My ferocious insistence is that medicine defaults its primary mission of assuring the human potential by adopting the wrong fundamental strategy, repair instead of prevention -- because it pays.
Heart attacks, cancer, diabetes, stroke command a repair strategy rather than prevention. To this list I add arthritis that is not a direct killer, but its many disabilities are predictors of a whole list of illnesses which it precedes.
I am on record as stating that the most important organ of an older person's body is not the heart or lungs or kidneys or brain but the legs. When the legs stay strong the rest of the body follows. "Noodle legs" are forerunners of disease.
The commonest form of arthritis is osteoarthritis or degenerative arthritis. Almost all old people have some evidence of it to some degree, incapacitating for some, a nuisance for others.
Osteoarthritis has a simple mechanical cause. Lining all joint spaces are elongated molecules chondroitin sulfate, a muco-polysaccharide. The integrity of the joint space is totally dependent on the structural geometry of these rows of molecules which act as shock absorbers, the health of which is precisely tuned to the compressive forces that act across the joint. When the vectors are misaligned or overloaded or underloaded the joint becomes unsteady and starts to rattle. This burden of malfunction becomes an arthritic joint. Evidences of its extent are bone spurs which actually are reflections of the joint's effort to heal inflammation, almost like a skin scab.
Perhaps the commonest cause of arthritis is obesity which simply overloads, as the joint trembles from carrying more than it is designed to carry.
Important too are injuries as precursors of arthritis. Knowing this I'm anxious about a delayed response to my early years when I had repeated ankle sprains from athletic injuries. So far, thankfully OK.
In addition are those of us who are born with a variety of joint issues such as flat feet, or knock knees, or bow legs. All of these deserve a much energized effort in "well-baby" exams so that their later in life symptoms do not come too late for simple corrective action
Arthritic joints represent an immense profit center. Our hospitals and hospital wings have beds dedicated to joint replacement surgery. My close friend and neighbor Jack, 60 years old, just had a hip replacement, cost $180,000! Outrageous! Orthopedic training programs clamor for recruits. Who can argue against this logic when med students are in debt $100,000? A quick payback.
Drugs too are a billion-dollar growth industry promising remedies to reduce joint inflammation with modest, at best, results.
In my lectures I often cite one of my favorite Oliver Wendell Holmes lines, "the Shield is nobler than the Spear."
Prevention or treatment?
We need a new specialty, preventive orthopedics, that pays. It should generate an on-going atlas of joint structure and function.
Our ultimate goal of 100 healthy years has its best chance of realization with good joints to gird it.