By Guy Riekeman, D.C.
The five health care dialogues everybody should be talking about
In the late 1980s, a statistician by the name of David Eisenberg was commissioned to measure the spread of “alternative medicine,” simply defined as “everything that wasn’t mainstream medicine.” His initial findings were published on the front page of USA Today as the cover story. It was a shot heard throughout the health care community: more visits to alternative practitioners than to medical doctors—37 million in all.
The shock was followed by concerns. Are people rejecting medicine? Who are those charlatans and quacks? Are these visits and practitioners delaying appropriate medical care and endangering lives? How are they marketing to uneducated consumers? Is this a trend, a blip or a mistake?
So, the study was authorized to continue throughout the ’90s, and other similar studies ensued. The conclusions were reflective of the cultural revolution that was at hand.
A researcher at Stanford University found that among the average consumers of alternative care, 50 percent had a college degree or higher, indicating that the more trained a person was in critical thinking, the more likely he or she was to choose alternative approaches to disease treatment and prevention/wellness. Of those who stayed in traditional medicine exclusively, 50 percent had a high school education or less. So much for uneducated consumers being duped by creative marketing.
University of California, Berkeley researchers found that alternative care consumers wanted a health care approach and system that reflected their social values. Things like eating organic foods, getting regular exercise, cessation of smoking, reducing stress, creating a positive outlook on life, maintaining healthy relationships and cleaning up the environment were paramount as a lifestyle approach to not only treating disease, but to prevention and wellness. Any person or profession offering this lifestyle approach was considered in a leadership role. Only 4.4 percent of the population had totally rejected medicine. The other 95.6 percent wanted natural, conservative, self-controlled care, with traditional medicine intervening only when the body was too far damaged or during emergencies.
As a result of these studies, the truth about medicine’s side effects also came to light. Simply stated, medicine had become the third leading cause of death in the United States. A combination of reactions to prescribed drugs (136,000 deaths), mistakes in hospitals (100,000 to 300,000 deaths) and medical malpractice (80,000 to 150,000 deaths) contributed to this conclusion.
The time was ripe for a new model of health care, and the participants for leadership were ready and waiting with answers to questions yet to be asked or defined. Integration of services was not even visible on the horizon, except to the most astute of futurists who believed that health care, like all consumer products, was customer-driven and not doctor-driven. This was inaccurately perceived as a professional battle; a political move by alternative care providers to overtake and replace medicine in the realm of professional dialogues. It was perceived by some as a battle for the hearts and minds of consumers and, as with any battle, there were advocates, winners and losers—and lots of money at stake. Unfortunately, the consumers of health care were voting with their feet and had little interest in the wars being waged by doctors, pharmaceutical companies and the health insurance industry. It’s not that these players weren’t, and aren’t still, having a major impact on health care policy, but were they getting to the core of the health care revolution? They would argue that national health care debates centering on cost and access were missing the point, and that this was truly a debate on principles of health care that were much more generative in nature than just “how to reduce cost” and “how to get everyone some form of health care coverage.”
But What Are We REALLY Talking About?
A book published by Ian Coulter of University of California, Los Angeles’ Rand Corporation proposed that there were essentially five core conversations going on in the wake of these studies and the uproar that followed. And while these dialogues were being actively discussed over the back fences of main street America, it is my opinion that they had not yet made it to the boardrooms of corporate medicine. The five dialogues proposed by Coulter to exist at the core of the innovative realignment of health care attitudes among this newly recognized group (educated consumers who were making lifestyle choices independent of corporate medicine) were:
n Vitalism vs. Mechanism
n Naturalism vs. External Interventions
n Holism vs. Reductionism
n Humanism vs. Authoritarianism
n Conservative Therapeutics vs. High-Risk Interventions
Let’s address each dialogue, from the left-hand (alternative care-choosing) perspective:
VITALISM accepts that all living organisms are sustained by an innate vital force that is both different from and greater than physical and chemical forces. Vitalism stands in direct opposition to materialism and mechanism, which hold that disease can be explained entirely in terms of materialistic forces. In philosophy, vitalism is usually held to be a metaphysical belief that failed (died the death of a thousand cuts), as excerpted from Coulter.
Throughout history, there have been two basic answers to the question, “What is the nature of a human being?” Are we physical matter only—a machine that can be manipulated into a normal range of function, whose diseases are caused strictly by materialistic/physical factors such as microorganisms, faulty genes or just plain bad luck? Traditional medicine is the heir apparent to this philosophy and has added to the conversation a definition of health that sets as its goal the elimination of symptoms and disease. It has been the dominate perspective for the past 300 years in the Newtonian model of the world. However, with the understanding that our universe is a universe of energy (the quantum model) and that health is not well defined by the absence of disease, but rather by quality of life, optimum function and social well-being, a new vitalism has evolved. Unlike the French vitalism, rejected by science because observers couldn’t measure ‘life’ or see it under a microscope, the new vitalism views living systems as conscious, self-developing, self-maintaining and self-healing. Simply stated, neo-vitalists have a great respect for nature and the human body. They believe the body is smarter than the doctor. They believe that you don’t need a doctor to orchestrate the development of a whole human being from two small half-cells. They believe that your body was born with the ability to be healthy and adapt to changing environments; that it innately can build productive relationships, expand awareness and knowledge and be well. They believe that the only thing that heals is an alive, well-functioning body; that no treatment of any kind can heal a cut on the finger of a corpse. The cynic might say that’s a silly example—after all, a corpse is dead! But that’s exactly the point: Healing is an automatic, natural outcome of life.
Since humans cannot hold competing beliefs at the same time, a battle ensues between the camps of vitalism and mechanism (some refer to the latter as atomism). The stakes are high. If mechanism persists as the dominate and, in some cases, only approach to health care, then we will continue to have a health care system based on treating sickness and disease with drugs, radiation and surgery. If we evolve to a system based on vitalism we will develop a health care approach designed to honor the body’s innate resources, remove interferences (physical, chemical and emotional) to restore its proper function, and relegate drugs and surgery to secondary back ups behind more natural, alternative methods.
NATURALISM consists of a set of philosophical principles that may best be expressed by the beliefs that the body is built on nature’s order, that it has a natural ability to heal itself, that it is reinforced by natural remedies, that it should not be tampered with unnecessarily through the use of drugs, radiation and surgery and that we should look to nature for the power to cure (Coulter).
Questions posed under the heading of naturalism confront issues like: What’s the best way to deliver a child—naturally or through cesarean section? What’s the best way to gain immunity in the environment—artificial vaccination or exposure to dirt, dust and dander? You get the theme. Statistics abound on both sides, with naturalists pointing to the impact of side effects from tampering with the natural order, be it a collapsing ecosystem or physician-induced (iatrogenic) diseases. Those who believe in artificial interventions use scare tactics to reinforce their most sacred rituals of vaccination and point to mass epidemics or images of crippled children to bolster their positions. This fear must be overcome to allow one to accumulate the data and research necessary to make a rational, personal decision. Even once these decisions are made, if they are not supported by the status quo, people must battle legal regulation, denial of entrance to schools for their children and government social services agencies who view alternative approaches as irresponsible parenting. Policies are changing, but not at the same pace as cultural change.
HOLISM postulates that health is related to the balanced integration of the individual in all aspects of being: body, mind and spirit, including interpersonal relationships and our relationship to the whole of nature and the environment. Holism, therefore, is contradictory to the notion of reductionism, since it holds that the whole is different from, and greater than, the sum of the parts (Coulter).
Reductionism is a concept held over from more than 2,500 years ago that believes the human body (and all of nature, actually) is too complex to understand and, therefore, must be broken down into ever more simple components from which we can derive understandings that can then be applied to the whole. The bulk of our scientific inquiry is based on this questionable assumption. Those who uphold holism believe you can’t understand an entire human by measuring a part—an eye, ear, nose or throat—and that to understand life and health, you must measure the whole and its relationship to its environment. We know, for example, that people who are in healthy relationships live longer, higher-quality lives than those who are not so blessed, even if the relationship is with a pet. This seems to point to a need for people to care for, and to be cared for by, other living beings for their own well-being—a relationship that cannot be reduced to a single part-A-to-part-B equation.
HUMANISM is based on the postulate that individuals have immutable rights, such as the right to dignity. There is extensive concern about the dehumanizing procedures, technologies and institutions that have come to typify care for the ill. Partly, humanism is a recognition of the personal, social and spiritual aspects of health, and a move away from the simple biology of health (Coulter).
Humanism stands in direct contrast to authoritarian practices that see the patient as an uninformed consumer who is ill-equipped to make his or her own health decisions. Recently, laws have been passed to protect the rights of patients, such as HIPAA regulations to protect patient health information. But humanism takes this idea even further, to imply that patients have the right to the final say in what type of services they desire for themselves and their children. It also implies that a doctor has an obligation to disclose all of the alternatives for care in a given situation, as well as the risk factors associated with each procedure, even if these services are not offered by that particular doctor or may be in conflict with his or her view of best practices. The expansion of the Internet has transformed this discussion, as consumers can now get instant access to each others’ personal perspectives and experiences, enabling them to research the outcomes of various procedures and the performance of individual doctors before, during and after their treatment. They can also easily explore a multitude of alternative options. In fact, it’s not uncommon for a patient to know more about their condition and options for treatment than their own doctor. These same patients are also able to locate and access doctors who provide the kinds of educational classes, prevention and wellness care that the patients are seeking. They can find doctors who believe what they believe and support their health paradigm.
CONSERVATIVE THERAPEUTICS believes in therapies that have a low level of side effects, and it tends to accept that the least care is the best care. If the body is capable of healing itself, the role of therapy is simply to initiate the process. This is not to suggest that complimentary alternative care treatments may not be extensive, but only that, philosophically, it tends to be conservative. Much of alternative care is oriented toward getting the patient to be active on his or her own behalf and, therefore, reducing therapeutic dependency (Coulter).
This idea stimulates a very simple, but profound question and it is the great experiment of this generation: Do regular, low-cost, low-risk interventions, applied consistently throughout life, allow one to avoid high-risk interventions (with the exception of emergencies)? No example illustrates this better than Chiropractic. Chiropractic care is a low-cost intervention with very low risk factors. Think of a typical, one-day stay in a hospital for a pacemaker insertion at a cost of $55,000. You could add up the costs of monthly gym fees, athletic wear, organic food shopping, regular massages for stress reduction and regular chiropractic care for you and your family and not come close to spending $55,000 in a decade of conservative health care. And the risk factors attached to all this conservative care are negligible. In fact, you could easily argue that the risks of not exercising, not eating well and not receiving Chiropractic care are much greater than any small risks associated with these activities. For proof, just look at the cost of malpractice insurance coverage for chiropractors, which ranges from $1,000–$3000 per year, as compared to that of a medical doctor, at as high as $250,000 per year. Insurance malpractice doesn’t give you a break because they like you; it’s based on risk factors. It’s important to note that conservative care does not reject medical care, but rather positions it as secondary—for use as emergency or catastrophic care. No one is suggesting that a car accident victim bleeding to death should be given nutritional advice in place of emergency medical services utilizing the highest levels of technology available to save his or her life. What conservative therapeutics does suggest is challenging the idea that medicine should be our only or even our primary option for health, as opposed to self-responsibility for developing healthy lifestyle practices like exercise, eating well, cultivating a positive outlook on life, chiropractic care, stress reduction, cleaning up the environment and other wellness-centered activities whose natural benefits greatly outweigh their risks.
Where Do We Go From Here?
First, an honest evaluation of your own real beliefs about your body and the health care practices that result from these principles is in order. Typically, proponents of conservative, natural, lifestyle-based health care (like myself, Life University and a majority of alternative care providers and seekers) will see themselves supportive of the principles of vitalism, naturalism, holism, humanism and conservative therapeutics.
Secondly, it’s critical to inform yourself of the practices that these principles invoke. Don’t get caught up in sloganism or peer pressure when it comes to making health decisions. This is your and your children’s well-being that’s at stake. Read the literature, do your homework and consult trusted practitioners who offer classes or online educational opportunities that can help you ask questions and get answers. Find a mentor who can connect you with other people in the community who believe in the things you believe.
Finally, there is a lot of material and content on the Internet today if you know where to look. Check out the National Vaccine Center if you’re looking for information about vaccines, or search Facebook for local chiropractors who frequently post content that speaks to you. And if you want to stay connected to Life University and myself, visit us on Facebook, Twitter or subscribe to my blog at life.edu/ThoughtLeadership, so you can keep tabs on when I might be lecturing in your area.
For docs who are reading this, it’s time to jump in and begin to address these questions and provide this type of information for your patients. The Chiropractic Social Academy (chirosocialmediaacademy.kajabi.com) dispenses regular information from chiropractors for chiropractors and their patients about topics touching on all of these dialogues. A free-of-charge program for DCs that LIFE helped create, it helps you to become one of those chiropractors with the kind of informative, relevant and frequently updated social media feeds we all look to for up-to-date news and insights.
So ask yourself: Am I having the right conversations? If so, share them! And if not, join in. We’d all like to hear what you have to say.