When a man can't sleep at night because of a chronic pain in his shoulder, his main focus is getting rid of the pain so he can sleep. If a doctor gives him a medicine that causes the pain to go away for a few hours at a time, the patient is very happy to be able to sleep.
He is:
- convinced that the medicine helped him because the pain comes back when he doesn't take the medicine.
- knows that the drug is the only thing that stands between him and misery.
- will keeping coming back to the doctor again and again, for the drug.
On the other hand, if a doctor is able to give the man a treatment that cures his shoulder pain completely, the patient:
- might conclude that his problem wasn't very bad and probably would have gotten better on its own, and that he didn't really need to see the doctor
- won't be coming back for more treatment because he's cured.
- probably won't spend a lot of time talking or thinking about shoulder pain and its treatment.
Undoubtedly, companies have discovered over the years that symptomatic treatments are more profitable than curative ones. If a treatment is not profitable enough, companies simply can't afford to promote them. In a sense, companies tend to talk about symptomatic treatments because they can. It is sustainable. The expense is being covered. As they talk about the symptomatic treatments, doctors start using them, and enough money comes in for them to be able to keep talking about the symptomatic treatments.
It's not that symptomatic treatments are better, or all there is, it's just that they tend to pay for themselves better. It's just economic reality. Patients want to be cured, but companies can only afford to talk about health benefits / products that are economically sustainable.
Therefore:
- it's up to companies to talk about the best products and benefits, that also happen to pay for themselves
- it's up to doctors and patients to find those products and treatments that have the best chance of restoring patients' health (even though they aren't profitable enough to support a lot of talk or attention).
The two aims are different. Sometimes they point in the same direction and many times they don't. For example, economic reality is what pressures HMO's to promote and provide care in a way that is not necessarily in the best interest of the patients. If you're looking for health care that can restore your health to normal, instead of health care that just pays for itself, you may have to look for and find it yourself because you may be the only one that can afford to tell you about it. Thank goodness for the Internet!
There is a saying, "Out of sight, out of mind." This is as true in medicine as it is anywhere else. When doctors hear a lot of talk from drug companies about the latest (usually symptomatic) treatment, they tend to think, talk, and teach about it more. And competing drug companies with lots of money are introducing more products all the time. This is a big reason why doctors tend to be taught about and use so many symptom-oriented treatments.
Doctors are taught to give a drug for this symptom and a drug for that symptom and not taught about how to correct the underlying problem. And it is not because of a big conspiracy on the part of doctors. Mostly, it's because the doctors have never heard of anything else, that's all they have been exposed to. And it's not necessarily because of a big conspiracy on the part of drug companies either. They can only talk about what they can afford to talk about. They are doing the best they can within the constraints of economic reality.
Sometimes Large Traditions Are Based On Very Little Reason
Our national health care system has been constrained more by (pick one):
- What works best to maintain and restore patients' health, or
- Patent law and what pays for itself
Which is easier for you to picture our health care system saying?:
"We'll give patients what works best for them even if it costs us more money than we can get in return."
"We'll give patients the best health care we can as long as it pays for itself (sustainable on a large scale over the long term)."
On one hand it's understandable. It's the age-old balance between
- what's best
- wo's going to pay for it.
For example, it might be best for everyone in America to have a new car but who's going to pay for them?
On the other hand, it can sound really funny. Which sounds more misdirected?
- Health care in America is about health care
- Health care in America is about patent law
Patent law? Why would our health care system be about patent law? At first glance it doesn't make sense, and at second glance it doesn't seem possible that so much could actually be based on so little.
To illustrate how great things can sometimes be based on very little reason (or no good reason), consider the following example which is adapted from a poem we can no longer find. If you know the poem please let us know where to find it so we can quote it exactly. Thank you!
In an open field over 200 years gone by, a butterfly danced in the sunlit sky.
As it fluttered along here and there a cat leapt after it, pawing the air.
Later that day, a hound dog, with nose to the ground,
followed the scent hoping the cat would be found.
As the sun began to set and the deer came out to graze,
they found the dog's parting of the grass a convenient way to pass.
When cows were left out there in the sun, they too began to follow the path one by one.
Over time the path became established more and more,
and people started following the trail, never really wondering what for.
Even a shepherd once led his sheep on the familiar route,
and as the area became more populated,
there people in carriages enjoyed their afternoons out.
Soon it became a popular road for many travelers who were "just passing through."
before long there was enough traffic to support a restaurant, and then a hotel, too.
Then came the automobile and the road was paved,
sidewalks were poured, and traffic signals waved.
The path of that great city's main street, lined with skyscrapers,
meanders that way why?
Because in an open field over 200 years gone by,
a butterfly danced that way in the sunlit sky.
If we look at street maps of many long-established cities we can see that many of the roads (not planned interstates) do tend to meander one way or another for no apparent reason. The roads are not mapped out in grids of streets, avenues, and blocks as they often are in planned cities. It's likely that a story similar to the one above has happened over and over again.
Sometimes paths are chosen because they are the best way to go and sometimes they're chosen because there is already an easy path to follow(like some roads in Calhoun County). Perhaps people that come down the road later assume that the people that came before carefully considered all the important issues and carefully selected the road's course. But they may not have. They may have simply paved a road that was already there because it was easier than cutting a more direct path through undeveloped property.
It's easy to see that many well-established and thoroughly paved traditions are not where they are because everyone carefully considered all the important issues and were able to determine the best path to the best results, but are only where they are because it's easier to follow a road already traveled. Perhaps the most interesting and ironic aspect of the whole story above is that the travels and settlements of all the earthbound creatures who did need to be concerned about the lay of the land allowed themselves to be directed by a flying creature that was totally unaffected by it. The butterfly had entirely different interests and concerns.
Likewise, it may be that many people who are suffering from health problems and many of the doctors that are treating them may be following long-established and thoroughly paved roads that have tended to follow the whims of companies and institutions with entirely different interests and concerns.
For example, some types of patents are easier to defend in court than others. The most defensible patent is a stuctural patent. That's where a company actually comes up with a new structure or molecule. Thus, there is essentially a legal and financial pressure or mandate for companies to come up with molecules that are not found in nature. The primary financial concern is not whether a molecule can cure an illness in the human body but whether or not it has a structure that's ever been patented before.
Because the Internet is such a low-cost means for people to communicate, and because it is so easy to search, it is now possible for people to find out about many wonderful treatments they might never have heard about otherwise.
Gas stations used to pump your gas for you, because it paid for itself. Now, practically all gas stations are self-serve. Health care is also becoming increasingly self-serve, because no one is more interested in the patients recovering than the patients. And just as technology is making self-service convenient at the gas station (clerk being able to activate the pump from inside), so too is the Internet making it easier for patients to find solutions to their health problems.
This is why the Wellness Education Foundation promotes online Wellness tools available through the WellCare Network.
(this content pulled from Dr Dennis Wilson's website)
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