It's a mystery to Dr. John Bergen why so many people make the "common mistake" of turning to doctors only when they're in trouble, when "the vast majority of your health needs can be met through your local pharmacy." When this blog originally wrote about the subject a couple of years ago, it cited research showing that the United States spends $750 billion a year on healthcare, "and yet patients get worse care than in almost any other country in the world."
Bergen argues that "Americans are too quick to focus on symptom relief," and overlook lifestyle habits that directly affect their health:
Consider this: The average American is overweight, even though he or she eats too much fat and too many calories, he drinks too much, doesn't exercise enough and smokes too much. Yet the average American is still sick. You can't have it both ways. You can't claim, "Take some medicine and change your eating habits so that you don't get diabetes," and then also ask the physician to "cure your diabetes." Both those things require lifestyle changes. You can't complain about your cholesterol level or high blood pressure, and then ask your doctor to fix it. You have to accept some responsibility for your health.
It's not just patients who get in the way of good care. Doctors themselves prevent people from doing the things that make them healthier. Doctors discourage physical activity, even though doing so makes it possible to live longer and to have better health. Doctors prescribe drugs when exercise and diet would work better, and fail to advise people how to make such changes. They fail to order routine tests because patients are used to paying for tests that are ordered. They fail to monitor how patients are doing because there are no incentives for them to do so, and doctors don't appreciate it when they are forced to do it anyway. There are many reasons why American health care costs so much, but the big reason is the inability of doctors and patients to cooperate and act in the best interests of the patient.
This report from the British Medical Journal sums up the general failure of today's medical system, which treats people like a problem to be solved rather than as a whole human being. All of this reflects why the American system has little or no "public support":
American medicine is focused on curing illness and delivering symptom relief and not on restoring and maintaining health. For example, American doctors almost never tell their patients to lose weight or exercise regularly, even though both of these are proven to decrease the risks of serious illness and death. In a study of 11,400 adult male health plans enrollees in 2000, the average participant was overweight (mean body mass index [BMI] of 26.5), smoked, and consumed less than half the recommended daily amount of fruits and vegetables, and less than one ounce of fish per week (the equivalent of one to two servings per week). Yet only one-third of men met the criterion for a recommended level of activity, such as taking a walk of 30 minutes per day. Overall, only 9 percent of men had a BMI under 25, which is considered ideal for health. Overall, men had the highest mean BMI at age 50 (31.6), then it decreased to 27.2 by age 60, and then increased again to 32.3 by age 70.
As most of us know from our own experience, good medical care is expensive. The same is true in many other countries, even some that have universal health care. A 2003 study that compared the quality of care in the United States and Canada found that a middle-class Canadian family pays "approximately 40 percent more than their Canadian counterpart" for the same medical service. This isn't just about the insurance coverage or the billing system. This is about what doctors believe they are doing when they prescribe drugs or perform procedures, and how they think their patients should respond to treatment.
In sum, the more health care a country pays for, the worse it gets, and that means that Americans spend far too much. Every dollar you spend on health care in the United States, according to a 2004 article in the New York Times, "tends to buy five or six times as much care as it would in countries where health spending averages less than one-fifth of our spending." There is a very simple way to get the best possible health care at the lowest possible price: If the United States had as much per capita spending on health care as Mexico, each American would save more than $6,000 per year on health care costs. If this number were increased by 50 percent, a person would save $10,000 per year.
The government covers almost nothing -- about 8 percent of health care costs -- and that means that most Americans have to pay all or part of their medical bills themselves. The more that the government spends, the more it costs. That is why it is called "a health care system." The main lesson to take away from this is not that "medical care is very expensive," but that many people don't get any better care at all.
Tuesday, July 19, 2011
A recent blog post by "Dr." John Bergman contains an error: "Even if a pill could cure cancer...the cure wouldn't be worth it. Cancer is a symptom, not a disease."
While "Dr." John Bergman is a good teacher in many ways, we are concerned that he is misleading the public about the nature of the problem of cancer. The disease kills more than 5,000 Americans every day. Although he is making his living by encouraging Americans to treat their own health problems without consulting a doctor, he apparently has no knowledge about how cancer works or how to treat it.
Contrary to what "Dr." Bergman might believe, cancer is not a symptom, but a disease. The American Cancer Society defines cancer as:
A term used for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems.
Cancers are not all the same. Some grow very quickly and then stop, while others grow slowly but never go away. Almost all cancers are caused by mistakes in a cell's genetic information, which may be hereditary or can be caused by other factors such as exposure to toxins, radiation, or tobacco smoke. Cancers can be named for the part of the body where they start or for the type of cell that is causing them, but they can't be named for how fast they are growing or for how they look under the microscope.
It would be foolish to attempt to treat a tumor by encouraging the body to kill cancer cells, because no one knows what causes cancer. That is why "cancer fighters" will not cure it. Cancer is an uncontrolled growth of cancer cells, which has spread from its original site. Cancer cells are normal cells that are growing in a disorderly and irregular way. Cancer cells are genetically different from the cells that surround them, and the difference is that they multiply too quickly. The term "cancer" is not used in any other disease, and it refers to uncontrolled growth of cells.
The most common form of cancer, which is responsible for almost half of all cases, is lung cancer. This accounts for more than 190,000 new cases and 160,000 deaths each year. The next most common form is colorectal cancer, which accounts for nearly 40,000 deaths annually. This ranks fifth in the most common cancers, which are those affecting the lung, breast, colon, and prostate. The last of these also has a hereditary form. Some cancers can develop at the cellular level due to exposure to carcinogens in tobacco smoke or from chemical toxins that are inhaled or absorbed through the skin or by drinking water. More than 100 different carcinogens have been identified in tobacco smoke. More than 30,000 people die each year from lung cancer in the United States, and more than 70,000 die from cancer of the colon. Another 70,000 die each year from cancer of the prostate, mostly from cancer of the prostate gland. This is why the "over-treatment" of cancer is a growing problem. It is not because doctors are trying to "cure" cancer. It is because there are too many cancer cells and they are multiplying.
As it is often said, "If you are not with us, you are against us."
Although Dr. Bergman's comments are uninformed, they reflect some of the concerns about quackery in American culture today. Our culture is so "disease oriented" that some people believe they can treat their disease by curing it with herbs or natural methods instead of standard medicine. At times this trend is a lot like medical quackery. Just as medical quackery can also be harmless, some alternative therapies can be effective. Still, these alternative therapies should not be confused with standard medical care.
On the other hand, at least some of the alternative therapies make excellent points that will be worth taking into account as more Americans are drawn into the medical system. Alternative therapies that encourage people to treat their own health conditions are part of the reason why it will cost more money to treat people with cancer than it would if everyone were simply given a flu shot. At the same time, some critics make it sound as though all alternative therapies were quackery, when in fact the alternative therapies can sometimes be "an effective blend of modern medical knowledge and natural therapy that can be effective at preventing and even curing disease."
Many of us had parents who were both doctors and nurses. For many reasons, we believe that traditional medicine is more effective than alternative medicine. However, in order to treat most disease there is no need to see a
