When I first heard about “individualized medicine”, maybe 2,5 years ago, I was pretty convinced that this is the “future” of medicine. “Individualized”, in my ears and the ears of many others sounded like something that is very patient friendly. But after being confronted with the mindset of Western medicine, especially after my own Atrial Fibrillation (AFib) diagnosis and journey, my point of view changed dramatically.
I am still convinced that “individualized medicine” is the future of Western medicine, but today I have great doubts that this future will be shaped in the patient’s interests. Too often I have experienced the “one big hammer” for everything an everybody approach.
My personal understanding of individualized medicine, seen from the patients perspective, is that all efforts first and foremost should aim at preventing people from becoming ill in the first place, and that this is done with consideration and, if necessary, providing support for changes in the general conditions which people live or have to live in. This for me includes e.g. workplace conditions, nutrition intake, stress compensation, etc. .
If an illness occurs nevertheless, from my point of view, everybody should receive a therapy that is tailored to him or her addressing the root cause of the problem and not just getting a “hammer blow” on all the symptoms that are coming up as alarm signals, as I have experienced it myself regarding blood pressure treatments, etc. .
Therapy in my eyes should always also focus on the question:
“What is out of balance in my life why I get these alarm signals now and how can I turn things back into balance?”
(Note: Of course there are emergency situations existing when you cannot do, or have to postpone, such a complete situation analysis (anamnese), like when having a broken bone etc. .)
The following seesaw picture illustrates what “Life-Balance” in my eyes is about:
From my experience it is better not to mix up Life-Balance with “Work-Life-Balance” approaches, because the whole life needs to be in balance, not only single parts of it. Another important point in my eyes is: The main goal in treatment, research and science should be healing from the beginning and not just only a longterm treatment.
Why is it so difficult to implement a health-system that is healthy to its patients?
For me a business consultant, knowing a little bit about the motivational factors of commercial enterprises, this idealistic thinking of switching over from “treating” to “healing” sounds completely utopic, as long as the motivation factors inside the health system are taken over one-to-one from the rest of the economic world. Todays companies, including medical institutions like hospitals etc., all have one goal, “endless” profit and “endless” growth. But there are in minimum two major problems regarding this thinking. First the word “endless” and second “a mindset” that is limited to the perspective of the own microcosm that ignores the feedback and impact to other “system parts”. This means, in simple words, if more and more people stay ill in a community, this on the one hand means more profit and growth for the health industry, but on the other hand results in a less overall performance of other areas of the community itself. This in turn also means less performance for the health system at least again – a devils circle.
Regarding the health system these two problems described before are particularly fatal, because people cannot really “decide” freely about their participation in this game because sooner or later all people are depending on the health system somehow. This is not comparable to the decision if buying a specific yoghurt at the supermarket or not. In other words the “damage” that might occure, because of “endless” growth thinking e.g. in yoghurt industry will be a little bit more self limited because of the limited community of “yoghurt lovers”, but regarding health industry the endless growth thinking can end up in a catastrophy, because the limitation factor is only given by the amount of the world`s population.
One of the biggest mistakes of economic thinking, in my eyes, is the assumption of unlimited resources, but it is exactly this mistake that describes the way we live today. Oil, for example, is a limited resource, but all supply routes for products that are essential to all humans are based on means of transport that directly or indirectly require oil e.g. trucks, ships, etc. . This is, in my opinion, absolutely not sustainable.
What is the strategy behind all of this?
At least there are many little strategies used not only one, but as we can see e.g. in other economic areas “producers” always try, as one strategy, to make people dependent on their products by making them incompatible to others or lets say they sell you a “car” and you still need to refill a special gas again and again if ou want to drive. (Note: In some cases this problem has been mitigated a little bit by standardization, e.g. car tires, USB technology etc.).
The fairest way to make people “dependent” to a product or service, in my point of view, should be “excellence in adressing the customers needs” and not “excellence in incompatibility” and and all this in consideration of the finite resources on our planet.
But what is done in Western medicine to make people dependent?
Here we also have many strategies but one of them is very sneaky and this is one is working by making their patients fear grow.
If your doctor tells you: “If you don’t do this or that medication then you will get e.g a stroke or a heart attack etc.!”, most people, I did too at the beginning, will believe in this and do what they are told by their doctors without questioning. (Note: I am not saying here that a doctors advice should be ignored! In some cases I absolutely agree with the “fear strategy”, e.g. in cases like smoking, overweight etc. when the doctor uses a little bit of “fear”, to get his patients out of the comfort zone, making their lifes change.) But what if the doctor works more like a “sales guy” selling “non-cancellable long-term contracts with subsequent costs” to his/her patients, just because of economical reasons?
You might say a doctor would never do that, but if you would know how doctors get paid by health insurances then you might get a little bit more sceptic about the motivational factors the “health system” offers to a doctor, that might support such kind of “business first” behavior (see e.g. doctors billing system in germany – german source).
Maybe it is a prejudice that sales people, just for example, sometimes intentionally don’t mention negative characteristics of their “contracts”, but what about the medical system?
If we take a look to a study named: “Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions: A Systematic Review” from Golder, Loke, Wright and Norman, we could get the impression that this kind of “bad news” hiding is not just something that only happens in car business only. If we also look at an interesting article from Kirsch et al. about “Antidepressants and the Placebo Effect“, we can find another indication that negative information in medicine often does not reach the “light of the public”. (Please see also my post “The ‘Worst Case’ Medicine”.)
For giving a more practicle example imagine if you, as a doctor, would only get a fixed amount of money every quarter per every single patient. Would you meet your “blood pressure”-patients every week for a half hour to discuss their progress regarding their “weight loss / nutrition / do more sports plan” or would you put him/her on pills what takes you 3 minutes for creating one new recipe per month (getting paid the same amount of money) and also being protected legally by implementing a very simple treatment plan (based on pills)? (Note: I know you would do the right thing, but the motivation factor “money” should not be underestimated, especially if you have to pay monthly your rent, expensive loans for medical equipment and staff salaries.)
So, you might get a gut feeling, by the given example, for the problem that the motivational (economical) factors for “patient individual treatments” are probably not that high for a doctor. This might be the reason why it feels like that doctors in Germany more and more switch over to private practice only, what sadly also does not automatically mean that the results are much better, maybe because the underlying mindset of the medical system at all is often still the same like before. This “health system” problem is also discussed from a little different perspective and argumentation in an article from Klaus Doerner at the “Deutsche Ärzteblatt” (a famous german magazine for doctors) named “Health system: In the progress trap” (german source).
(Note: I don’t say that all doctors and therapists work in this way, but the motivational factors are definitely not always on the “side of the patient” (and I am sure often also not on the side of the doctors who want to do a great job for their patients). But to be fair we also shouldn’t forget that there are many patients out there who prefer “a pill” instead of changing their lives radically.)
Regarding the topic individualized medicine, I would prefer to be free in my decision to choose myself a (maybe more stony) therapy without pills or a “pill only” therapy, but I never got this option by the most of my doctors and that makes me very sad and sceptic.
Another example: Imagine you are a medical manufacturer or researcher and you have discovered that for a specific disease the best new therapy is weight loss through exercise, avoiding fast food, drinking water and vitamin-rich natural foods (like in simplified words what the “PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study.” says, that you can find in the library).
Although this new therapy can be offered as a “product or service” by the medical manufacturer, it cannot be legally protected, which makes economic exploitation considerably more difficult and therefore such developments unfortunately rarely find their way into a therapeutic approach.
Why? Because who would be interested in the creation of such economically insecure offers, except perhaps the patient? With “a pill” things are different. Pills can mostly only be produced by specialized companies and can usually, depending on the design, be legally protected, which makes them a much more interesting business model.
My personal conclusion: As long as illness and not health is the “thing” that is paid for, this imbalance in interests can not be expected to be resolved. As I have personally experienced when I have tried to find a therapy for my burnout / depression condition some hospitals make it a condition of admission that you consent to take a particular medication and this even before you start the therapy or had a deeper diagnosis. Without agreeing to a medication plan in “anticipatory obedience” people in need will be rejected from help (Note: “That’s crazy man!”).
As often the scandinavian countries are here once again the pioneers for a complete different and in my eyes much better approach as described in an article by Roger Whitaker named “Medication-Free Treatment in Norway: A Private Hospital Takes Center Stage”. In this approach doctors are focussing thenselves on the patients needs without putting a medication plan in the center of their treatment concept.
This leads me to two more questions, I asked myself, as an outlook for the future of Western medicine:
1. What do I see as a worst case szenario for the future of Western medicine?
My dystopic worst case szenario for the future of Western medicine is that people have to put their arms into a machine (no doctors or therapist is needed anymore) and the machine “analysis” who has an alleged “genetic risk profile” and then spends correspondingly lifelong different medications for “diseases” of which no one really knows whether a) they really would have occurred in the treated persons future, b) were prevented at all by the medication given and c) not perhaps even other much more dangerous problems have occurred by the medication itself.
This szenario puts fear and unknown and unverifiable results together to a business model, what is very dangerous in my eyes.
2. What could be in my eyes a better strategy for Western medicine?
It would be great if Western medicine adapts the idea of that illnesses are an “imbalance” of body and soul like the idea of Ayuverda and Traditional Chinese Medicine ‘TCM’ is based on. Western medicine should focus on patient centered/ tailored evidence based treatments and medication profiles (if not preventable) that aim on curing and less on (lifelong) “treatment” of patients. (Note: Deprescribing will also be a new word that the “doctors of the future”, I have in mind, might have to learn.)
Example:
From my point of view it sounds great if when someone shows up at his doctor e. g. with a “high blood pressure problem”, the doctor or therapist would first intensively try to focus on finding the reason why the body and soul of his/her patient might have been out of balance and sees the blood pressure more likely as symptom (alarm signal) and not only as an illness itself. Here Western medicine can learn a lot from homeopathic medicine and its way of making a holistic ananmese. The healing aporoach in my eyes should be in general much more based on the idea of rebalancing the whole body soul system and where ever possible by using evidence based natural treatments and substances. I want to see such alternative natural treatment plans in the future of doctors education and study Programms. Science should and can support that approach as we can see on the “PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation: the REVERSE-AF study” mentioned above.
If a natural based approach does not work after intensive tryings patients can e. g. still get an artificial medication plan in addition but in a dosis that is exactly fitted to their needs, not more and not less, what means, if a typical standard dosis of a drug is 4mg, 8mg or 16mg but the patient needs 10mg then he gets exactly the dosis from the pharmacy that is needed. While taking the medication the doctor should always continously support the patient to get back to a natural state where no or less artificial medication is needed.
To sum it up I would say: “The mindset that diseases and not health are the economic drivers of the healthcare system must be changed urgently.”.
But this approach needs a complete change regarding the mindset and motivational factors of the medical complex / health care system. It must be seen as a part of the whole community system not only as a “profit center bubble”.
Please always remind the Disclaimer as a condition for the use of this blog.
Get rid of AFib Blog 