In the last 100 years, we have had tremendous advances in the health care sector. The main advances include controlling most infectious diseases, anesthesia and the capacity to perform surgery and organ transplants, life support, infection control, vaccines, and drugs – the list is extensive. These advancements have been and still are important. We should consider ourselves privileged and lucky to live in a time where so many dangerous hurdles have been overcome and life expectancy is at the highest ever. But with that being said the times have changed. In the grand scheme of things, the main problem of our time is chronic diseases.
Today, 70 % of health care conditions reported in the US are chronic (defined as a disease that is persistent or otherwise long-lasting) (1). Common chronic diseases include diabetes, arthritis, and dementia, among others. And these diseases will be fatal to approximately 70-90% of those patients (2). Not only that, but of the total healthcare costs in the United States, more than 75% goes toward treating chronic conditions. A staggering number as the US spends around 18% of its GDP on healthcare (a number that continues to increase year over year) (3). To put in perspective, this is more than the combined federal expenditures for national defense, homeland security, education, and welfare.
Unfortunately, the health outcome does not correlate with the price tag. The US has by far the costliest health care system in the world and yet the population is far from being the healthiest.
This is something we need to spend more time investigating. Most chronic disease occurs at the later stages of life. The advances made against chronic diseases over the last 30 years have come to a halt. We live longer in the Western world than we used to. However, for many those last years of life are filled with the costs and efforts of managing multiple chronic diseases. Although medicine can prolong many patients’ lives, it is evident that chronic disease requires a practice of medicine quite different from what is used for acute care.
Why is that? Well, research shows that those with healthy habits live longer. Not only that but their health impairments are postponed and compressed into fewer years and have a smoother transition to the end of life. Healthy aging is mostly the result of our behavior, our weight, nutrition, exercise, education, abuse of cigarettes and alcohol, relationships, and coping styles. Research is increasingly clear on the fact that diet, exercise, stress reduction, nutrients, can counteract the decline that leaves us vulnerable to disease and disability. As an example diabetes type 2 can be prevented, reversed, or at least delayed, with the same approach (4). Despite this, diabetes as a disease is on the rise and it’s not a lack of information this is happening.
So if we know this, why isn’t the focus more on healthy aging for everyone? Part of it is the current medical education and history of treating chronic disease. Our healthcare providers are not getting sufficient training in this area. With few exceptions, the current medical education is based on treating disease with the means of medication and surgeries, looking for a single disease, single agent, and a single outcome. When a diagnosis is made and a drug is prescribed, the process is complete. This often results in less than ideal time spent per patient, quick access to drugs, and less emphasis on therapeutic interventions of diet, exercise, and lifestyle.
Conventional medicine has undeniably become the master of the acute and the life-threatening. And the use of drugs and/or surgery should not disappear and needs to remain an important aspect of healthcare. But in this day and age we need to look at a bigger picture and that applies prevention-focused interventions, not controlling signs and symptoms, but restoring health and function, and that has gathered and organized filtered research and clinical evidence.
There is also a gap between what research is finding and the integration of this knowledge into clinical practice. It is estimated to take about 10-20 years for scientific evidence to bridge the gap between research and clinical practice5. On top of that, we know that a lot of medical research has focused on finding molecules that inhibit specific enzymes downstream. The medication that was developed from this approach has been beneficial and made important strides for the world. However, it has also fueled the growth of a pharmaceutical industry that often guides the direction of new medicine development with the stockholders’ best interests in mind.
All that being said, I don’t believe that this situation can be attributed to a single stakeholder. This is not the point I’m trying to make. The system is not perfect, and this is somewhat justifiable and extremely difficult to achieve. However, it is more important to focus on solutions for the future. What we know is that chronic diseases are overwhelming the health care system. The current model seems to build on the assumption that we can only minimize the progression of chronic disease, not restore health. This needs to change. We must realize that the biggest health threats now arise from how we live, work, eat, play, and move.
Fortunately, there has been great progress in the medical community with the emergence of Functional Medicine. Functional Medicine focuses on combining the best of cutting-edge science and proven methods without potential bias. In addition to providing a more effective approach to preventing, treating, and reversing complex chronic diseases, Functional Medicine is bridging the alternative and conventional. This enhances the delivery of care and creates productive professional relationships. It also allows for finding a common meeting ground that is important to create a shift in the entire healthcare system. The medical community has started to embrace this area, with 30% percent of medical schools in the US now teaching it as part of their curriculum, and prestigious hospitals such as the Mayo Clinic and the Cleveland Clinic have developed Functional Medicine departments. Although it remains to be seen, Functional Medicine is maybe exactly what is needed to solve our chronic disease pickle.
Chronic diseases are of a complicated nature in our complex network of biological systems. However, there are always patterns of dysfunction present in chronic diseases. We must understand that, interpret it and look at what it is that’s driving the disease. We must look at current research and be eager to apply it to clinical practice. This is how we attack the disease from the roots. We need a healthcare system of qualified physicians to apply prevention-focused interventions such as nutrition, diet, and exercise so that the risk is minimized. Effective prevention also requires an understanding of individual genetic risk factors and the effects of different lifestyles upon those variations. In short, we all need to shift our way of thinking to effectively address the chronic disease epidemic. Healthy aging is the most effective means and the least costly in the long run. If we all pull together and focus on changing to a more preventative health care mindset it will benefit us all in the long run. I remain optimistic that this can shift can happen and our health care system will benefit patients of all ages.
- Chronic Conditions Charts: 2015. Baltimore, MD: Centers for Medicare & Medicaid Services. Found on the internet at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ChronicConditions/Chartbook_Charts.html
- National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017.
- HealthLeaders. “Healthcare Spending at 20% of GDP? That’s an Economy-Wide Problem.” HealthLeaders Media, www.healthleadersmedia.com/finance/healthcare-spending-20-gdp-thats-economy-wide-problem.
- “Prevent Type 2 Diabetes.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 July 2021, www.cdc.gov/diabetes/prevent-type-2/index.html.
- Morris, Zoë Slote, et al. “The Answer Is 17 Years, What Is the QUESTION: Understanding Time Lags in Translational Research.” Journal of the Royal Society of Medicine, Royal Society of Medicine Press, Dec. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3241518/.