How to Achieve Real Change in Health Care. Is Anyone Listening?

A physician I knew (he died at a ripe old age) once quipped, “Medicine is America’s fastest growing failing business.” And unless we refocus our entire approach to health care, it’s going to grow and fail even faster.

Most proposals for health-care reform have focused on either expanding the availability of insurance or reducing the costs of prescription drugs. While necessary, these approaches are essentially extensions of a dysfunctional health-care system, and they fail to correct its fundamental flaws.

Health care (of which medicine is part) is an oxymoron. It’s really a disease-care system that continues to exist only because of the rationing of treatment. Millions of people are excluded from health-care coverage, and others must deal with huge out-of-pocket expenses or simply do without.

The solution I envision would transform this disease-care system into a genuine health-care system. The only way to accomplish this, at a price this nation can afford, is to emphasize prevention.

I don’t mean inoculations or well-baby checkups, although they certainly should be part of any health-care system. Nor do I mean near-compulsive cholesterol and blood pressure checks, although they too have a place.

Rather, I recommend that the incoming Obama administration fund a large federal and state campaign that tackles prevention in a way similar to how government discouraged the use of tobacco products. The anti-tobacco campaign has largely worked, and one focusing on prevention can work as well.

Focusing on prevention is imperative. Unless we reduce the demands placed on disease care, the current or extended disease-care system will eventually collapse financially.

Nearly all experts agree that most chronic health problems result from poor eating habits, a lack of physical activity, and other lifestyle issues, such as smoking and alcohol consumption. These are behaviors that can be modified to reduce the risk of disease, and less disease means lower health-care costs.

It’s important that this campaign convey the message that each and every one of us is a partner in our own health. We can’t abuse our bodies and then expect doctors or magic pills to reverse the damage, regardless of who pays. We must acknowledge our personal responsibility for staying healthy and do a much better job of eating more nutritious foods and staying reasonably fit.

I would make nutrition the foundation of any health-care campaign, for a couple of reasons. First, it’s the basis of our biology and biochemistry. Second, two of every three Americans are now overweight or obese. More than 23 million have type 2 diabetes, and somewhere between 40 and 100 million have some form of prediabetes. These are signs that our eating habits and lifestyles are truly warped. Ominously, these health problems increase the risk of heart disease and most other chronic degeneration diseases.

There’s no need to get distracted by arguments over which diet is best. Everything I’ve learned about healthy habits boils down to emphasizing fresh foods over almost anything that comes in a box, can, jar, bottle, or bag. It’s as simple as that. Opt for a piece of fish or chicken and some vegetables instead of a burger and fries in the drive-thru. And yes, eat smaller portions.

Physical fitness is important as well. While we don’t have to build Schwarzenegger-type bodies, we do need to realize that all the time we spend in front of televisions and computers helps make us fat. Just going for a daily walk improves blood sugar and weight, and obviously the more we do, the better off we’ll be.

Food companies could certainly be given incentives to help spread the word about eating better and becoming more physically active. They could also retool some of their food products to wean people off junk foods. After all, the health of their profits will at some point depend on the health of the nation.

A consortium of medical societies, food-industry lobbying groups, and vitamin supplement associations could also help underwrite consumer-education campaigns geared to preventing disease.

Even the Food and Drug Administration could play a role by clearly discouraging the use of hydrogenated oils and caloric sweeteners, maybe by requiring warning labels on some packages. The FDA could also streamline the now complicated processes of making health claims for foods and supplements.

Doctors may dismiss my proposal by saying that patients want a quick fix (code word for prescription drug) and aren’t compliant with dietary changes. But the studies show that one-on-one nutrition coaching and follow-ups do result in compliance and consistency.

Will there be resistance to what I propose? Of course they will be. Every billion dollars saved in disease care will translate to a billion lost in drug company and hospital profits.

But something has got to give. As a nation, we’ve got to get off our duff and make some changes. It’s far easier, better, and less costly in the long run to prevent (or lower the risk of) disease than to struggle to treat it. Furthermore, as people get healthier, they will also have more energy, use fewer sick days, and be more productive. That can only be good for our economy.

We need more than a Band-Aid when it comes to reforming health care and controlling costs. I hate to say it, but for a permanent cure, health care needs major surgery followed, of course, by a lean diet and time to heal. This process will certainly take more than a couple of years to yield clear benefits, but so did the campaign to reduce tobacco use.

Early Diagnosis Is Not Prevention

Several years ago I wrote about a disturbing example of what George Orwell called “double-think” – holding simultaneous contradictory views. At the time I focused on mammography, which has often been promoted for “preventing” breast cancer.

Mammography, however, has nothing to do with preventing breast cancer. It’s a diagnostic tool. You can have a hundred mammograms performed, but they won’t prevent a single case of breast cancer. (In fact, a recent study suggested that mammograms might even increase the risk.) Once diagnosed, a patient will usually be pushed into a medical maze with surgery, chemotherapy, and radiation.

The idea that early diagnosis equals prevention is returning. Recently, a story in the New York Times kept referring to colonoscopies as a way of “preventing” colon cancer. When I emailed the editor that colonoscopies don’t prevent colon cancer, she steadfastly defended her writer’s choice of the word.

Huh? Early diagnosis is not the same as prevention. Confusing the two is double-think.

Meanwhile, a supermarket ran an ad in my local newspaper encouraging people to get various medical tests from a portable testing lab. People could pay for a “heart disease prevention package” or a “stroke and aneurysm prevention package” of tests.

The tests are fine if you want them and if you want to pay for them. But they do not prevent cancer or cardiovascular diseases. They too are a form of early diagnosis.

If such tests do reveal serious health problems, then you have a choice: you can enter the medical maze and subject yourself to drugs and surgery, or you can improve your eating habits and lifestyle. But once in the medical maze – the same one that confuses early diagnosis with prevention – odds are that you’ll be pushed toward the more aggressive and more expensive therapies. After all, the point of early diagnosis is only partly to help patients. The other part is to make money off you.

The Controversy Over Vitamin C and Cancer

A recent study – in cells and mice – was published in the journal Cancer Research and immediately followed by newspaper and internet headlines screaming that vitamin C interfered with the cancer-killing effect of several chemotherapeutic drugs.

The finding contradicted several promising studies – in cells, animals, and people – showing that large amounts of vitamin C enhance the body’s ability to fight cancer. What gives?

The study, conducted by researchers at the Memorial Sloan-Kettering Cancer Center in New York City, used an awful methodology. That’s what gives. I’ll explain.

Most of the vitamin C found in foods and supplements is chemically known as ascorbic acid. The Sloan-Kettering researchers did not use this type of vitamin C. Instead, they used dehydroascorbic acid, which is the “oxidized” form of the vitamin, and found that it reduced the effectiveness of chemo drugs on cells. Meanwhile, in the mouse study, the researchers used dehydroascorbic acid in doses known to be toxic.

No one in the entire world sells dehydoascorbic acid supplements. In fact, when dehydroascorbic acid is formed in the body, it is quickly broken down because of its inherent toxicity. It makes absolutely no sense to (1) call dehydroascorbic acid vitamin C or (2) to use it in cancer experiments.

Several studies have successfully used large amounts of real vitamin C to destroy cancer cells in cell experiments, animals, and people. The current theory is that large amounts of vitamin C – large intravenous doses of vitamin C in people – generate hydrogen peroxide, which functions as a natural chemotherapeutic agent but does not harm normal cells.