Why Our Health Matters: A Vision of Medicine That Can Transform Our Future
Andrew Weil, MD. New York: Hudson Street Press, 2009. ISBN 97 8-1-59463-066-8
Direct, assertive, bold. Confronting the nature of our dying health care “non-system”, Dr. Andrew Weil approaches problems and solutions like an expert doctor dealing with an emergency resuscitation.
In Chapter 1, he starts by demythologizing some dysfunctional beliefs about health care in the US. Myth #1:
Because America has the most expensive health care system in the word, it must have the best. Indeed, we rate on a scale of health care outcomes as #37 in the world, on a par with Serbia. Myth #2:
Our medical technology is our greatest asset. In fact such technology is very useful but is often misused, over-prescribed, and not only is overly expensive but frequently leads to worse health outcomes. Myth #3:
Our medical schools and research facilities excel at creating the finest physicians and most productive medical investigators. However, our extensive infrastructure omits large areas of education and research that focus on healthy lifestyles practices and wellbeing. Researchers are trained to think in a logical and reductionist method with strong emphasis on pharmaceutical drugs.
Chapter 2 presents convincing data that deconstructs these myths accounting for why our health system functions so poorly at such high costs. While acknowledging the strengths of US health care, Weil laments the tragedy of so much done at such high cost with such poor health outcomes. He points out the cost of technology and the folly of continuing to train more specialists for management of chronic disease. This is the current biomedical curricular culture which underemphasizes training in areas such basic, primary prevention and health promotion. We also essentially ignore the body’s ability to heal itself, focusing rather on ‘fixing the machine when it is broken.’ The research enterprise meanwhile, though highly productive, is also highly beholden to industry support from pharmaceutical companies and other corporate interests. This creates inherent conflicts of interests that are highly concerning.
Dr. Weil does not leave us just with a diagnosis but in despair. In Part Two, “Where We Need to Be,” he offers us a hopeful future with treatment for the dire prognosis for our health care system. In Chapter 3 he names three toxic trends we need to reverse. Trend #1:
Deterioration of medical practice and philosophy--the darkside of technology including undermining the spirit of self reliance and faith in our bodies’ ability to heal themselves as well as escalating costs. I would add it has “dummied down” the history and physical exam process for medical students, residents, and practicing physicians with the naïve assumption that all diagnoses can be made technologically. Such beliefs also fuel the medicolegal monster of defensive medicine, e.g. ‘If only Dr. A had ordered a scan earlier, the condition could have been detected in a treatable stage…..etc.’ Trend #2:
Failure to provide health care for all--enough said. Trend #3:
The growing influence of money--or how health care has become a profit-driven business at the expense of patient care.
Solutions for reversing these trends are in Chapter 4 include: 1) The need for low tech, high touch medicine, 2) Making good health care available to all, and 3) Making medicine and insurance affordable.
As our nation engages in intense discussion on how to solve these problems, Weil establishes a basic premise with which I completely concur. We are not addressing the upstream costs of health care, with low tech, high touch approaches. We have not yet created a society that incentivizes production of affordable, healthy food, encourages exercise, de-glamorizes tobacco, junk food, and alcohol, nor a society that actively encourages healthy choices as a challenge to these cultural patterns. However, we have made some steps in this direction such a banning smoking in many public places and stocking school vending machines with more nutritious choices.
Americans resist a “nanny-state” where any such measures are imposed or forced through top-down legislative or other political pressures. Instead the author offers practical suggestions on entirely rethinking how we train the doctors of the future. He also encourages that we engage society at large with positive health promotion. As we did with reducing tobacco usage, this can be done socially, legally, medically, but above all educationally. An educated and health-literate population is a stronger position to make healthier choices without coercion or unpopular governmentally imposed mandates and rules. This is the only way we can reduce escalating costs from such chronic diseases as obesity, diabetes, coronary artery disease, cancer.
In Part III, Weil details plans on “How to Get There.” In this section, the author is pragmatic, realistic, and uncompromising in his approach. Reducing medical costs cannot be solved by legislative fiat. Corporate entities cannot be expected to give up their profitable stakes in the health care economy easily. But these changes must occur for our health care system to survive.
Prevention, health promotion, and risk reduction through lifestyle change must take place at all levels, the individual, family, community, workplace, and nationally. This can happen by stopping incentives to agricultural practices that only encourage production of cheap but unhealthy foods and make healthier foods less affordable in comparison.
It is essential to create built environments in our communities so walking and cycling are encouraged as forms of exercise and commuting. Making more smoke-free public spaces and taking on the obesity epidemic head on are all components of a healthier future for ourselves, our children, and our grandchildren.
New preventive measures based on the principles of integrative medicine can help support an educated public to be motivated for such changes. Insurance policies must align with prevention and risk reduction rather than paying primarily for treatments, drugs, and testing.
The Centers for Disease Control should support such health and healing incentives with at least 20% of its budget. We also ought to create a Institute for Health and Healing at the NIH that can create a greater awareness of the body’s capacity to heal and how to further this. Health coaching and education oriented spa vacations would be covered by insurance to help give people the tools, resources, motivation, and skills to make healthy lifestyle choices.
Again, these changes require a higher degree of health literacy in our society along with social will. This literacy must be promoted in schools, businesses, social, and governmental agendas.
Ultimately, we must change the conversation about health care reform from saving a failing system that demonstrably doesn’t work. Mitigating the influence of pharmaceutical, insurance companies, and medical specialty societies is essential. We must expand the pool of primary care providers through changing education and reimbursement. These measures are necessary if we wish get ahead of the curve of the chronic disease care that is becoming exponentially unsustainable.
Overall, this is a book of common sense and hope. It both indentifies problems and solutions. Integrative medicine is central to the shaping of the future of health and health care for our nation. Weil encourages consumers and health care professionals to take responsibility not only for their own well being but for society’s though personal choices, involvement in legislative action, community change processes, and more. Dr. Weil offers us a change model not only that we can believe in, but live with. He also points out the dire consequences of not making such changes.
I strongly recommend this book for all audiences, the general public, health professionals, academics, and especially for public servants, legislators, and policy makers. We are a long way from done with health reform no matter what bills Congress passes. To put into action such suggestions as contained in this book will truly revolutionize the landscape and quality of American health care while reducing its inefficiencies and high costs. We cannot afford to do less if we are to preserve our wellbeing, and vitality as individuals and as a nation.
Victor Sierpina, M.D.