The contentious partisan dispute surrounding the country's move to a new way of financing health care, embodied in the ongoing government shutdown, obscures an even more fundamental issue in our health care system. My friend and colleague, Dr. Mark Hyman, defined that issue brilliantly when he said that "it is not just about who we provide the medicine to, but about the type of medicine they receive."
The type of medicine we all must now receive represents a paradigm shift from the medicine the system delivered throughout the last century and continues to deliver today. The shift will require corresponding changes in the infrastructure for delivering care and treatment, in the strategy for training health care providers, and in the way individual patients interact with the health care system as well as in the financing methods now so much in the news. In other words, a wholly new model of medicine is needed -- and it is inevitable.
Why? Why must we change a model of medicine that has worked so well for so long and that our politicians, at least, continually tout as "the best medical care in the world"? There are two reasons: the nature of the illnesses we face and the new understanding of human biology provided to us by the revolutionary discoveries of our post-genomic era.
A century and a half ago, similar reasons caused a paradigm shift in the medicine being practiced at that time. Back then, infectious diseases were the scourge and life expectancy averaged 47 years. The discoveries of the physiological revolution -- of Pasteur, Koch, Lister, and others in the late nineteenth century -- changed all that radically. Now acute infections could be identified and zapped, and the model of medicine changed accordingly. The content of the care changed. The delivery system changed. The training changed. The tools of cure, pharmaceuticals, gave birth to a giant new industry. Over the course of three generations, life expectancy in the U.S. rose from 47 to 74.
And in this greater longevity, we confront a very different health crisis. Today, the issue is chronic illness -- all those diseases and conditions that don't heal on their own, that only get worse, that afflict us with multiple symptoms and derive from multiple causes: heart and blood vessel diseases like diabetes and high blood pressure, autoimmune diseases, digestive diseases, muscle pain and weakness, cancer.
We know two truths about this new health crisis: It is global, and our current pill-for-an-ill medical model is ill-equipped -- is indeed helpless -- to confront it.
Yet just as was true a century and a half ago, new scientific discoveries give us the tools to create the medical model that can address our new health reality. The genomic revolution has rewritten our understanding of how our genes interact with our environment, stimulating responses in our core physiological processes that form our individual "health profiles" throughout our lifetime. This new understanding cries out for a new model of medical care that focuses on that interaction and on how those core processes are functioning.
It is called functional medicine, and it is happening right now -- despite partisan shrieking in Washington and in the face of an old health care model that we all know is not working to mitigate, much less cure, what really ails us. Is there any one of us who has not experienced -- or watched a family member or friend experience -- well-meaning health care professionals trying their best yet falling short of delivering a positive health outcome? Is there anyone who doesn't recognize that ours is an over-medicated society of chronically ill people revolving through a system of disease care, not health care -- a system of demonstrably inflated costs and demonstrably ineffective outcomes? It is as frustrating for medical professionals as for patients.
Instead, we need to move boldly to a model of collaboration between individuals engaged in their own care and their providers, working together to implement a personally tailored health management program for each individual patient. Such a program would combine pharmaceutical science, where necessary, with changes in the patient's environment, diet, and lifestyle -- not just to bring relief to the individual but to realize his or her full genetic potential for vitality and longevity.
Are there forces out there trying to perpetuate institutions and medical systems kept intact through various subsidies? You bet there are. But the insights of Pasteur, Mendel, and Florence Nightingale met opposition and inertia too. It's time now -- in fact, the current stalemate in Washington makes the time particularly propitious -- to start the conversation about a new model of medicine.
Our lives depend on it.
Dr. Jeffrey Bland is the author of the upcoming book The Disease Delusion, scheduled for release by HarperWave, a division of HarperCollins Publishers, in Spring 2014.
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