What Are We Waiting For?

I've participated in many discussions about why people would prefer to treat medical problems as opposed to preventing them. Opinions have ranged from that people are often in denial that something bad will happen to them to they think that genetics plays such a big role that it doesn't really matter what they do within reason. Others believe in the strength of our medical system so that if something bad does happen, the system will fix it. The most common opinion is that is just tough to change bad habits developed over many years and they will hope for the best.

Unfortunately, they are wrong on many counts. Everyone knows someone who died prematurely and so we know bad things can happen to anyone. Genetics plays a relatively small role, less than 30% in our health. The health care system is strong on science, but weak on miracles. Letting your health deteriorate and relying strictly on health care providers is a risky bet. Habits may be hard to break, but they are not impossible to change. Support, guidance, and good knowledge can help.

I think the real problem why we don't focus on prevention is because there is a perverse incentive for the health care system to allow you to get sick so it can treat you. And by health system I mean pharmaceutical companies, health insurance companies (they charge premiums based on a cost plus basis), and of course health care providers, which include hospitals, doctors, and suppliers, who are generally only paid for treating a problem, not preventing it.

A number of year ago, I read an article about how the pharmaceutical industry hardly ever works on developing preventive medicines because it doesn't think there is a market for it.  Some may think that Statins, the cholesterol lowering drugs, are of a preventive nature, but they would be wrong. Statins are only prescribed (and at that, at an excessive rate) only when you already have elevated cholesterol. I don't blame the pharmaceuticals. Why create something for which there is little demand?

So we know the problem, what should we do about it?

My answer is education. education, education. Let's expose our citizenry to a series of self-administered quizzes about their health. Let's open their eyes to the consequences of their behaviors likely to lead to the development of chronic diseases. Let's require schools to school our children to a level where they can demonstrate a fundamental knowledge of what eating properly looks like, the importance of physical activity, and how to best manage stress.

Let's require that every insured patient submit to an annual wellness visit within 90 days of their insurance renewal to stay insured. Let's require during that visit a specific review of medical and family history and dietary, physical activity, sleep, and stress patterns. Let's also do a thorough review of medications and dietary supplements to make sure that they are being used sensibly.  In its totality, this visit will force, yes force, people to take stock of their health before something goes wrong. I believe that while all may not respond well to such a requirement, enough will benefit for it to make a huge difference.

As a society that insures every person over the age of 65, we can no longer afford to hope for the best when it comes to the future of our health care system. We need to get serious about propagating wellness and lifestyle modification and it all starts with education.

This week, Centers for Medicare and Medicaid Services (CMS) announced the first round of grants for its Health Care Innovations Challenge Program. There are certainly a number of meritorious applications among them that will improve our health care system. But sorely lacking among the first group was any real focus on education and primary prevention. Does our government appreciate that an ounce of prevention is really worth a pound of cure? One can only hope that in the next round, to be announced in early June, this absence will be remedied.

We will all be better served if we stop, or even slow down, the progression of avoidable chronic diseases among our populace.  For that, we need our government to help fund such efforts.