In discussing health care reform, it's easy to become mired in statistics and abstractions, so let's examine it in personal terms. Here's the story of a patient I saw recently that provides a specific example of what medicine does now -- and what, in my view, it must learn to do.
The man was relatively healthy, in his mid-30s, and had been diagnosed as having a very common ailment -- gastroesophageal reflux disease -- also known as GERD. (This condition used to be called "heartburn.") In recent years, the pharmaceutical industry has been both clever and deceptive in giving this kind of polysyllabic, clinical name to even mild, transient versions of common ailments as a way of persuading both doctors and patients that their new, potent drugs are essential to our well-being.
The patient's GP had prescribed daily doses of the most popular proton pump inhibitors, drugs that suppress stomach acid, and he wanted to get off them.
For over a year, regurgitation of stomach acid into his lower esophagus had been causing him to belch and experience burning pain in his upper abdomen. This problem accounts for 4.6 million doctor visits a year. Severe, persistent GERD raises the risk of esophageal cancer, one of the most difficult and costly cancers to treat.
His previous physician hadn't taken a dietary history, hadn't asked about other aspects of his lifestyle, and hadn't explained the nature of GERD. Nor had the doctor told him about the long-term effects of suppressing stomach acid production: impaired nutrient absorption and lowered defenses against food-borne pathogens.
Without exploring any possible low-tech approaches, the doctor prescribed an expensive pharmaceutical drug that was never intended for long-term use. It gave relief, but whenever the man stopped taking it, the symptoms returned with a vengeance. He understandably disliked the idea of being forever dependent upon a drug.
I did a review of his diet and lifestyle, which is fundamental to an integrative medical assessment. Then I explained to him that many factors contribute to GERD, especially stress and certain foods. This fellow generally took good care of himself, but he did drink coffee, exercised very strenuously (perhaps too strenuously), and worked long hours at the computer. My intuitive sense was that he was habitually tense, and that this was keeping his GI system from functioning properly.
My recommendations were few and simple:
I told him that after a few weeks of implementing these changes, he could try weaning himself slowly off the drug. He did so successfully and no longer needs a drug that costs $50 a month and is unsafe for long-term use. The only "side effect" of this treatment was enhanced general health from learning to neutralize the harmful effects of stress. He will have to be more careful about his food choices and eating habits in order to keep the symptoms from recurring, but if they do, he now knows about other simple remedies he can try.
This is not brilliant doctoring. Any motivated medical student can learn how to interview a patient to get to the true root of a problem. He or she can also learn simple, safe, inexpensive treatment protocols like these. At the Arizona Center for Integrative Medicine, the program I began at the University of Arizona in Tucson in 1994, we've taught more than 500 physicians (as well as nurse practitioners, medical residents, and students) techniques like these to treat a variety of ills. Some of our graduates are now training others; you can find a fellowship graduate here.
These physicians are also well-versed in the high-tech, expensive and sophisticated methodologies that are needed for less common, serious, life-threatening illnesses. They know how to intelligently deploy both simple and complex protocols, depending on the conditions that they see.
This kind of medicine should be the new foundation of American health care. It is the key to cutting the out-of-control costs that are sinking the system.
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