before it's an emergency
Fair warning, this is a bit of a rant.
As an emergency room doctor, I get to spend a lot of time on the front lines of our country’s health care system. I hear debates about health insurance, pharmaceutical companies, hospital administration, etc. There are well-thought opinions, on both sides of each issue, about why our country is sick despite the enormous amount of money and time that we spend trying to make it all work.
But they’re all completely wrong. Probably every good argument you’ve ever heard about healthcare is completely and totally irrelevant. Why? Because we do not have a health care system in our country. We have a disease care system. Until we take the time to define the word “health”, not one argument, facebook meme, or hospital policy is going to make any useful difference in the health of our country’s citizens. The leading cause of death in our country is consequence. And until we understand what creates and preserves health, we will continue to suffer the consequences of our ignorance.
In our current disease care system, we use evidence based medicine to test for and pharmaceutically or surgically address the presence of disease. Evidence based medicine is very useful for dealing with disease and acute injury. In the ER, when a patient is dying from a car wreck, they do not need aromatherapy and a juice cleanse. They need the highest quality information derived from well designed studies. I see evidence based western medicine save lives, and I have committed my adult life to being as good at using it as I can be.
But, we cannot use evidence based medicine to determine how to create and maintain health. Health is not merely the absence of disease, it is a state of functional resilience that is not easy to measure. And you can only study things that you can measure. It’s easy to measure how many people got cancer. It’s very difficult to study how many people did not get cancer because of healthy choices. There are many problems with evidence based medicine (publication bias, expense of trials for non patented interventions, manipulation of evidence by pharmaceutical companies, etc) but the inability to quantify and study health is the most significant.
So how do we go about creating a health care system?
It starts by acknowledging our ignorance. Medical error is the 3rd leading cause of death in our country. Nearly 50 Americans a day die from prescription narcotics. Life expectancy is dropping for the second year in a row. This is despite spending $8,233 per person in the United States on healthcare. I could list statistics like this for pages. Our heavily administered, corruptly lobbied, and deceitfully advertised disease care system is killing us and profiting from our deaths. I say this to you as a doctor who has devoted his adult life to the practice of medicine. As a pharmaceutical company, you can’t make money by keeping people healthy. As a health care administrator, you cannot make money keeping people out of the hospital. As an insurance company, you cannot make money by paying doctors to keep patients healthy.
Next, we get honest about health. Health is generally a product of decision making, not pill taking. As an ER doctor I am overly aware of the fact that calamity and disease strike with cruel impartiality, but fate is a topic the health care system can never address. Health is something that can be created by meditation, exercise, diet, therapy, love, and ten thousand other unmeasurable, unprofitable choices.
In the ER, I address disease. I work hard to know every scrap of evidence that might help me and the nurses and techs that I work with stand between someone and catastrophe. With a little luck, it even works sometimes. As an integrative medical marijuana doctor, I don’t have any illusions that I’m eliminating disease. But with what we’re beginning to understand about the endocannabinoid system, meditation, and diet, I am hoping to help people create health. I love my emergency room job, but I also love trying to keep people out of the emergency room.
-Josh Short MD