provide definitive answers.  Clearly health science is at a disadvantage when risk factors such as possible carcinogens, pollutants, pesticides, household chemicals, food additives, sources of stress, electromagnetic field exposure and sedentary work policies can be introduced into our environment at a much higher rate than the many years of RCTs that are needed to show definitive cause and effect.

These are some of our options:

  1. Become your own health detective.
  2. Become an expert on your own individual health.
  3. Find ways to unite with chronic disease prevention and health promotion advocates worldwide.
  4. Find ways to unite with world-wide economic change advocates.
  5. Vote for people who understand the importance of the above perspective for the future of world health.

As a health detective you will learn to monitor your health and environment more closely to detect symptoms earlier and effect environmental and lifestyle changes needed to correct problems before medical intervention becomes necessary.  The key strategy is development of personal agency (the ability to initiate actions that improve ones personal outcomes).

As an expert on your own individual health your doctor becomes your ally rather than your savior.  You are in a better position to keep yourself healthy than the doctor.  Of course the doctor is an essential part of restoring health if you are sick, but you must be the driver of your health.

There is strength in numbers and we must find more ways to unite with the specific goal of chronic disease prevention and health promotion at the community, national and world level.  The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is a good place to begin the search for group involvement but must be greatly expanded upon in the years to come.  There are many groups already promoting multimodal chronic disease prevention strategies such as Sharp Again Naturally,  NEWSTART, AARP Global Council on Brain Health, etc.

Finally the elephant in the room must be addressed.  Human beings created our economic system and human beings can improve it. Sure it has been forged through suffering, sweat, tears and sacrifice throughout history largely through social structures based upon predatory-prey type relationships. But personal agency is our greatest asset and we must prevent our predatory-prey instincts from destroying the world and ourselves in the process.   Wealth inequality, slavery in the form of monetized debt and a profit driven economy that turns human beings into commodities are the greatest drivers of the world’s health problems.  The world needs a new vision of the future that includes health as the cornerstone.

Let’s begin building that vision.

Breathing In Breathing Out

Breathing is something we take for granted.
Breathing is something we often take for granted but is deeply connected to a healthy mind, body and spirit. Photo by vickiayala @ www.morguefile.com

Thích Nhất Hạnh is a Vietnamese Budhist Monk who became 90 years old this past October.  In his book, “you are here,” Nhất teaches that there is a very profound power in the act of breathing, and that breathing meditation can bring us back into the present moment in a way that is powerfully healing.  He argues that our brains have complicated our lives so much that we have lost sight of how easy it is for a person to have complete happiness and joy. He emphasizes that human beings create heaven and hell within themselves and that heaven is reachable in this life for everyone through simple breathing meditation.

I have found his approach very helpful in my own life and have begun applying it to my marriage as well for improving communication.   It begins with these simple words:

Breathing in,  I know I am breathing in.

Breathing out, I know I am breathing out.

These simple words hold the keys to a profound transformation and evolution of human thought and consciousness.  I have often wondered how society could transition from one of engineered scarcity in which individuals battle one another in fierce competition over artificially constrained resources, to a society in which everyone is wealthy and successful.

For example, consider an apple orchard in which every tree has access to water, sunlight and enough soil to anchor its roots.  These trees could be considered wealthy and successful.  But what does it take for a human being to be considered wealthy and successful?  Many people conjure up images of palaces, servants, expensive toys and thousands of adoring fans.  But Nhất has uncovered something surprising.  These ideas of wealth and success are all illusions.  True wealth and success begin with the freedom to breathe mindfully, and this is available to everyone right in the present moment!

Do you get what this means?  We have been led to think that we are sentenced to toil and hard labor as we seek to earn scarce moments of happiness.  But the reality is that we can have complete joy and happiness in the present moment at any time simply by practicing the beauty of breathing meditation.

 What makes breathing so special

The power of mindful breathing meditation is that it opens the doors to our true nature of miraculous inter-being in the moment.  Once we are drawn to a deep awareness of the present we can more fully appreciate that all things are present through each other and not separately.   For example, if I am eating an apple during breathing meditation , I become aware that the sun is in the apple as are the clouds that watered the orchard and the soil that nurtured the tree.  We are not isolated beings but rather inter-beings!  This becomes a deep realization through breathing meditation.

Think of it, all along we only needed to learn to breath to be successful and wealthy.   Sort of how Dorothy always had the power to go home in the Wizard of Oz but had to find this out for herself after an arduous journey.  This underscores how the important things in life are not taught to us in school.  I find it amazing that I had never heard of Thich Nhat Hanh until recently when the book, “you are here,”  was discussed on an online LinkedIn group named Universal Quest.  

Breathing is also special because it lies on the boundary between voluntary and involuntary movement.  Breathing can be controlled automatically without conscious intervention, or consciously.  This allows it to  play an important role in connecting our mind and bodies harmoniously.  Thus during breathing meditation the goal is not to control our breathing but rather to allow the body to control breathing. During this meditation the mind focuses on simple pairs of thoughts such as deep and slow, calmness and ease, the present moment and its wonder. The links below provide some first hand information on breathing meditation.  The word ‘sangha’ mentioned in the links below refers to any group of breathing meditation practitioners that meet to support each other.  Enjoy!

Interview with Oprah Winfrey

Discussion of the Dharma-Body (Dharmakāya)
and the practice of mindful breathing.

Health’s Big Picture

health_svklimkin
Who defines health as “a state of complete physical, mental and social well-being?” Photo by svklimkin on morguefile.com

The World Health Organization’s (WHO) definition of health has not changed since 1948 when the organization was first created.  The organization demonstrated a futuristic vision by defining health as follows:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The beauty of this definition is that it captures the holistic human being as composed of body, mind and spirit, where the spirit is accurately reflected by the social dimension of being.  The WHO definition of health was (and is) futuristic because our health system is traditionally based on the biomedical model which views health much more narrowly as simply the absence of disease or infirmity.  In the old perspective an unhealthy person is viewed as a broken machine that needs to be fixed, and the physician is viewed simply as a mechanic.  The mechanic is concerned with how to fix (i.e. cure) the problem rather than worrying much about how it could be prevented.

In the old biomedical model of health individual behavior,  social structures, culture and environment are assumed to be fixed and the only thing amenable to change is the individual’s biology and biochemistry.  An extreme example of this form of health care is the Army doctor who treats combat casualties.  It is assumed that combat is an essential aspect of the world and therefore preventing war is not perceived as an important goal of the health care system.

In 1977 George Engel’s biopsychosocial (BPS) model of health began ousting the strongly entrenched biomedical model of health and disease.   This model promotes WHO’s definition of health and holds the health care team responsible for evaluating the social, and environmental, psychological and physical causes of disease or infirmity.  However, as a society we have a long way to go before the BPS model and WHO’s definition of health can reach its full potential.

The Biopsychosocial Model of Health

If we work with the BPS model we can find root causes of illness and disease that are not simply limited to biology.  For example, in the US up to 80% of chronic diseases such as diabetes, heart disease and stroke are preventable with lifestyle, behavior and environmental modification strategies.  Because the biomedical model is failing us when it comes to chronic diseases, our government is finally coming around to implementing the BPS approach to health care.

In March of 2016 the Diabetes Prevention Program (DPP) became the first prevention service model ever to become certified for expansion by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.  On January 1, 2018 the DPP is scheduled to begin benefiting more medicare beneficiaries.  The DPP consists of a coached 1 year program that helps people with pre-diabetes cut their risk of developing diabetes by 58% over a 5 year period through modest weight loss coupled with physical activity of 150 minutes per week.

This monumental transition from treatment of diabetes to prevention of diabetes has taken over 25 years of accumulated research that can be traced at least as far back as the 6-year Malmö feasibility study in Sweden that was published in 1991.   Twenty five years later, and following the Diabetes Prevention Programs multicenter clinical research study published in 2002, the US government has come to the conclusion that it can save money by helping people prevent chronic disease rather waiting for them to get sick and then having to pay for many years of treatment .  This positive transition in perspective may begin to fundamentally alter the future of health care in America and the world.

Is It Really all about Money?

In a poem by James Brown (pen name James J. Lachard) God says that what surprises him most about humankind is:

“That they lose their health to make money and then lose their money to restore their health.”

It never ceases to amaze me that of all earth’s species only humans are dependent on money in order to retain health!  No other animal needs it.   Does that make us smarter or in a way dumber than other animals?  Our brilliance seems to lie in harnessing the complexity of the brain to create more and more barriers in the path of success (and health) for a large portion of the population. Consider that in 2014 the number of US deaths from suicide totalled 42,773 (ranked number 10 overall) and that suicide was the second highest cause of death for ages 10-34.  These statistics bear down directly on the social aspect of health in the biopsychosocial model.

Unfortunately for man (and woman) it truly appears that our oversized cerebral cortex when compared to other mammals has been misappropriated to the task of obfuscation.  That is, our ‘smartness’ has been turned against us through centuries of manipulation by the few to control and harness the power of the many.  The sad result is thwarted social evolution even as technological knowledge and sophistication continues to increase.  This intelligent obfuscation  means that humans are often worse off than other animals with far less cognitive ability.

When seen in the proper context  it becomes evident that in the BPS model the biggest health challenges arise in the social sphere, because society has been structured to induce loss of health on many levels in order to promote the wealth of the few at the expense of the health of the many.

The Health of the Many Traded into Wealth for a Few

Any factor that reduces the spendable income of Americans ultimately takes a toll on health, especially when it affects food quality choices (i.e. organic vs non-organic, processed food vs fresh food), fitness choices (gym memberships and available time for fitness activities) or family time.  Thus excess income inequality, taxes, insurance costs, and interest payment costs  create a burden that decreases the holistic health of society.

Take for example how our society entraps college students today. The total student debt has been estimated at 1.3 trillion dollars and in 2016 two-thirds of graduate students owed an average of $35,000 each.  Debt needs to be called out as form of slavery!  We like to think of ourselves as a free country,  but yet we sell our children into the slavery of debt, and in fact the country as a whole is sold into slavery through the national debt.

The BPS model of health gives us a framework for making decisions to change social structures. such as a monetary system based on debt, that inhibit health as defined by WHO.

The Future of Health (Big Picture)

The earth and its biosphere can be viewed as a seed in the relatively lifeless environment of space.  Like a seed the earth contains in abundance all of the ingredients for life to develop to a certain extent, after which sustenance must be derived from outside of the seed.  In a like manner, the sun which powers our biosphere is a middle-aged yellow-dwarf star that is 4.6 billion years into its main sequence of life.   In as little as, 1 billion years we can expect the increase of solar output to begin causing serious challenges to life on earth.  This may seem like a long time but there are many technological barriers that must be overcome before life can expand from the earth-seed to other solar systems. In his 2015 State of the Union Address President Barrack Obama stated,

“I want Americans … Pushing out into the solar system not just to visit, but to stay.”

In order for our earth-seed to be successful, optimum health will be required of all of its human and non-human inhabitants.  By this I mean health according to the WHO definition: “…a state of complete physical, mental and social well-being.”  

From the biopsychosocial model we can see that this will require a complete overhaul of social structures throughout the world.  Social structures that are depleting and restricting our human potential must be replaced with new health-oriented structures such as debt-free societies.  Then the power of 7 billion human brains can truly be harnessed and applied to the future of the earth-seed.

Live long and prosper!

astronaut_salutes_nimoy_from_orbit
Live long and prosper! By NASA Astronaut, Terry W. Virts (nasa.gov, archived link.) [Public domain], via Wikimedia Commons

 

 

 

 

Huggly For Health

The idea for the  Huggly Formulation came during the night seven days ago.   After working on the question of scarcity and abundance in natural economies during the previous day, my altered state of sleep hit upon a solution in the form of The Huggly Formulation.

The Huggly Formulation for Abundant Health

Alaska visit
Group hug! By English: U.S. Air Force Staff Sgt. D. Myles Cullen [Public domain1], via Wikimedia Commons
In natural economies (such as the human body made up of trillions of individual cells) the fruit of production (i.e health) exists in abundance when the following five principles interact:

  • Harmonious orchestration of 7 fundamental virtues (i.e. Compassion, Faith, Truth, Justice, Security, Abundance and Joy).  This harmonious orchestration of virtues is the essence of Love.
  • Generation, preservation and celebration of diversity – continuous creation is the is the object of health.
  •  Invisible abundance supports visible abundance – natural abundance and health exist on many scales.  For example there are 100 billion neurons in the brain,  100 billion stars in the Milky Way galaxy, and 100 billion galaxies in the universe.
  • The “whole” is always greater than the “sum of the parts”
  • Each individual voice must be heard and each individual must be free.
Why “Huggly”

Other than the fact that it was recommended in a dream, the word huggly is used because it merges three other words – hug, snuggle and ugly.    The analogy is that a hug or snuggle are positive outcomes if the timing, duration and intensity are properly orchestrated.  If the hug is too intense or the timing and duration incorrect, things can turn ugly.  The same is true for all virtues relating to health.  They must be properly orchestrated to maximize positive outcomes, and prevent negative excess or scarcity.  For example:

  1. Faith without Truth is bankrupt – if you invest in a vision of the future that cannot come to fruition then your investment is lost.
  2. Compassion without Justice is incomplete – true compassion seeks correction and healing.
  3.  Security or Abundance without Joy is empty – the intangible joy is what makes life worthwhile.
  4. Joy without Compassion could be considered cruel.
800px-Rope-03235
Strands twisted into rope. By Nevit Dilmen – GNU Free Documentation License

Like a rope with 7 strands, the 7 virtues need to be twisted together, hugging each other tightly in a septuple balanced helix for maximum health.  This spiral analogy keeps all the virtues in check, and represents the Huggly Formulation.

The Orchestration of a Healthy Memory

In a wonderful example of the role of orchestration on health published by CNN this week, Dr. Dale Bredesen, Director of the Mary S. Easton Center for Alzheimer’s Disease Research at UCLA, was able to reverse the symptoms of Alzheimer’s in 9 out of 10 patients that participated in his pilot study.

Dr. Bredesen used a protocol that targets 36 sources of deficiency, imbalance and inflammation that  contribute to Alzheimer’s and Dementia.  According to the CNN article, “Bredesen said that most of the study participants had between 10 and 24 problems that needed correcting.”  The article goes on to state that,

“The effect of focusing on so many targets at once runs counter to what Bredesen said is a prevailing — and flawed — notion of identifying single targets to treat a disease caused by many factors.”

This exciting research brings hope to many who are suffering from dementia, and points to a new development in medicine whereby early Alzheimer’s may be treated by personalized health matrices that include

  1. Low glycemic, low grain, anti-inflamatory diets
  2. 30 to 60 minutes of exercise 4 to 6 days per week
  3. 12 hours a day of fasting between dinner and breakfast and at least 3 hours between dinner and bedtime
  4. Prebiotics to nourish good GI bacteria and probiotics to replenish healthy bacteria
  5. Stress reduction through yoga, meditation or music
  6. 8 hours of sleep per night and the possible use of melatonin and tryptophan
  7. Brain stimulation through the use of interactive software from companies such Posit Science.
  8. Chelation for heavy metal toxicity
  9. Ensure nocturnal oxygenation and treat sleep apnea
  10. Hormone supplements if needed to improve hormone balance
  11. Other supplements such a vitamin D3, K2 (see the full protocol in Table 1 of this link)

Although the specific protocol used by Dr. Bredesen should only be used under a doctor’s supervision, we can see that many elements of the protocol point to the importance of understanding how to properly orchestrate a balanced and virtuous lifestyle.

The Huggly Formulation provides a high level template that may serve as a scaffold  for designing and understanding complete lifestyle orchestration for maximum health.

Stay tuned for future posts on The Huggly Formulation.

Don’t forget to stay huggly, and have a merry Christmas!

A New Kind of Old

Does your doctor prescribe medications for your symptoms after 5 to 10 minutes of face time?

lossy-page1-303px-Prescription_medication_being_dispensed_tiff
What is the proper role of medications in health? By CDC [Public domain], via Wikimedia Commons
If so your doctor may be under the gun to see more patients and to increase productivity.  Does your doctor  resort mostly to medications for treating your health problems?   Chances are that this approach to health care will take you down a slow spiral to perpetual chronic illness.

However, a new kind of medical practice may be on the horizon.  In the 2012 documentary “Escape Fire”, Dr.  Erin Martin described how she left conventional medicine after facing an onslaught of patients that she was never given enough time to truly help.

Reimbursement in the conventional setting was strictly based on the numbers of patients treated and was not tied to how successful the treatment was.  This meant that patients were part of a revolving door system where they kept coming back for the same or related problems because the root cause of their problems were never dealt with.

According to her recent blog post, Dr.  Martin left her conventional practice in 2011 and completed a 2 year fellowship in Integrative Medicine with Andrew Weil.  She followed this with a 2 year program in functional medicine.   Now she has a practice in Hood River, OR named TrueMed Institute that she claims allows her to provide true healing to her patients.

Integrative medicine combines medical traditions such as conventional medicine, Chinese Medicine, Acupuncture, Naturopathy, Ayurvedic Medicine, Homeopathy, and Functional Medicine, just to name a few.  As described on Dr. Martin’s website:

“Functional medicine looks to get to the “root cause” of illness, looking “upstream” to consider the complex web of interactions in one’s history, physiology, and lifestyle that can lead to illness.”

This “root cause” approach is also at the heart of the OnTierraHealth Technology’s quest for health.   And we believe that in many cases the root cause will be traceable back to the non-organic methods that are being used in the conventional farming that expose us to too many pesticides, and herbicides.

This means that if we truly value our health we will need to carefully track both  the manner in which our food is grown, and the origin of the seeds (GMO’s may be implicated in cancer according to the documentary film GMO OMG).

The Harvard Pilgrim Healthcare Foundation / New Haven Farms Initiative now has 7 organic farms in New Haven, CT that are used to provide free 20 week educational courses to patients that are dealing with chronic illnesses such as type II diabetes and arthritis. These organic farming courses are intended to increase the health consciousness of the community and to empower individuals to play a greater role in improving their own health.

So it seems that our “new kind of medicine” is very likely to take us full circle,  to a time when people knew exactly where their food was grown, by whom and from which seeds.  Once again we will take the words of Hippocrates to heart, “Let food be thy medicine and medicine by thy food.”

One thing is for sure, there will be exciting times ahead for modern-day health detectives who are interested in tracking health to its roots!  Now may be the time for each of us to learn more about integrative medicine and growing our own healthy organic foods.

Revolutionary Thinking for the Future of Health Care

In a new post on the thehealthcareblog.com author John Haughom, MD states “There is an urgent need for clinicians to step up, lead the debate and design a new future for health care. ”  I agree with his analysis that, “health problems related to lifestyle, such as obesity, smoking, substance abuse and diabetes will not be solved by more hospitals but rather through access to primary care physicians, innovations in public health, and lessons from the emerging discipline of behavioral modification.”

In particular I like the emphasis on “the emerging discipline of behavior modification”.   However, this behavior modification must be applied not only to patients, but to doctors as well in order for a true revolution in health care to begin to blossom.  In this day and age doctors still often see themselves as only knowing how to treat disease, and often feel there is not much they can do to help the patient improve their health unless they are already sick.

This state of affairs comes back to the financial incentive model of medical care.   Will it be possible to create a model of health care in which doctors can profit from assisting “healthy” people to become healthier.

Just as every variable also has a derivative (i.e. rate of change), the same is so with our health.  The individual health index and health derivative should be calculated and we should determine if we are healthy and getting healthier or healthy and getting sicker.   It is important to know our health derivative before the doctor actually detects a treatable sickness if at all possible.  We need a truly revolutionary model for the future of health care that places the physician in forefront of improving health, while of course retaining their position at the forefront of treating disease.   But will doctors be able to morph into this new role?   What do you think?

The Big Elephant in the Health Care Room

The United States is facing a health care crisis, due to a model of healthcare (i.e. disease-care) that rewards doctors mostly when people are sick.   Because of this structure, we find that less effort is placed on prevention of disease then one would expect given the direct consequences that lifestyle and environment have on health.

As the baby boomer generation also experiences becoming the sandwich generation, we have become distraught at how ineffective the current medical establishment has become at dealing with chronic illnesses that are to a large degree lifestyle and environmentally triggered.

Would Americans be better served by a healthcare model in which the health insurance sector is merged with the medical sector such that doctors can be paid bonuses when their patients remain healthy or improve their health instead of having salaries that increase as the population gets sicker?

I will refer to this as the Health Margin Model of healthcare since the idea is that doctors should be rewarded for how much they can improve the health of their clients before they actually become patients.

What do you think?