Author Q&A
Q. Why did you write Why Our Health Matters?I wrote Why Our Health Matters because I care very much about health, about my profession, and about my country. I would like to see people become informed, and upset and angry with the facts about health care in America. I want them to understand how much we are paying and how little we are getting. I want to show them all the things that have to change.Q. Can you talk about the three myths of American health care and the realities?I think many people buy into three myths about American health care that really deaden us to the realities.The first is that because American health care is the most expensive in the world, it must be the best. The reality is that although we spend more per capita on health care than any people in the world by a long shot, our health outcomes are at or near the bottom compared to those of other developed countries. The World Health Organization recently ranked America thirty-seventh in a survey of countries in terms of health-care outcomes. That puts us on a par with Serbia. And thatís any way you look at it, whether itís in terms of infant mortality, longevity, or rates of chronic disease. The second myth is that having the most elaborate and expensive medical technology in the world must translate into medical excellence. The reality is that medical technology has helped us in certain areas like the management of trauma and critical conditions. It has, however, served us very poorly in terms of creating cost-effective health care. In fact, one of the main reasons American health care is so expensive is that our interventions are based in expensive technology—including pharmaceutical drugs. There are many low-tech methods of intervening in disease that our doctors simply donít learn. Also, our entire health-care system is geared toward intervention in established disease, yet the vast majority of that disease is lifestyle related and therefore preventable. The third myth is that we have the best medical schools and research institutions in the world and that they are producing the best physicians and the best research in the world. The fact is that we have a great medical infrastructure, in terms of bricks and mortar and very highly trained faculty. But the curriculum of medical school—and this is also true of nursing and pharmacy schools—omits very large areas that are extremely relevant to health and healing. For example, our health professionals know next to nothing about nutrition. They donít learn about botanical medicine. They donít learn about mind/body interactions. We conduct a great deal of research, but the fraction of it that is relevant to health and healing and to developing cost-effective treatment strategies is very low. Q. Why arenít we doing better at preventing disease in this country?I think our efforts at prevention are feeble because we work from a model of prevention that is not very robust. The cornerstone of prevention should be lifestyle medicine. That means teaching people how to make better choices about how they eat, how they exercise, how they rest, how they neutralize stress. This is primarily something that needs to be done in terms of education, but the whole society has to pull in the same direction. The government and corporations both have to work to make the right lifestyle choices affordable and easy. You canít have the federal government telling people to eat more fruits and vegetables while at the same time making unhealthy foods cheap and healthy foods expensive through its patterns of crop subsidies. Also, a lot of our preventive efforts are very limited in that they have a lopsided preference for pharmaceutical drugs, like statins to prevent heart attacks or bone-building drugs to prevent osteoporosis. This is not the most cost-effective way to prevent disease. We need to think about prevention in new and better ways. Q. What is health and who is responsible for it?To me health is an inner state of balance and resilience that allows you to move through life and not get hurt by all the things out there that have the potential to hurt you. An image that I like to use to illustrate that is a childís knock-down toy with a weighted bottom. You can knock it over; it bounces back up to the center. You can hold it down; it will stay down for as long as you hold it, but if you let go, it bounces back to center. If you have that kind of inner springiness or resilience you can interact with germs and not get infections. You can interact with allergens and not have allergic responses. You can interact with toxins and not be harmed. Thatís a quality that weíre all born with. This quality is innate, but itís up to us to learn how to protect and enhance that quality as we go through life. So I think, ultimately, that health is an individual responsibility. But itís also the responsibility of society to help us in that effort. Q. Congress is about to pass a health-care bill. What do you think is inadequate about this bill?You know Iím very happy to see health-care reform on the table. Now itís a major topic in the news, with the president and the Congress taking up the issue. But most of the debate that I see centers on trying to give more people access to the present system and figuring out how to pay for it. Thatís not what we should be concerned about. Any attempt to reform health care that does not include a radical transformation of medicine and a huge shift of energy away from disease intervention to health promotion and disease prevention is doomed to fail. Even if we create the cleverest system of national health care, it will eventually be taken down by unmanageable cost unless we change the content of health care. Q. What do we need to change in order to solve the health-care crisis?In order to solve the health-care crisis, first of all, we need to shift our energies and focus away from intervention in established disease and focus on disease prevention and health promotion. In order to deliver health care to all, we have to end the administrative waste of the present system and create a new kind of medicine that emphasizes low-tech, cost-effective approaches. At present, we are terribly over reliant on pharmaceutical drugs and other costly, high-tech methods. It never occurs to many doctors or patients that it is possible to manage disease very well without prescribing pharmaceutical drugs. To create a new kind of medicine, we need a new model of medical education. We also have to train pharmacists differently; we have to train nurses and allied health professionals differently.Q. What should our long-term goal for changing the current state of health care in this country be?We want health care that serves everyone and leaves out no one, that doesnít bankrupt us individually or collectively, and that raises our health outcomes to the levels we deserve. I want to see us create a new culture of health, in which health is fashionable and affordable, and people are motivated to work toward attaining it. Our government and our corporations must all work together to support this new culture.Q. What is the difference between conventional medicine and integrative medicine?Conventional medicine is more and more a specialized system that is best at dealing with critical situations, at managing trauma and disease involving vital organs. The more serious and the more acute the problem, the better conventional medicine is suited for it.Integrative medicine is the intelligent combination of the best ideas and practices of conventional and alternative medicine. But integrative medicine is much more than that. It is the way of the future. Integrative medicine emphasizes the body’s own potential for healing. It stresses prevention. It looks at all lifestyle influences on health and illness and insists that patients are more than physical bodies. We are also mental, emotional beings, spiritual entities, as well as members of a community. Those other dimensions of human life are extremely relevant to health and illness. Integrative medicine also places great value on the practitioner/patient relationship as central to the healing process. It is willing to look at a broad range of therapeutic options, not just those therapies which are now taught in conventional schools of medicine. Q. What can individuals do to maintain optimum health throughout their lives?Iíve spent much of my career giving people information about how to obtain and maintain optimum health. That includes paying attention to how you eat, getting the right kind and amount of physical activity, getting good quality rest and sleep, learning and practicing methods of neutralizing harmful effects of stress, and so forth. So I think the answer to the question is that you have to learn and put into practice what we know about how lifestyle choices influence your health, longevity, and risks of disease.
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