New kind of medicine....

Today's Post: Thursday, 5-5-2011

What doctors have done and still do is to diagnose problems and recommend treatments.

Often these short term and immediate problems are easy to diagnose and the treatments are effective. And, the treatments are either are only hard to live with a short time or have few side effects at all.

I. Why do we need to upgrade this model?

A. For some of the most important and avoidable health problems, one of three things are often the case.

1. The most important and effective way to remove the threat from your health is to upgrade key parts of your lifestyle. This can also prevent worse problems in the future. And, if other treatments are used, doing this step is essential for getting good results for many of our worst health problems.

Such preventable problems are beginning to cost so much it’s taking money out of people’s pockets and slowing our economy.

So the American Heart Association has a new program to ask doctors to work with their patients to do more of such lifestyle upgrades that prevent diseases and do so starting at an earlier age. More and more researchers, policy makers, and public health people are joining in.

2. Very often traditional treatments other than such lifestyle upgrades are only partly effective. That’s one of the reasons the lifestyle upgrades are essential.

3. Some of the treatments other than lifestyle upgrades are harmful and cause other health problems or ruin your quality of life.

Our last post was about how this is true of many of the drugs people are prescribed for lowering high blood pressure. And recently it was in the news that some of the drugs to lower high blood sugar increased heart attack risks.

Statin drugs tend to deplete energy from people and help cause or contribute to heart failure in many cases. Our next point relates to this specifically.

B. In many cases, Dr Mark Hyman has found, what doctors tend to diagnose as a single disease is often caused by a set of specific malfunctions that differ from person to person.

He found that if you know how to get a reading on these specific malfunctions for an individual patient and how to treat them effectively with drugs or lifestyle upgrades, you can often cure people who other doctors do not.

An example that we recently posted about is where a genetic test costing less than $150 can tell you and your doctor whether you are in the minority of people who are actually helped by statin drugs. Everyone else is far better helped by treatments that center around niacin -- research has found.

This kind of systems analysis could be called Integrated Medicine as Dr Hyman does. Intelligently individualized medicine would also fit.

Integrated Medicine, however, also suggests that lifestyle upgrades and other non-medical treatments for specific malfunctions that work better be included in the treatment in addition to traditional treatment where it works best.

II. So, what do we go to as a new general model for medicine.

A. This analysis suggests that medical groups include prevention specialists in addition to the doctors.

And, doctors need to be far better educated as to why this is needed, why it can work well, and why it leads to better results.

In addition, since doctors are often the initial point of contact or the director of the effort, they need to know what key questions to ask and refer their patients to these prevention specialists.

Some doctors are skilled at selling patients on making lifestyle upgrades but, today, most are not. And, even those doctors who have the skill haven’t the time or expertise to help patients enough to do the job.

That’s why prevention specialists or trainers or coaches are needed.

B. Personal doctors who get to know patients and are often the first to see them, need to learn the new integrated and individualized medicine.

They need to be skilled at using the key tests to find how to help patients.

The doctor who has unusually high skill at using these tests and diagnosing problems that happen less frequently may need to be a member of the team with each patient’s primary or personal doctor.

Some primary doctors may have both skill sets. But the main job of primary doctors is to ask good questions, relate well to patients, get to know them and their strengths and weaknesses and needs. They also need to be able to solve the most common and easily fixed medical problems.

Lastly, they need to be the doctor who makes sure the team is coordinated. These skills in relating to people and managing their care are not quite the same as those needed to analyze and test for specific problems.

So, both kinds of doctors are needed. My hope is that most medical teams will have some doctors with both skill sets and some having one of each.

Then the other doctors in the team will be the specialists who are expert in more specific areas of medicine and who keep up with the research in their specialty.

B. Lastly, to drive down costs, advanced students, and experienced nurse practitioners will do much of the work leaving the more expensive doctors to manage or work in specific areas.

C. We will also need to have many kinds of courses and online services for people to use to manage the preventive actions and lifestyle upgrades they need to stay healthy.

This is a second key to keeping this system cost effective.

This is the kind of medicine that will do the best job. So this is the direction I support it taking.

Mercifully, there are doctors who understand this need, such as Dr Mark Hyman and other doctors at major medical centers.

As you know, my expertise is on the preventive side. But that’s one of the most needed and least developed parts of this system.