If we are to reform health care, we must ask different questions


POSTED: Sunday, December 21, 2008

As the health care crisis deepens both here and on the mainland, discussion centers largely on how to most fairly and comprehensively foot the bill for rising health care costs. Maybe that isn't the right question. Maybe we should be asking how to transform health care as it is being practiced. That would take us to what might be the core of the problem - treating the person with the disease rather than just treating the disease. This would engage each of us in sharing responsibility for our own health and healing. It would also give complementary and alternative medicine, CAM, a central, not complementary, role in health care, creating an integrative approach.

Take the case of Stella, a 35-year-old computer operator who had suffered from increasingly severe back pain for more than a year. She went to an orthopedic physician and had done physical therapy twice a week. Nothing helped. X-rays showed a compressed spine. After months of unsuccessful treatment by drugs, orthopedic intervention and physical therapy, the orthopedic physician suggested spinal fusion surgery, which has an estimated 40 percent success rate, with a need for extensive physical therapy follow-up.

As Stella pondered this option, she filed for temporary disability and left work. As the sole breadwinner she and her family were facing welfare. Stella was one of the lucky ones, however. The attending nurse suggested she try a chiropractor. Within four weeks of combined chiropractic and acupuncture treatments twice a week, she was able to return to work and all her pain was gone. In addition, the chiropractor worked with her in identifying the need for changes in her work station. Cost of the CAM treatments was $550. An integrative approach to her condition would have had the physician working early on with the chiropractor rather than offering surgery as a last, and unattractive, option.

  Conventional medicine and the training of physicians are designed to best address acute and crisis conditions. There is no substitute for a surgeon who can reset a broken leg or an emergency room physician and staff who can provide the necessary resuscitation to save the life of a patient in crisis. Unfortunately, the bulk of the illnesses that take us to physicians are chronic conditions that can most effectively be treated with changes in lifestyle and gentle, noninvasive therapies. These make up an estimated 70 percent to 80 percent of conditions that doctors treat.

Up to 50 percent of deaths and 70 percent of diseases in the United States are caused by unhealthy lifestyles. Stress and/or nutrition are factors in nearly 90 percent of health conditions. In spite of this, less than 25 percent of medical schools require courses in nutrition or other aspects of lifestyle medicine

Instead, medical students are taught to respond to these chronic health conditions with a combination of drugs, surgery and high tech tests and interventions. Top CEOs of health care institutions recently called the current system financially wasteful, inefficient and, in the words of Kaiser Permanente chief executive George Halvorson, often dangerous. The current approach addresses the symptoms and tries to hold the condition at a manageable level, responding to it with emergency medicine when drug side effects or symptoms reach a crisis level. Conventional medical treatments seldom go below the surface to address the source of the problem. Nor do they engage the patient in making critical lifestyle changes.

Costs associated with this approach to health care include the hourly rate for physicians the cost of technological equipment, and the ever-rising costs of drugs. Pharmaceuticals accounted for nearly 50 percent of health care cost increases between 2000 and 2003. Drug side effects are estimated to account for up to 250,000 deaths a year. Finally, the cost of medical mistakes was estimated by the National Conference of State Legislatures in a 2000 report, to be as much as $29 billion a year.

  Given the above, integrative medicine might be the answer. It combines the best of conventional and complementary/alternative treatments.

CAM practitioners have been trained to focus on low-tech, lifestyle-related, gentle and non-invasive approaches to healthcare and healing. These treatments are less expensive, result in few side effects and are gentler and safer. People in Hawaii rely on them, using provider-directed CAM treatments at four to six times the national average.

What would happen to the health care crisis if the low-tech and high-tech approaches began to work together; if the patient were guided and supported in making critical changes in lifestyle and taking responsibility for maintaining and returning to health? What would happen if health care insurance companies, which define what is paid for, and thereby what approach to medicine we favor, viewed CAM treatments as integral to good health care? The cost of health care would go down dramatically. Health-care providers would do the work they do best. Hospitals wouldn't waste billions of dollars on patients who could be better treated elsewhere. And malpractice insurance would likely drop.

  Taking this approach, an integrative approach to health care works better and costs less. It is time that we introduce this reality into the discussion. Let's start asking the right question.


Laura Crites is executive director of the Hawaii Consortium for Integrative Healthcare.