Start Making Sense Let’s Use Prevention, Part 2
PART II – STRATEGIES FOR PREVENTION, COLLECTIVE AND INDIVIDUAL
The environmental factors that affect health and longevity can be largely remedied by individual and community action and public policy measures. There is much to be done by neighborhoods, communities, service organizations, businesses, and governments that could affect air and water quality, neighborhood and traffic safety, workplace safety, social connections, job satisfaction, and education about wise use of medical resources.
A much larger area of health risk involves individuals and is responsive to personal decisions, habits, and ways of living. Over half of the causes of death are strongly related to individual behaviors.
To affect the individual lifestyle factors, we as individuals must educate ourselves and take the necessary actions if we choose to live healthy lives. There could also be many changes in the design and implementation of health care that could encourage, educate, and motivate people so that lifestyle changes would be made more easily, and much suffering, premature death and aging, disability, and wasteful medical costs could be prevented.
For a beginning, we could change the financial incentives in health care. The current system, as mostly defined by the conventional medical, model and as designed and perpetuated by insurance companies, the federal government, hospitals, organized medicine, and the pharmaceutical industries, pays for treatment and management of illness, and very little for prevention.
The HMO’s, (Health Maintenance Organizations) name implies that they were intended to maintain health by prevention, but what they ended up dong was shifting liability for medical treatment costs to the provider’s and away from insurance companies and restricting access. Theoretically, if doctors knew how to magically prevent these diseases without any additional resources, the plan would have worked, and costs would have been saved without restricting access. “Managed care” was meant to manage the care of patients in a more effective way, but that concept was lost also in the managing of the financing of medical care and restricting access to care.
There have been changes in health insurance including Medicare, to give lip service to prevention by paying for pap smears, mammograms, sigmoidoscopies, and PSA’s, but these are just early detection and early medical treatment of disease, called “secondary prevention.” The cost effectiveness of these procedures is, yet to be proven. Medicare does have one pilot project, which could qualify as secondary prevention, because it is based entirely on lifestyle changes and uses no medical treatments. These are the studies with the Dean Ornish heart disease reversal program.
For the greater part, prevention is not a part of the current system, and attempts by physicians to get reimbursement from insurance for preventive education and lifestyle management integrated into medical treatment (as it needs to be done) is subject to criminal prosecution for fraud.
The Natural Low Party’s candidate for President, Dr. John Hagelin, speaks thus the statement, “Prevention is illegal,” repeatedly. This “third party” stands out uniquely among all the parties as promoting real prevention as major part of its platform.
If payment is made for treatment of disease and not for prevention, then it follows as a “no-brainer” that medical care providers are faced with a profound financial conflict of interest: The sicker people are, the more money there is to be made.
The financial incentives both for the insurance subscribers (potential patients and families) and for the providers need to be reversed from their current status.
Expensive, uncomfortable, invasive procedures and extremely toxic drugs that have no proven value but are used in a desperate attempt to “do something” when nothing else works for terminal or ‘incurable’ diseases are a violation of the Hippocratic oath to “First, do no harm.”
Many times the impetus for some chemotherapy and cancer and other chronic diseases comes from university based specialists who have new high-tech tools to try out without a clearly defined long term prospective, randomized, double-blind, placebo- controlled experiment for which there is credible evidence that the procedure or drug is likely to have benefit.