Looking for a bargain? You won’t find it in health care. Particularly in the United States, where Americans spend more each year, but somehow have less to show for it.
The United States also suffers the highest chronic disease burden, with an obesity rate two times higher than the average in other peer countries. This may explain why Americans saw the highest number of hospitalizations from preventable causes, and the highest rate of avoidable deaths.
Despite spending more, Americans make fewer physician visits. And very few of these visits are spent talking to a doctor face to face. Instead, patients are more likely to utilize expensive, high-tech scans and specialized procedures compared to their other counterparts in other wealthy nations.
The trend is nothing new. The Commonwealth Fund regularly does an analysis comparing the health care systems of various nations, and America’s appalling record has held strong for the past 20 years.
Of course, from the average consumer’s point of view, it might not seem so bad. Because insurance typically covers the cost for most of us, we don’t see the bill—directly.
Another Approach
According to Dr. Andrew Weil, our money could go a lot further if we just gave natural medicine a chance.Weil is best known for his many books and articles discussing subjects such as meditation, an anti-inflammatory diet, and physical exercise as viable paths to optimal health. But he has been an advocate for natural remedies since the very beginning of his long career in medicine.
In the 1960s, Weil earned two degrees from Harvard University, one in medicine and another in botany. Throughout the 1970s and ‘80s, he was on the research staff of the Harvard Botanical Museum, conducting investigations into the medicinal and psychoactive properties of plants.
“The demand for this kind of training and information has steadily grown,” he said.
Natural Approach
Natural medicine has been around forever, and interest in these methods among the public has increased significantly since the 1970s. Since more and more doctors are now gravitating toward this approach, why hasn’t the health care system followed along?Weil mentions several reasons, but he says the biggest obstacle is the powerful vested interests that control the system.
As it now stands, the health care system is built to incentivize drugs and procedures over holistic strategies, such as counseling patients to eat better and adopt healthier habits. This dynamic has a huge influence over how we address health concerns, for both patients and physicians alike.
For a doctor concerned with making a living, the message is clear: It takes a lot less time to prescribe a pill that insurance will cover than it does to discuss health-promoting changes that a patient will have to pay for out of pocket—and may not follow through on.
Patients have also become conditioned toward pill-based solutions. In a world of instant gratification, diet and lifestyle can take weeks or even months to show results. Drugs, meanwhile, often work quickly and demand nothing but that you take it.
An Integrative Approach
Some may hear of a proposal to steer health care toward natural medicine and picture an extreme situation in which people foolishly try to solve serious medical problems with kale and crystals. However, the integrative approach Weil advocates emphasizes something much more balanced.This approach takes from the best features natural and conventional medicine have to offer and wisely applies each one.
For example, it’s clear that modern medical advances excel in acute care and a few key areas, such as managing trauma and tackling severe illness that develops quickly. Modern medicine also has incredible drugs for treating bacterial infections (although over-reliance on them has resulted in bacterial resistance) and effective treatments for controlling high blood pressure.
“These are all examples of where conventional medicine shines,” Weil said. “I often give this example: If I were in a serious car accident, I would not want to first go to a chiropractor or an herbalist. I want to go to a trauma center and get put back together. But then, as soon as I could, I might use other methods I know about to speed the healing process.”
However, the vast majority of diseases doctors see today don’t involve trauma or infection but are instead rooted in poor lifestyle choices. And the results of applying modern medical techniques to these sorts of diseases speak for themselves. Consider the epidemics of obesity, diabetes, chronic disease, hypertension, and mental illness, which have risen sharply in the past few decades.
Modern medicine offers tools to manage these conditions but gives little, if any, diet or lifestyle instruction that could actually turn these diseases around.
The Value of a Therapeutic Relationship
Today, patients can see integrative doctors, but chances are slim that insurance will cover them. Instead, they pay for the service out of pocket. But what if this integrative approach was applied to the entire American health care system? This strategy would involve shifting the focus of medicine away from pharmaceuticals to manage symptoms (and more drugs to manage side effects) toward prevention and health promotion. It would also bring into the mainstream effective treatments that aren’t dependent on expensive drugs and technology.However, doing so would mean that doctors would have to spend more time, and patients would have to accept more responsibility, in making appropriate changes.
“When I see a patient, I often take an hour. I spend the first half of that taking a history, and then I give recommendations. I could probably do that in 30 minutes if I had to, but it has to be enough of a chunk of time that I can get a sense of that person and establish a therapeutic relationship with them,” Weil said.
Doctors have instructed patients in the art of healthy living since ancient times. This sort of expert advice is hardly the standard of care today, but perhaps it’s even more important than ever because we live in a world with an abundance of unhealthy pitfalls.
Even for those simply trying to lead a healthy lifestyle on their own, the system works against them. In the United States, in particular, the unhealthiest foods are typically the cheapest and most available. Federal government subsidies of commodity crops have given rise to pathetically cheap ingredients that food manufacturers have come to favor—things such as high fructose corn syrup and refined soybean oil.
Another way in which the system is slanted is that doctors, hospitals, and insurance companies are conditioned to base treatment plans on drug trials, not on lifestyle instruction. These studies may provide evidence for a drug, but they don’t show the whole picture.
“When we study drugs, we test them against placebos, we don’t test them against lifestyle change, which would be much more useful data to have,” Weil said.
Getting people to understand the high cost and poor outcomes of conventional medicine is a huge factor in showcasing the strengths of a more integrative approach. But how do you show consumers what they actually get for their health care dollars and how this money might be better spent?
Weil proposes a study idea to make the message clear. It would involve collecting data on outcomes and effectiveness of integrative treatment versus conventional treatment for various chronic diseases. You would follow two large groups of people, match them for age and medical diagnosis, and compare them for the outcome, cost, and patient satisfaction over time.
“That kind of data is what we really need today in order to show the payers that integrative medicine is in their interest. I’m quite sure we can do that,” Weil said. “The problem is that the National Institutes of Health doesn’t see this within its mission. So who’s going to do that?”
It takes big bucks to get quality data, and since the architects of the current health care system have no interest in funding a trial that explores the virtues of natural medicine, Weil proposes enlisting the private sector. It might start with a few pilot studies initially, but he says the information that these trials would produce would be invaluable to corporations currently hobbled by health care costs.
“They’re only interested in what works. And they’re not bound by ideology. So this is an initiative that I and people at my center are working on—to try to get at least some of these beginning studies going,” Weil said.
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