Dr. Greg Nigh

February 2003

Never in history has there been so much collective angst about the high costs of health care in the United States, about the impersonal nature of office visits, the frustrating and seemingly endless cycle of medications, and many other issues. Every day one can read articles about health care reform somewhere in the press. Ironically, the two fundamental goals of health care reform offered by both ends of the political spectrum are to lower the price and to provide greater access.

These are noble goals, to be sure, but they overlook a fairly significant problem: the health care system we have today has very little to do with either “health” or “care,” at least in any meaningful sense of those words. Lowering the price or gaining access to the present system will do nothing to change this fundamental issue.

Short-term gains in symptomatic relief can be valuable and even essential at times, but a primary care medical system built predominantly upon suppression of symptoms does not make for a satisfied clientele over time, as poll after poll has shown.

Two or five or six simultaneous prescriptions for one individual are not uncommon. A recent report from the Academy of Managed Care Pharmacy noted that 4 billion total prescriptions are expected to be written in the United States by 2005. Just as shocking, between 1992 and 1999 the number of prescription written grew by 44%. Pharmacy Review reported at the end of 2002 that the average person in their 20s fills 3 prescriptions each year. By the age of 65 that average climbs to 20.

Medical services for patients with chronic illness account for 75% of the $1 trillion annual health care bill in the United States according to the Center for Disease Control and Prevention, which acknowledges that chronic diseases are “the most prevalent, costly, and preventable of all health problems.”

Unfortunately, once an individual has been diagnosed with a chronic disease, the “health care” for that individual largely consists of prescriptions to make the symptoms more tolerable. Rarely or never is the focus on addressing the factors that caused arteries to clog, or blood sugar to rise, or joints to become inflamed, or migraines to recur. Instead, a life of escalating prescription dependency begins, leaving both doctors and patient frustrated.

But there is an even greater tragedy in this relationship of dependency between the medical system and the chronically ill patient. Most medications increase the chances that an individual’s health will be compromised in other ways. The treatment becomes a source of future health problems.

For example, medications widely used to treat indigestion are quite effective at alleviating digestive discomfort. However, those medications may also interfere with digestion and absorption of protein, minerals and other nutrients; they may interfere with the growth of healthy bacteria and thereby facilitate the growth of unhealthy bacteria, and they can even alter levels of neurotransmitters in the brain. Neurotransmitters are extremely important in the regulation of moods and sleep, to name only two vital functions.

Thus, treating one complaint potentially compromises overall health in other ways, leading to increased likelihood that future medications will be needed to treat future problems that result. And it is highly unlikely that those future problems, which may not manifest as symptoms for years, would be associated with the consumption of that medication. There is no way to know what role medications themselves have played in the rising tide of chronic disease and the concurrent rise in prescriptions to treat them.

Neither doctors nor patients are solely responsible for this cycle of medication madness. Direct-to-consumer drug advertising makes each new drug seem like a wonderful possibility for renewed vitality. Consumers are taught to ask for the latest drugs. At the same time, the economics of the industry have constrained both the time and the flexibility that physicians have for patient care, leaving prescriptions as an easy default treatment.

Where does health care reform fit into this picture? The growing mass of people suffering chronic conditions may gain easier access to medications, but this would be a very good time to be careful what is wished for. It is without question that the conventional medical system offers excellent emergency care, and enhanced access for these services is vital. Emergency care, though, represents less than 2% of the nation’s total health care expenditures.

The national dialogue on health care reform should begin by asking what is meant by the terms “health” and “care.” If suppressing symptoms in the short-term while potentially compromising function in the long-term is agreed to constitute health care, then the current drive for cheaper drugs and greater access is right on track.

However, it is possible to think that caring for health means not only relief in the short-term, but also an enhanced vitality over the long-term. Health care could mean increasing independence from the medical system, rather than ongoing or increasing dependence. Perhaps we want health care to mean a relationship with a physician who has time to sit and hear how our ailments evolved over time, how they impact our lives, and to tell us how we can be proactive in addressing the causes behind the symptoms.

If we want health care to mean any of these things, then focusing health care reform on issues of access and cost are misplaced. To create a health care system that we want, we should be so optimistic as to ask for a system that actually cares for our health.

Greg Nigh is a naturopathic physician and a licensed acupuncturist practicing in downtown Portland. He can be reached at drnigh@naturecuresclinic.com.