Dr. Greg Nigh

February 2002

Unpublished editorial

Health care reform is a perennial topic. Unfortunately for us all, the national discussion stays relentlessly focused on the funding of services, while virtually no attention is paid to the nature of the services themselves.

President Bush wants to implement a “drug card,” giving Medicare recipients a discount on the purchase of prescription medications. A number of private drug manufacturers have weighed in the debate with their own discount drug cards, each offering reduced prices to Medicare recipients. Implementation of Bush’s plan was blocked with a lawsuit by a coalition of pharmacists and drug store chains in September of last year, but the President is making another push for the same program in a slightly different wrapping.

The Democrats tend to favor a much larger government investment in Medicare and Medicaid, shifting the cost of expensive drugs away from the consumer and onto the government. The most liberal of the Democrats and the Greens have long proposed universal health care, in which everyone has equal access to the medical system and its treatments, with costs resting fully on the Federal government subsidized through taxes.

The assumption behind all of these proposals, from Republican to Green, is that the system being accessed with these cards, or through free services under a national plan, is promoting health. After all, it must be called “health care reform” because it is a system that cares for our health.

However, when examined closely the health care system we have today is only marginally devoted to the promotion of health in any meaning sense of the word. Until that focused has changed, health care reform will remain nothing other than disease management reform.

Surely it is important to manage disease adequately, but who would not prefer to have their overall health and well-being promoted through their medical care. Such health promotion need not be separate from treatment of symptoms, but can be part of that treatment. It is a radical shift in focus, but the other options simply use money to distract from the fact that much of the “care” the system offers doesn’t make us healthier.

Among senior citizens aged 65-74, the average number of prescription medications per senior is 9, while for those 75 or older the average is 11. Every one of these medications has a list of side-effects. But in addition to this list, each medication has consequences for an individual’s overall healthy functioning, consequences that are usually beyond the scope of recognized side effects.

Side effects are relatively immediate reactions to a medication, reactions that can be found in studies lasting from a few weeks to a few months. Most medications, though, have consequences that may not be evident as symptoms for months or years. Examples abound.

Newsweek reported that, in the year ending June 2000, two drugs prescribed to treat symptoms of stomach burning and reflux ranked among the top 5 in total drug sales: Prilosec and Prevacid. Million of people take these medications every day as part of their heath care. The drugs reduce the level of acidity in the stomach, thereby offering symptomatic relief of burning.

Lowering the acid level in the stomach has a number of other consequences, though. For instance, acid in the stomach is necessary to adequately digest protein and absorb some minerals. Stomach acid also creates an ideal environment for the “healthy bacteria” that populate the digestive tract. The simple act of taking a medication to remove a symptom thereby compromises overall health by increasing the chances for protein malabsorption and for excess growth of unwanted bacteria in the digestive system.

Both of these, if they occur, would likely produce some other set of symptoms which would be managed with yet other medications. For example, the symptoms associated with protein malnutrition, such as an increased risk of infections, is not typically associated with those ulcer medications and may be only a subtle decline in immune status over time. Consequent infections are then likely treated with other medications.

Every medication prescribed has consequences for an individual’s overall health. The issue is not whether the symptoms they are meant to alleviate should be addressed or not. They certainly should. The issue is whether managing those symptoms primarily through the use of medications that compromise some other aspect of heath is the most rational way treat illness.

Imagine a medical system that spent over $27 billion this year on health, what “causes” that condition and how to promote it, rather than on disease and how to manage it. It would look nothing like the system we have today. It would, however, offer those who use its primary care services more than an array of medications to manage symptoms.

Primary care disease management is tragically expensive for the medical system and offers little hope to patients that the treatment they receive will actually make them less likely to get sick in the future. Rational health care reform doesn’t simply make access to current therapies cheaper. It must assure that the therapies received are not compromising our health, making us more likely to get sick in the future. Rational reform must protect the customer not simply from high prices, but from a focus exclusively on temporary management of symptoms at the expense of overall, long-term functioning.

The conventional medical system has an outstanding record of success in addressing emergencies: broken bones, heart attacks, shock, etc. But the vast majority of primary health care needs are not emergencies. Reform should not do away with that which works. Rather, health care reform must move toward a health care system that makes our need for that system less likely, outside of emergency situations. Each encounter should promote our present and future well-being, rather than sacrifice it for short-term gains.

Taking exorbitant profits out of disease management is only the first step to developing a health care system that truly promotes the health of those who use its services.

About the Author:

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