Why Our Health Matters: A Vision of Medicine That Can Transform Our Future

Question: Why did you write Why Our Health Matters?

Answer: I wrote Why Our Health Matters because I care very much about health, about my profession, and about my country. I would like to see people become informed, and upset and angry with the facts about health care in America. I want them to understand how much we are paying and how little we are getting. I want to show them all the things that have to change.

A: I think many people buy into three myths about American health care that really deaden us to the realities.

The first is that because American health care is the most expensive in the world, it must be the best. The reality is that although we spend more per capita on health care than any people in the world by a long shot, our health outcomes are at or near the bottom compared to those of other developed countries. The World Health Organization recently ranked America thirty-seventh in a survey of countries in terms of health-care outcomes. That puts us on a par with Serbia. And that’s any way you look at it, whether it’s in terms of infant mortality, longevity, or rates of chronic disease.

The second myth is that having the most elaborate and expensive medical technology in the world must translate into medical excellence. The reality is that medical technology has helped us in certain areas like the management of trauma and critical conditions. It has, however, served us very poorly in terms of creating cost-effective health care. In fact, one of the main reasons American health care is so expensive is that our interventions are based in expensive technology—including pharmaceutical drugs. There are many low-tech methods of intervening in disease that our doctors simply don’t learn. Also, our entire health-care system is geared toward intervention in established disease, yet the vast majority of that disease is lifestyle related and therefore preventable.

The third myth is that we have the best medical schools and research institutions in the world and that they are producing the best physicians and the best research in the world. The fact is that we have a great medical infrastructure, in terms of bricks and mortar and very highly trained faculty. But the curriculum of medical school—and this is also true of nursing and pharmacy schools—omits very large areas that are extremely relevant to health and healing. For example, our health professionals know next to nothing about nutrition. They don’t learn about botanical medicine. They don’t learn about mind/body interactions. We conduct a great deal of research, but the fraction of it that is relevant to health and healing and to developing cost-effective treatment strategies is very low.

A: I think our efforts at prevention are feeble because we work from a model of prevention that is not very robust. The cornerstone of prevention should be lifestyle medicine. That means teaching people how to make better choices about how they eat, how they exercise, how they rest, how they neutralize stress. This is primarily something that needs to be done in terms of education, but the whole society has to pull in the same direction. The government and corporations both have to work to make the right lifestyle choices affordable and easy. You can’t have the federal government telling people to eat more fruits and vegetables while at the same time making unhealthy foods cheap and healthy foods expensive through its patterns of crop subsidies. Also, a lot of our preventive efforts are very limited in that they have a lopsided preference for pharmaceutical drugs, like statins to prevent heart attacks or bone-building drugs to prevent osteoporosis. This is not the most cost-effective way to prevent disease. We need to think about prevention in new and better ways.

A: To me health is an inner state of balance and resilience that allows you to move through life and not get hurt by all the things out there that have the potential to hurt you. An image that I like to use to illustrate that is a child’s knock-down toy with a weighted bottom. You can knock it over; it bounces back up to the center. You can hold it down; it will stay down for as long as you hold it, but if you let go, it bounces back to center. If you have that kind of inner springiness or resilience you can interact with germs and not get infections. You can interact with allergens and not have allergic responses. You can interact with toxins and not be harmed. That’s a quality that we’re all born with. This quality is innate, but it’s up to us to learn how to protect and enhance that quality as we go through life. So I think, ultimately, that health is an individual responsibility. But it’s also the responsibility of society to help us in that effort.