An Ounce of Prevention Is Worth...? (March 27, 2007)
Knowledgeable correspondent Nurse Dorothy had this thought-provoking response to a recent entry on managed care in the U.S.:
This is in response to the March 14th blog about managed care. In particular I would like to address the issue of preventive care. It is not really our lifestyle that needs to change but our culture. Culture is what drives lifestyle. As an example, being a nurse I meet many people from all walks of life, rich to poor. Whether poor or rich, both sides tend to work long hours, have high stress, lack exercise, and eat poorly all of which leads to chronic disease. Why, because whatever extra money Americans make is spent on stuff.Dorothy gives voice to something I felt but could not express as well as she has here: that the obsession with who's going to pay for the skyrocketing costs of marginally effective drugs, operations and care is sidestepping the real issue, which is becoming healthier as a nation. What we should be obsessed with is the prevention of every disease which is preventable via lifestyle changes and diet-- i.e. a significant percentage of the disease we suffer.
The revolution would have to be of values, specifically, personal responsibility. It would no longer be the role or responsibility of society or medicine to "fix" the damage which we inflict on ourselves.
We live with a curious paradox of values: if you drink yourself silly and smash your car into someone, you will be arrested and charged with a crime. No one steps up to pay for your "cure" or for your attorney. Those are your responsibilities.
But if you smoke and get lung cancer, or drink excessively and destroy your liver, or eat to excess and end up carrying 187 pounds on a 5-foot, 5-inch frame and are prediabetic at 21 years of age, then "somebody" is supposed to "fix" you, and pay for it, too.
Does anyone else notice the disconnect here? Just because we can be struck down with diseases over which we have no control, such as brain cancer or mental illness, then we're off the hook entirely for all the diseases we can influence or control? It doesn't make sense.
Human beings respond to incentives and disincentives. If you know someone will magically save you from the consequences of your actions, you respond differently than if you will suffer the consequences, and you will respond in yet another way when the consequences start hitting home. This story by a 21-year old prediabetic is a real eye-opener:
Sugar isn't sweet for her anymore; She's one of 54 million with prediabetes.
When connected to the trend of obesity, these plague-level stats are enough to make news headlines regularly. It's hard to ignore a figure like 74 million, the total number of Americans with prediabetes, Type 1, and Type 2 diabetes.There is another way of living, of course, a healthier way, and it appears to be centered around exercise. While we obsess over diet, the active, alert 90-year old I know ate a standard mid-century European diet of white bread and sausage. What differentiates him from millions of others is not some astonishingly complicated "healthy" diet and dozens of obscure supplements but his daily routine of long, vigorous walks. Here's an article which substantiates this view:
You Can Stop 'Normal' Aging; New research reveals surprising facts about our changing bodies.
So where do we stand on personal responsibility and health? The young writer with prediabetes mourns the loss of her "carefree" self who could binge on junk food and guzzle six cans of soda a day; when did self-destruction become confused with freedom? When did visibly unhealthy excess become "normal"? Did you really feel great after the 5th or 6th can of sugar-water? Somehow I doubt it.
Perhaps what the writer mourns is her loss of the current hallmark of being American: the ability to indulge in excess without consequences. I can't be the only one who sees a direct link between "judgment-free" debt binging and "judgment-free" food binging, for the idea is the same: I should be able to get everything I want and eat everything I want now, without future consequences, without discipline, without limits and without judgment, i.e. being challenged.
Our health constantly challenges us all. None of us are immune from temptations and the various conditions we are dealt by genes and our environment, and I certainly don't want to minimize the difficulties in staying healthy and fit. I had to lose 10 pounds last year and need to shed a few more because I have borderline high blood pressure (which I've lowered via lifestyle changes, as described here before). I won't bore you with a roster of my aches, pains, chronic conditions, etc. because that's just normal life.
We all have to manage our physical and mental well-being, and adopt routines which get us where we want to go rather than create roadblocks and more problems. It's like all the other disciplines required by life. If it was easy we'd all look like models, just as we'd all be millionaires if making money in the stock market was easy.
It is a stunning indictment of our culture that fully 25% of our entire population of 300 million people is at risk of what is largely a preventable lifestyle illness. Throw in heart disease (ditto), smoking (ditto), abd various other addictions and the total easily exceeds 50% of the population. And we wonder why medical costs are skyrocketing?
It is difficult not to conclude that the loss of wealth and health we face is an unfortunate but apparently necessary step we must collectively get through to restore some semblance of common-sense values to our culture.
Oh, and there's one more tiny little problem. We are rapidly approaching the end of the line in our ability to pay for the nation's bloated, inefficient and mal-adapted medical care. When the money runs out--that is, when the Chinese central bank and the Saudis stop loaning our government hundreds of billions of "free money" via buying Treasury bonds, then we'll rediscover the one great truth of prevention--it's so very much cheaper than any cure.
If the site hasn't annoyed you too terribly yet. . . Your readership is greatly appreciated with or without a donation.
For more on this subject and a wide array of other topics, please visit my weblog.
copyright © 2007 Charles Hugh Smith. All rights reserved in all media.
I would be honored if you linked this wEssay to your site, or printed a copy for your own use.