When I was growing up, I was fascinated by the human body and the way it worked. I was immediately drawn to the biological sciences, physiology and anatomy. On the surface, I found the medical profession, as a whole, driven by knowledge, curiosity and strived for continued advancement to improve the human condition. Much to my dismay, this is an illusion, focusing on short-term metrics and missing the larger picture. Hyperspecialization and expanding understanding in the nuances of certain fields of medicine give us, both physicians and patients, false comfort that we are progressing rapidly for the greater good of our patients. Unfortunately, in most cases, this is not the situation. I’m not suggesting that all medical research is not impactful for improvement of quality or longevity of life, but much of it is not. As a society, we have become fatter and sicker through modernity and with contemporary practice methods.
As our understanding of all disciplines of medicine have significantly expanded in the last 60 years, it has led to disappointing results. In the last 60 years, the life expectancy in the United States has only increased by 8.5 years.1 Meanwhile, in that same period of time, obesity rates have increased nearly 300%.2,3 Not only have our obesity rates increased, our super obesity rates have increased disproportionately. There has been nearly a 600% increase in the prevalence of type II diabetes mellitus in that time frame.4 Cancer diagnoses have increased (some of this is due to more rigorous screening).5 The United States spent $730.4 billion in 2016 on preventable diseases.6 These are only some of the staggering statistics demonstrating worsening health of Americans, despite our medical advancements. I don’t want to suggest that all medical services rendered are futile, but it’s hard to ignore that the industry promotes disease maintenance rather than restoration of health.
I cannot think of another industry that provides such an expensive service with such dismal results. The National Institutes of Health, the major funding source for medical research in the United States, has an annual budget for medical research around $41.7 billion.7 Preventable disease costs in the United States continue to increase annually, but there have been no initiatives that have reversed this trend. While we would like to believe that our government is independent of medical “progress,” the two are very much integrated. Application of a medical grant is quite onerous and have to be approved by a committee within the entity that is providing the funding. Most of the research dollars come from the federal government as they have the most money to hand out to the researchers applying for the grants. If the research you are interested in does not coincide with what the government wants us to “know,” it is not funded. Private companies (Pfizer, Eli Lilly, Moderna, Johnson & Johnson, etc.) do have independent funds for research and development as well, but ultimately have to “play by the rules” the government sets in order to have a fair consideration when the Food and Drug Administration reviews products for market approval. Our government primarily controls what they want us to know by controlling the grant money. They don’t have an interest in us having knowledge in how to cure disease because that would eliminate a revenue stream.
In the book “Antifragile,” written by Nassim Nicholas Taleb, he writes about noise-to-signal ratio as it applies to research. Much of what we read is noise and it is difficult to identify signal amongst the noise. Many university professors are required to either pay their own salary or significantly support their salary by acquiring grants and producing publications. Not everything that is published has significant impact in their field of study. Editors of many of these journals are very financially and socially connected to certain institutions and researchers. That certainly plays a role in the content that is published. A lot of medical research has very small sample sizes and we are supposed to extrapolate the results to a much larger population. Statistical analysis attempts to control for all variables, but this is not always perfect. Mark Twain once said, “There are three types of lies; lies, damned lies and statistics.” I am by no means attacking the discipline of statistics, but it is not perfect. There are numerous layers of bias that goes into publication from the people supplying the grant money to the editors that publish the research. It is not only important intellectual ideas that progress science, there is a significant financial and social component that is involved.
Ultimately I’m an optimist, but I’m quite pessimistic that we will produce a system that will result in resolving the problem of “preventable diseases.” The government and hospital systems would lose out on significant sums of money if we had a population of healthy people. We have found a way to make lots of money from obese patients through bariatric surgery. Other chronic diseases are well maintained on medication. Polypharmacy has become the norm for our elderly population. I would submit that the human body was not designed to be sustained on chemicals and procedures. Our society has been conditioned to believe that there is a quick fix for all conditions. When people have lived with decades of poor biology, it is impossible to correct this poor biology with a physician’s prescription with a pharmaceutical “cure.”
1https://www.macrotrends.net/countries/USA/united-states/life-expectancy
2https://infogram.com/us-adult-obesity-rates-since-1960-1gzxop49on65mwy
3https://www.tfah.org/report-details/state-of-obesity-2020/
4http://www.diabetesandenvironment.org/home/incidence
5https://www.progressreport.cancer.gov/diagnosis/incidence#field_most_recent_estimates
6https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext
Integrated Health Care 