Winter 2016 – Industrial medicine, as practiced for the majority of the 20th century is giving way to a new paradigm.
The therapeutic approach used to treat acute conditions has been effectively mastered and continues to be refined. Trauma, infections, imminent vascular and other surgical conditions, and the like are perfectly suited for this industrial paradigm and the advances in microbiology, pharmacology, interventional radiology, minimally invasive surgery, etc., have led to these conditions moving far down the ranks of leading causes of death (notwithstanding the emerging “super-bug” bacteria which are becoming resistant to most often over-used antibiotics).
These successes have given us the luxury of living long enough to die from other causes.
The philosophy, logic and methodology that is so well-suited to the treatment of acute fulminant ailments often applies poorly to the current leading causes of morbidity and mortality: chronic disease.
Many of the chronic diseases that now account for both the greatest burden of suffering as well as the leading causes of death in developed countries (and increasingly in developing countries as well) have root causes in the interaction of genetic predispositions which are activated and triggered by specific lifestyle-related factors and behaviors.
The focus on relieving the acute symptoms of a disease process often mitigates immediate deterioration and can prevent the decompensation toward a imminent health crisis event, but this perspective rarely results in identification and treatment of true underlying causes, which may require looking several steps “upstream” in the natural history of disease progression to properly assess and address, and ultimately help prevent.
Therefore a new kind of healthcare model is emerging, often as an amalgamation of a variety of intersecting fields and under a variety of overlapping banners, which is bringing the focus and attention to the true (and frequently multiple) origins of disease.
The intellectual underpinnings of this new medicine are, by definition, highly multidisciplinary and incorporate elements from naturopathy, functional medicine, anti-aging medicine, complementary-alternative medicine, environmental medicine, life-coaching, psychology and behavioral medicine, as well as advanced diagnostics including precision medicine, and many other emerging fields without negating or denying the immense value of basic conventional “MD-style” healthcare where it is appropriate.
The very emergence of this paradigm is due to the acknowledgement that conventional medicine often does not adequately address the many aspects of chronic disease and a more broad-minded approach is necessary.
This new paradigm, which I refer to as “source-cause medicine” intuitively recognizes the importance of 10 inter-related aspects of health and life—in addition to its clear focus on investigation and identification of the underlying cause or causes of disease—which were either inadequately addressed or overtly ignored by the industrial healthcare model.
The first is the appropriate integration of quality-of-life measures into the calculus of medical decision making.
The second is sufficient attention to the risk/benefit ratio for both diagnostic and therapeutic interventions that are available.
The third is a firm grasp of the science and psychology of behavior change as it relates to lifestyle and health.
The fourth is the objective and thoughtful recognition of the degree to which flaws and bias exist within a significant portion of conventional medical and scientific studies from which current best practice guidelines are derived.
The fifth is the application of increasingly refined personalized rather than population-based protocols and interventions.
The sixth is the awareness that traditional reference ranges for “normal” lab values which often span entire orders of magnitude must be appropriately updated to reflect “optimal” ranges.
The seventh is the recognition and emphasis upon the subtraction of certain disease-causing factors which can often be equally or more effective than the addition of purported health-promoting factors (i.e. pharmacotherapies).
The eighth is understanding that primary care is affordable to the vast majority of people and that (unlike for catastrophic conditions) no basis exists for encumbering primary care with insurance-based fee-for-service administrative burdens.
The ninth is the affirmation that individuals vary greatly in susceptibilities and tolerances to various potentially noxious stimuli including various environmental exposures as well as prescribed medical therapies.
The tenth is our evolution beyond paternalistic medicine, allowing physicians to see ourselves as guides, mentors, interpreters, and partners rather than authoritarian decision-makers for our patients.
As this new paradigm takes shape and more healthcare providers and patients resonate with such principles, we will be better able to rise to the mounting challenges within the realms of medical practice as well as healthcare informatics, economics, and policy.