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Why medicine is not health

| Meds | September 26, 2011

Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half hour show! I believe we are in the middle of the medicalization of America, and I don’t think this is a good thing.

Let me ask you three questions: How many people over the age of 35 do you know that are not on any medicines? Why is it that our patients now come to us asking for specific medicines? And why are we as a society spending so much money on healthcare?

I believe that the core principle behind these questions and the medicalization of our society is the pharmaceutical pill. And while I certainly am a fan of modern technology, I believe that now more than ever we need to pause and reflect upon this notion. We have made the medicine synonymous with health, when in fact, these are two separate entities.

Before antibiotics, we as physicians had to rely on many different healing practices: mercury ingestion, blood letting, herbal botanicals, surgery, and countless other healing modalities including song, dance and even prayer. But antibiotics changed everything.

Now patients could take a pill and get predictable healing without the many unwanted side effects that came along with the harsher treatments of mercury and blood letting. Antibiotics truly helped our society transition into the Industrial age. After antibiotics we were introduced to hormones and blood pressure medicine and diabetes medicine and antipsychotic medicine. The pill became our greatest ally in helping fight disease and improving health.

But, as we grew accustomed to the medicines, we could not escape being changed by the medicines. As a physician you know this is true–just think about your medical training and the focus of today’s evidence based medicine. Nearly all of it is defined and literally financed by the pharmaceutical companies. And as a society we know this is true when we see how many of us are taking medicines and how much money we spend on these medicines.

But medicine is not health. Why is it that today we have more people taking medicines, yet have more disease? There is more heart disease and cancer and autoimmune disease than ever before. If medicines truly defined health, than we should see greater reductions in morbidity and mortality.

The pill is not the panacea of health. Yet, our patients expect us to write for them and we have been trained to intervene with them. I think many of you would even argue that we do not see lower rates of disease because patients are not as compliant with their pills as they could and should be.

But I think differently. By defining health by the medicine, we have neglected our greatest ally in medicine itself: the doctor/ patient relationship. We have traded in our interactions with patients for the myriad of medicines we prescribe them. This is not all of our fault by any means. In our pressured insurance-based model of medicine, we have to see more patients everyday, thus allowing us only a brief few moments with each patient. In this type of environment, it is no wonder that we are quick to fire our prescription writing off, giving the patient something to get “better” with.

The reality, though, is that patients don’t want more prescriptions, they want to feel better. But because we have medicalized the very essence of health, we, oftentimes, misunderstand our roles as doctors.

Medicine itself is a wonderful tool, a powerful one. But as we move forward in trying to determine what the next landscape of medicine will look like, let us not continue defining health by the medicine itself. Next time you go into the exam room with your patient, try putting the prescription pad away and see what happens.

Craig Koniver practices integrative medicine and consults with physicians at The New Rules of Medicine.

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  • http://www.facebook.com/profile.php?id=553105686 Leslie Edwards

    Great column! At our home, we mute the commercials because we are tired of health care advertising.
     
    I only take medication for conditions I have been diagnosed with and those medications are effective, safe, and generic. The few medications I take have improved my life with little to no side effects. I’m an example of how a little pill can truly benefit someone. I had terrible symptoms with a clear diagnosis, and medication has brought it under control.
     
    One of those medications is known to interfere with several other medications and substances. It’s actually a blessing because I need this medication so badly that it’s hard to justify taking any of those unless I have a really good reason.
     
    Having a true health concern has shed light on how much gets medicalized in our society. Now I tend not to get any medical care that I’m not sure is accomplishing something obvious.

    • http://www.facebook.com/people/Craig-Koniver/100001463176810 Craig Koniver

      Thanks for sharing your situation. I agree that there is certainly a time and place for medicines. But, in my opinion, is has become way too easy for doctors to write prescriptions. Too easy because it does not require much thought and too easy because many times it does not truly address the root of the patient problem. Thanks again for sharing your insight.

  • Tracy Krulik

    Well said. I’ve been weaning myself off of medications over the past couple of years, and I’m healthier and stronger than ever. And that’s WITH cancer (metastatic neuroendocrine). We’ve realized that my body actually seems to be better with fewer medications and better nutrition and exercise. I’m not opposed to taking meds, but if I can hold off my disease without taking any for a long time, hopefully there will be better treatments available when I do need some help. (http://tracykrulik.com)

  • Anonymous

    Agree with the general thrust of Dr. Koniver’s post – people dwell overmuch on “health” – but as for his question #3: 

    “why are we as a society spending so much money on healthcare?”

    it’s mostly that we pay unduly high prices for it. And while that surely applies to pills, it applies to a greater degree to physician fees (not all physician fees, mind you; but that matter is better pursued in other topics).

  • Anonymous

     As a psychiatrist I can certainly attest to the preoccupation with pills on both the doctor and the patient side of things.  And yes, as a resident I was shocked when the editor of the Green Journal gave a grand rounds at my ivory tower institution, and I saw  the Janssen rep accompany her to the lecture, setting up the slides, etc.  At that point I realized that our relationship with the pharma industry was much more concerning than the free pens. 

    I also feel that our culture is seriously lacking in the social and spiritual realms.  It’s as if the only way we know how to express need is by making a medical complaint.  Emergency departments are the only places that are open 24 hours a day, where a distressed person can walk in and receive care.  Patients expect psychiatrists to prescribe medication that will remove any and all unpleasant feelings regardless if the feelings are perfectly appropriate to the patients  situation.  I once had a patient say to me, “I don’t like opening mail, can you give me something that will help with that?”

  • Melissa Carroll

    Dr. Koniver – great article!!

  • http://www.facebook.com/profile.php?id=614323806 Michele Lee Bordelon

    Thank you!  So true….such as taking a statin preventively….I know folks who do this and it makes no sense to me. “If it ain’t broke, don’t fix it….”

  • http://CANDIDMDEXPSLAINSHIGHCOSTDECLININGQUALITYUSHEALTHCARE.COM Alan D. Cato MD

         “We have the best health care in the
    world. Why should we want to change it?” In reality, what we have is an
    abundance of the best medical
    expertise and an abundance of the best and most expensive medical technology in
    the world. The problem is that, increasingly, we also have
    an abundance of medical expertise who, under the influence of business
    pressures and cultural expectations, is no longer ordering tests and treatments
    in the manner they were trained, en route to their medical diplomas and specialty
    certifications. This has resulted in routine over-utilization of some of the
    most expensive diagnostic technology in the world, and, all too often,
    employment of medical interventions and treatments that are of minimal, to no
    benefit, to the patient—all because of their availability and the consumers’
    desire for and expectation of them.  And,
    of course, a very large part of the consumers’–“desire-for”—is being generated by the media’s daily onslaught of
    “latest medical break throughs” and
    the legions of direct advertisements of medical products, that consumers are
    being deluged with daily.

         .  In their
    attempt at bringing much-needed cost control to the American health care
    system, Congress faces the unique conundrum that the perpetrators of much of
    this unnecessary cost are the American consumer and the American ideology—free
    enterprise. The Unpalatable truth is, for any real and long-term cost control
    to be achieved, Congress will need to make a calculated special exemption in
    the case of health care, and veer slightly (only slightly) away from total sacred-cow status
    for free enterprise. Initially this would be met with angry rhetoric and doomsday
    predictions from the drug manufacturers and the medical sector’s lobbyists, but
    it might not be as bad as Congress fears.

         By proactively dampening, only slightly,
    the rampant free enterprise philosophy within the health care sector,
    tremendous dividends in cost reduction and improved quality of care could be achieved
    simultaneously, since being sold tests, drugs, and treatments that are
    unnecessary or of marginal effectiveness, constitutes poor quality of
    care.  For example, a good start would be for Congress
    to provide the FDA with—“consumer-friendly”—new drug efficacy
    standards.  Instead of proof that a new
    drug’s efficacy is not inferior to
    drugs of the same class, already approved for market, the focus for approval of
    the new drug should be on proof that it performs significantly better than
    similar drugs of the same class, already on the market.  At least then, when the consumer capitulates
    to the pharmaceutical company’s endless multimillion dollar advertising blitz
    of its new drug, the consumer’s high-end dollars would be purchasing a product
    that actually worked significantly better than its less expensive counter parts,
    already on the market. —Alan D. Cato MD, F.A.A.F.P. (past) and author of The Medical Profession Is Dead and the Doctor
    Is “Critically ill!” (Oct.,
    2010)

  • Joe Kosterich

    This is spot on. We confuse “managing disease” by providing pills with health.The two are not the same. The former  is also very expensive whereas genuine health is not

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