Today, healthcare in the United States consumes nearly 18% of the gross domestic product or about $3.2 trillion dollars per year.1 The amount spent on healthcare is more than three times the amount spent on education (supposedly good for the future of the country), and nearly five times more than spent on the military (supposedly to protect us from rest of the world). The biggest industry we have in the United States is treating sick people, and it’s growing. That’s not how you make America great.
Evidence-Based Medicine, and What We Have to Show For It
Evidence-based medicine is the guiding principle to our healthcare system. The premise is to use validated scientific research to make decisions about the care of individual patients. However, I believe the focus has truly been geared towards using drugs to treat illness as opposed to helping individuals improve their overall wellness.
In the last 15 years, the cost of U.S. healthcare has doubled, and in 2015 it rose by another 6%. That spells trouble for a country with an aging population. To add insult to injury, we also pay twice as much per capita on healthcare than other developed countries, yet the U.S. ranks like a developing country.2
Does a country have an obligation to provide some basic health services to its citizens? Of course it does, just like they have the obligation to provide police services to protect their citizens from internal violence. But these are two-way obligations. We also have an obligation to obey the laws as well as take care of themselves the best we can.
In the good old days, healthcare services were minimal at best. For the poor and the elderly, they were almost non-existent. If they paid for them, they quickly became destitute. Their only recourse was showing up at hospital emergency rooms. The hospitals that run those emergency rooms were becoming bankrupt by providing such basic care knowing that they would never be reimbursed. That’s why hospitals were such a strong lobby for the passage of Medicare and Medicaid. Now 50 years later, we are seeing fiscal consequences of this hospital bailout, which is making the bailout of Wall Street in 2008 look financially insignificant.
Much of our current healthcare expenses come from the treatment of chronic diseases. Most of these have a metabolic origin. That means they are primarily diet-induced. It is diet-induced inflammation that causes chronic diseases.3 In my opinion, the only “drug” there is to reverse such inflammation is an anti-inflammatory diet. Thinking that new technology will save us from ourselves is living in a fool’s paradise. New technology means more expensive healthcare, but not necessarily better health outcomes.
The Shift from Evidence-Based Medicine to Evidence-Based Wellness
We need is a new paradigm of healthcare based on what I call “Evidence-Based Wellness.” There are thousands of markers of chronic disease, but very few for determining wellness. If you can’t measure something, then it is difficult to monitor it, let alone optimize it.
Our current thinking is that if you don’t have a chronic disease, then you are probably well. Most chronic diseases only occur after years, if not decades of inflammatory assaults by low-level chronic cellular inflammation.4 Chronic diseases don’t happen overnight until there is enough accumulated damage that organ function is eventually compromised.
The usual treatment after that point is taking drugs for a lifetime to treat the symptoms, but not the underlying cause (cellular inflammation) that caused the loss of function in the first place.
Much of what is made of our increasing longevity is indicative of benefits of modern medicine. But once you factor in the decreased mortality of early childhood and mortality during childbirth, the increase longevity, especially in those who reach the age 50, has not increased that much.
Frankly, the greatest impact in health in the 20th century was not drugs, but improved sanitation (to reduce infectious diseases) and getting physicians to wash their hands (to reduce mortality during childbirth).
It is not longevity that is most important in life, but a longer health span. Health span is defined as years of longevity minus years of disability. In Western Europe (whose per capita healthcare costs are about half of those in the United States), the life span after age 50 has been increasing nearly three times faster than the health span.5 What a great trade-off, getting more years of compromised health. This is great news for drug companies, but not such great news for the taxpayers and their government who pay the increasing healthcare costs.
In my opinion, the real thrust of medicine should be understanding how to maintain wellness for as long as possible as opposed to simply extending lifespan. That can be achieved by committing to an anti-inflammatory diet for a lifetime. That’s my story and I am sticking to it.
- Martin AB et al. “National health care spending: Faster growth in 2015 as coverage expands and utilization increases.” Health Affairs 36:1-11 (2017).
- Murray C and Frank J. “Ranking 37th — Measuring the Performance of the U.S. Health Care System.” New Engl J Med 362:98-99 (2010).
- Franceschi C and Campisi J. “Chronic inflammation and its potential contribution to age-associated diseases.” J Gerontol A Biol Sci Med 69:54-59 (2014).
- Sears B. The Mediterranean Zone. Ballantine Books. New York, NY (2014).
- Fouweather T et al. “Comparison of socio-economic indicators explaining inequalities in healthy life years at 50 in Europe. Eur J Pub Heal 10:1093-1099 (2015).