November 4, 2015
Healthcare System, Heal Thyself
Dr. Lewis Thomas offers a write-up on the current state of the healthcare, or medical, profession. His blandly-titled article “The Health-Care System” has a strong implied thesis. Paraphrased by this reader, it would say something like: “We are throwing billions of dollars at, and paying more attention to, a system than actually bettering the health of the American people.” Though if it is facts the reader wants in order to check up on some of the things Dr. Thomas puts in his article, they will be hard-pressed to find anything more than his opinions and observations. Throughout the article he makes more than a dozen of these observations, many of which the reader of that time need only open their eyes and ears in order to realize for themselves. In other words, he’s not wrong. In the entire article, however, he only cites one source (the U.S. Vital Statistics Reports) with reference to his comment about “the illnesses that plague us the most”. Which at the time, were respiratory and gastrointestinal infections. A quick Google search led this reader to the online version of The New England Journal of Medicine in order to find out when this article was first published. It came out on December 11, 1975. While he may be referring to morbidity over mortality (it’s unclear) with his statement regarding the two particular illnesses, a second search yielded a Portable Data File (PDF) of vital statistics from the Centers for Disease Control. Scrolling down and scanning for keywords, however, a table listing “Death Rates for 69 Selected Causes: United States, 1968-75” was located. The numbers for such causes as “Major cardiovascular diseases” (one line in the table) were much higher—ten times—than even the aggregate of any and all the lines citing respiratory-ailments-as-cause-of-death during that time period. This fact shows that cardiovascular issues were by-and-large a greater cause for concern than the gastrointestinal and respiratory issues that Dr. Thomas cited as the biggest problem. This reader has been unable to locate a searchable PDF—one that directly applies to the information—in order to fully sound out the statistics Dr. Thomas cites. And while he held an impressive pedigree, which included a career as a doctor and university professor (he also held degrees from Princeton and Harvard), none of this made him the sole authority on health.
Dr. Thomas’ tone is one of utmost gentility. He aims to put to rest the nervous temperaments of his readers by exposing the folly of being overly preoccupied with such a broad abstract as their own good health. But this reader finds that he comes across as merely a non-serious observer. He says facetiously, “Chewing gum is sold as tooth cleanser. Vitamins have taken the place of prayer.” And elsewhere that “the transformation of our environment [costs] rather more than the moon” (not really, the moon is worth upwards of 500 quadrillion dollars). Again, one can see his irreverent tone in relation to what might be a very real problem: that of the effect of pollutants on the air we breathe. Though instead of proffering any salient solutions at fixing (or else slaying) this multi-appendaged beast that is the healthcare system—one with no discernible head nor tail—his observations come across more as a barely-interested deity, looking down on the masses for whom he feels little in common.
Granted, one person may not be able to do much in the face of what Dr. Thomas might consider to be a lumbering, “staggering” (the opening descriptive adjective in his article) giant that takes more propping up than any middle-aged and half-healthy human, but the reader must accept the brief explanatory paragraph as to who he is and where he’s come from as proof of his being qualified to opine on this subject. It is not this reader’s intention to come across as harsh with Dr. Thomas. After all, there is a prize awarded annually to the most outstanding writer in a scientific field, one who bridges the sciences and the humanities by writing about how the two topics intersect in a digestible way for the common reader. It’s called the “The Lewis Thomas Prize for Writing about Science”, which Dr. Thomas does in this article in a pragmatic, country-doctor sort of way. His legacy for writing and opining and otherwise drawing the two worlds of Medicine and layperson reader together, survives.
The turning point of his article, however, is when he says “There is something fundamentally, radically unhealthy about all of this.” He is referring to capital expenditure balanced against the media’s ever-present push for more health care. He says that the dollar amount spent on healthcare in 1975 was $115 billion. He also says “The official guess is that we are now investing around 8 percent of the GNP in Health.” Assuming that was accurate (again, he doesn’t cite a source for either of these two pieces of information), that is an exorbitantly high number. The implication is that the reader would need only use a little common sense in order to see that such high spending is supreme folly. And if they thought $115 billion was high, they would be shocked to find that today, 40 years later, the expenditure is around $3 trillion.
Dr. Thomas’ article was not written as an answer or a counter to any of the problematic observations he makes. None of the mild references he cites—from television commercials to the number of diet books clogging the bookstores or the fact that people are now jogging in greater numbers than ever before—need any corroboration. And he offers no alternative perspective to the field laid out before the reader, only his two cents. Nearly all the assertions he makes come from having spent a long, storied career at the top of this food chain and he’s only now looking back over his shoulder to see what it has become.
Nevertheless, the second part to his turning-point statement holds true: “We do not seem to be seeking more exuberance in living.” If any of the points he looks to make are true, the corollary is that striving for good health for its own sake is not the best thing to do with one’s (relatively short) life. This reader feels that Dr. Thomas understood this. He understood that immortality was not a worthy goal unless one had something enjoyable to do with their (infinite) time. Something more, he says, than jogging “each day in underpants, moving in a stolid sort of rapid trudge.”
The writer William Gibson has called the human body “the product, for the most part, of unskilled labor” (Gibson 215). Meaning successive and small changes over millions of years have led to what we have and live and walk around in today. Human beings as a race make it through all sorts of drastic and not-so-drastic health-related issues. Dr. Thomas alludes to this fact when he says in his article that “we are amazingly tough, durable organisms, full of health, ready for most contingencies.” So with reference to all the stuff that could be out there and harming us, the only real danger is thinking like a casualty (i.e. worrying ourselves sick) and then developing the very diseases through some sort of psychosomatic process. But again, this assertion can neither be confirmed nor denied.
My opinion is that exercising, eating right, and a minimizing of chronic stress (if at all possible) are the antidotes to too much healthcare. When a patient has to take a certain type of medication for the main problem but then has to get another prescription in order to counter the side-effects of the first drug, something is wrong. This is what is costing the American people that $3 trillion dollar bill. And it doesn’t take advanced degrees from Ivy League universities in order to see this. I agree with Dr. Thomas’ implication that all this worry over good health is itself detrimental to the health of the American people. According to David Orenstein-Brown, author of an article on dialysis cost, the $3.9 billion spent by Medicare on anemia drugs is the largest expenditure for Medicare. The main causes of kidney failure are Type 2 diabetes and high blood pressure. In other words, poor dietary choices (i.e. too much sugar and processed food) and too much stress lead to the exact opposite of a life lived in full health and confidence.
In closing, what Dr. Thomas wrote 40 years ago is simply a broad elucidation of today’s watchword against Googling one’s own symptoms. His article works, but only on one level. It’s as if he’s saying “Here is what’s wrong.” and that’s all. The readers would need to get Thomas’ take and then investigate it for themselves while munching on an apple.
Gibson, William. Distrust That Particular Flavor. New York: Berkley, 2012. Print.
Mann, Jake. “What’s the Moon Worth?” The Motley Fool. 10 Mar. 2014. Web. 28 Oct. 2015.
Orenstein-Brown, David. “Medicare kidney spending at crucial moment” News From Brown. 4 Sept. 2012. Web. 28 Oct. 2015
Thomas, Lewis. “The Health-Care System.” The New England Journal of Medicine. 11 Dec. 1975. Web. 28 Oct. 2015