A paradigm is defined most simply as a model; I’ll be using the term in this discussion as our cultural perception and expectation of our health care model, or our cultural idea of what health care should be and do. As we begin, I’d like to ask you to think for a few minutes about this quote from Arthur Schopenhauer, the nineteenth century German philosopher- “Every truth goes through three stages of acceptance; in the first, ridicule, in the second, opposition, and in the third, regarded as self-evident.” I see the reality of these words every day as I look at the changes, both positive and negative, taking place in our health care system. I believe that most of you reading this substantially agree with me about the kind of care you would like to receive; perhaps together we can promote the idea of promoting good health until this thought is “regarded as self-evident”.
Let me first describe the “old” paradigm, the model that most members of our society (mistakenly) believe is current. Under this model, a patient visits a physician with a health concern, the physician makes a diagnosis based on his/her understanding of the body’s proper function, the physician makes a decision about a course of therapy intended to promote healing where possible, and the patient is responsible only for following the physician’s prescribed protocol. This top down decision model worked very well for a long time, but for all practical purposes no longer exists on a large scale.
Several societal changes lie beneath the move from the “old” paradigm to the primary model we see in practice today. Some of these changes may seem to be outside health care, but their impact is profound, for they affect our health itself. The most important of these are two; the broad cultural decline in physical activity required for daily living and the significant decline in micronutrients in our cultural diet as we moved en masse to products provided by the growing food processing industry. The most significant changes affecting the provision of health care are related to economic forces and the growth of two industries; health insurance in all its various forms and offshoots, and the international growth of the pharmaceutical industry. The effect may not appear to be obvious at first glance but the impact cannot be ignored when we realize the not-so-subtle controls that have evolved. Information flow in our medical model is almost wholly funded (and therefore controlled) by pharmaceutical manufacturers (medical schools, published research, medical journals, office visits, etc.). Cash flow in our medical model is controlled in large part by health insurers, and the insurers in turn are influenced by the pharmaceutical industry since manufacturer rebates contribute to the insurance profit picture.
So how does this change our model? Cash flow controls assure that administrators often make de facto decisions about a patient’s care, limiting the physician’s choices to those that uphold insurance industry profits. Even more insidiously, control of information has altered the scope of the physician’s diagnosis and the direction of therapy prescribed so that the primary thrust is often disease management rather than healing. So to compare, in this current model our patient visits a physician with a health concern, the physician makes a diagnosis based on matching symptoms as criteria for a burgeoning list of diseases, chooses a therapy protocol designed by a drug manufacturer (if allowed by an insurer), and the patient is expected to follow this protocol in order to manage his/her disease, sometimes for life.
I’d like to suggest a new paradigm for health care, one that is growing in our society today as more health care practitioners become aware of the restraints in our current model. This paradigm often leads to integration of multiple systems of care, with practitioners from different disciplines working as a team to effect healing. It may be called a wellness model, integrative care, or functional medicine, but regardless of the name is focused on restoring health by restoring normal function. In the old model decision power was vested in the physician. In our current societal model, decisions depend on the corporate bottom line. In this new model the patient plays a much greater role, becoming part of the team with the physician, the chiropractor, the therapist, the nutritionist, the pharmacist, or whatever professionals come together to develop a plan to help the patient restore bountiful health.
I believe that we are created or designed to be healthy and with biochemical mechanisms in place for healing. Our bodies are always working toward homeostasis, working to restore balance. We are remarkably tolerant, surviving in spite of our cultural diet and environment, but only with epidemic levels of chronic diseases. However, when we provide the biochemical building blocks through adequate dietary and lifestyle changes and assure proper detoxification and elimination of metabolic and environmental toxins we enable restoration of our good health. This new paradigm only exists and grows as practitioners and patients alike demand control and broaden their focus from disease management to include functional support and preventive care. Would you like to control your health without drugs-for-life? Would you like to be healthy again? Maybe that’s not just a dream…