Wednesday, June 11, 2014

The Healthcare Crisis

The healthcare crisis is not due to a lack of answers. And we don’t need more research. It’s due to a loss of logic, a lack of discipline, and too many people more concerned with the profits of healthcare at the expense of human quality of life.

Health insurance governs most of our decisions and actions. We know this because the first question most people ask once they’ve decided to take action is “Is this covered by my health insurance?” Subsequent actions are typically determined by the answer they receive as deductibles and co-pays continue rising to unaffordable levels. But treatment that is covered by our insurance is consistently diminishing.

If we continue to allow health insurance guidelines to lead us in our quest to be healthy, we’re going to lose—physically, emotionally and financially. Our bodies are going to degenerate prematurely and we’ll spend a whole lot more on ourselves over the course of our lifetime. Instead of continuing to contribute to the root cause of this crisis, we must adopt a new game plan, a new set of guidelines that will help us enjoy the rest of our lives.

Each person must cost less over the course of their lifetime. If every person had this as a goal, and was willing to do whatever it takes to reach the goal of reducing their cost for staying healthy, the financial burden of our current healthcare system would disappear. But for many, the medical industry is a for-profit industry. Change will not come without a fight. Unfortunately, things probably will have to get worse before they get better.

If we look at the auto industry, we see that change has already taken place. New standards in gas mileage and emission controls have to be met. The energy industry has known for years that we need alternative sources of renewable and cleaner energy. In both cases, change continues to take place.

In the healthcare industry, we’re merely shifting economic responsibility. Who’s going to pay the bills? Not once have we heard that all Americans need to improve their health as a solution to this crisis. The health insurance industry, the pharmaceutical industry, and the medical industry all make huge profits from our broken system. In order to be profitable, these industries need acutely ill people. It’s going to take improved education and disciplined positive action from all of us to fix this crisis. Many hands will make light work.

The Journey to Crisis

There are simple reasons why this crisis is full blown. First of all, our system is based on three basic tenets:
  • We teach people to react instead of act. We teach them to basically do nothing until they’re broken. With a shrinking reimbursement allowance to cover healthcare costs, human nature is to wait longer and hope their symptoms will miraculously disappear. The more time that goes by, the more wear and tear and degenerative changes take place in our bodies. This creates an irreversible scenario.
  • We look only at the site of the injury. Treating symptoms first has become more and more the norm, so we’ve fragmented the body into parts. In the orthopedic world, I often hear statements like “He’s the best hand guy” or “He’s the best shoulder guy.” He may be good with hands or shoulders, but all parts of the body are interconnected. Every part has some global influence over the other parts of the body. To only look at the site of injury is near-sighted and contributes greatly to long-term, increased costs.
  • Our only goal is to eliminate symptoms. Whether we receive an injection, a bottle of ibuprofen, a small number of visits with the chiropractor or physical therapist, or any other palliative treatment, we’re taught that once the symptoms are gone, we should be “good to go.” This belief is so flawed. It should never have to be mentioned. However, everything in our society pushes this reactive, symptom-only approach, from advertising and marketing that reminds us “You haven’t got time for the pain” to physicians who only know what to do when you’re broken. We have an insurance system that will pay only after we’re broken, which encourages us to react after we’re hurt instead of acting to stay healthy.
But change is inevitable. People want to stay healthier longer. We know that smoking is bad for us. We know that we must exercise. We’ve learned that diet and nutrition are not only important, but mandatory for good health. We know that sugar and sugar products are detrimental to good health. Now we know that we must teach the rules for good health and the rule for cost containment in our healthcare system.

One means of addressing our healthcare crisis is to look at a system of the body that, if not maintained, can lead to the premature breakdown of other systems. This is our musculoskeletal system. The architecture of the human body plays an important role in the degenerative diseases that people are afflicted with in their lifetime. But because the preservation of the musculoskeletal system inspires little enthusiasm with fundraisers and researchers, unless we keep people active, exercising and moving without pain longer during their lifetime, many other degenerative conditions, such as obesity, heart disease, arthritis, osteoporosis, and diabetes, are inevitable and will continue costing more and more each year.

The Greatest Cost

In March 2002, President George W. Bush declared the years 2002-2011 the National Bone and Joint Decade. The mission of the U.S. Bone and Joint Decade was to “promote and facilitate collaboration among organizations committed to improving bone and joint health through education and research.”

Musculoskeletal disorders and diseases are the leading cause of disability in the United States and account for more than one-half of all chronic conditions in people over 50 years of age in developed countries. The economic impact of these conditions is also staggering. In 2004, the sum of the direct expenditures in health care costs and the indirect expenditures in lost wages for persons with musculoskeletal disease diagnosis has been estimated to be $849 billion, or 7.7 percent of the national gross domestic product.

Beyond these statistics, the human toll in terms of the diminished quality of life is immeasurable. This situation is unlikely to improve in the foreseeable future and will likely be intensified by current demographic trends, including the graying of the baby boomer population, the epidemic of morbid obesity, and the higher recreational activity levels of our elderly population.

Despite these compelling facts, the investment in musculoskeletal research in the United States lags behind other chronic conditions. While musculoskeletal diseases are common, disabling, and costly, they remain under-appreciated, under-recognized, and under-resourced by our national policy-makers.

These data should stimulate increased investment in basic, translational, clinical, and health policy research to delineate the underlying mechanisms of these diseases and their response to treatment. Through such research, novel preventive and therapeutic approaches with potential to mitigate the societal and personal impact of musculoskeletal disease will emerge.
De-emphasis and Lack of Knowledge

Most of our doctors and healthcare providers are not adequately educated in human biomechanics. Physicians may know some anatomy and how to diagnose some injuries, but they don’t know how the nervous system, the muscular system, and the skeletal system interact as a unit. Medical schools have de-emphasized the teaching of anatomy and physiology, and now focus more on pharmacology, high tech testing, and specialization. The majority of physicians in practice today wouldn’t know what to do with a healthy 15-year-old athlete whose parents just want to know what they can do to help keep this kid from being injured.

Human biomechanics is the application of the principles of mechanics to living systems, in this
case, the human body. Much like the orthodontist, who evaluates the alignment of teeth, it is also possible for someone trained in biomechanics to evaluate the human body, whether or not symptoms are present. The muscular system, the skeletal system and the nervous system all interact with each other, and their alignment, balance, organization and function are of paramount importance to people who want to live a long and fruitful life. Imbalances, fixations, and distortion patterns of the human structure will lead to a premature breakdown of joints, tendons, and muscles, which will ultimately affect the nervous system. But there are no physicians looking at the biomechanics of the human body. There is no insurance coverage for the detection and correction of biomechanical faults when there are no symptoms.

Our middle school and high school athletes, for example, must undergo physical examinations before the season begins, but the examiners are medical examiners looking at the eyes, ears, nose, and throat. The only biomechanical test these examiners do is for scoliosis. Because this exam is more of a scan and lacks proper imaging, it’s very difficult for it to be accurate. During these mandatory examinations, no one ever looks at the interrelationship of the muscular systems, the skeletal systems, and the nervous systems of our young athletes. No one is looking at the systems that are the leading cause of disabilities over the age of 50. Might there be a correlation between this gross omission and premature degeneration? Of course there is.

With the increasingly long seasons in high school sports, weight room training, the increased use of technology, like computers, video games, and mobile devices, plus the obesity epidemic in our youth, we can’t even begin to imagine what this world will look like in 25 years if we don’t address the critically important musculoskeletal system. We must become proactive and abandon the reactive-only approach. We need to take action, get biomechanical exams at a young age and work to correct and improve the many postural and biomechanical faults that are found. We must do this long before symptoms and injuries begin.

The greatest resource being overlooked in the journey to “fix” our healthcare system is the energy that lies within each and every one of us. We all have a responsibility to each other to do our part, live a little healthier and strive to cost less during our lifetimes. Paying now instead of paying later is always less costly.

Musculoskeletal Research—NOT

In 2002, when I was doing my radio show, The Sports Medicine Hour, at Rensselaer Polytechnic Institute (RPI), a top engineering school in upstate New York, I had an idea to visit Dr. Robert Spiller, the head of the biomedical engineering department there. I asked if the biomedical engineering department at RPI was in the process of doing any research on the preservation of the human structure. Dr. Spiller said no, but added that he believed that other biomechanical research centers attached to some of the bigger universities were doing some of that research. I told him I’d not been able to identify any schools that were looking at the preservation of the human structure and asked if he could point me in the right direction.

Approximately two weeks later, I received an e mail from Dr. Spiller telling me that, to his surprise, he couldn’t find any current studies. To the best of my knowledge, that sad truth still prevails today. Common biomechanical research studies focus on topics such as materials for prosthetics and robotics, but to the best of my knowledge, they ignore the preservation of the human structure.

I remember a couple years ago when my brother-in-law, a physician, gave me a promotional letter from an orthopedic group on their latest technology with regard to knee replacements. This group stressed the fact that they used advanced technology to insure proper alignment of the new knee and how this helped to ensure longevity in the replacement. My simple question was, Wouldn’t that same logic apply to the knee long before the replacement? If we can help to align knees and pelvises and spines before they break down, preservation of the human structure will have begun.
Early Detection Exams

Colonoscopies, mammograms, stress tests, eye exams, dental exams, yearly gynecological exams, and other physical exams can detect problems before they become serious. The concept is correct, and many physicians now make a living by performing these early detection exams.

But there is nothing even remotely close to such exams in the musculoskeletal world. There are no professions that recommend musculoskeletal exams. In fact, no exams have been developed in this country to look at a healthy person’s musculoskeletal system. On this page we describe and review the Structural Fingerprint® Exam, which is a comprehensive biomechanical exam that identifies biomechanical imbalances, weaknesses, sites of wear and tear, restrictions and other biomechanical defects. An examiner can determine the detailed status of a patient’s postural biomechanics by performing this exam. Then a proactive, corrective set of recommendations can be made.

The goal for every patient, regardless of condition or age, should be to strive to reach his or her maximum biomechanical potential. Once these biomechanical faults are identified, a customized corrective program can be designed to strive for improved postural balance, increased range of motion and improved flexibility. This will give the best chance for long-term musculoskeletal functioning.

I often joke with my elderly patients and say, “They can’t throw dirt on you as long as you’re moving, so keep going”. This truth rings louder and deeper than any of us can imagine. Movement is the key to preserve the ability to move.

How many times have you heard people say, “I’d love to exercise, but I have a bad back,” or, “I used to love to play tennis, but this knee just can’t handle it anymore”? These comments are all too common. As soon as we begin to lose our ability to move and participate in the activities and sports we enjoy, negative (and costly) physiological changes begin to take place.

Weight gain and obesity are the most obvious changes, but diabetes, cancer, and heart disease are not far behind. Combined with our bad habits of eating and celebrating more than we should, the loss of motion in our body is the beginning of the end. The law of life—“If you don’t use it, you lose it”—cannot be seen any more clearly than in the case of the prematurely arthritic American. We’re gaining epidemic status.

When an injury or disability enters your life, our healthcare system is not set up to analyze why you have it and or help you learn what you need to do to restore your body back to normal. Our system merely wants to get you out of the severe state, as quickly and cheaply as possible. If I’ve heard it once, I’ve heard it a thousand times from patients: Wouldn’t the insurance companies save money if they fixed you rather than paying for ultimate surgery? The answer is simple. Of course they would.

When you look at the effect musculoskeletal disease has on other health-related issues, the costs of testing, treatment and disability become exponential. Even though musculoskeletal disease is not a morbidity disease, meaning you don’t directly die from it, the potential for morbidity becomes a much bigger issue because the conditions that cause death dramatically increase when someone loses motion, exercise, and activity. A simple example is the 49-year-old male with a bad back who can’t exercise and is on disability from work. Over time, weight gain, diabetes, and arthritis become a much greater possibility.


Just as the energy industry continues looking for alternative fuel sources, so should the healthcare industry be looking for alternative sources. Here is a list of specializations that demand more interest:
  • Acupuncture
  • Chiropractic
  • Massage
  • Nutrition
  • Homeopathy
  • Naturopathy
  • Reflexology
  • Auricular Therapy
But our political system gets in the way. Because the lobbyists with the most money have the loudest voices, no alternative healthcare provider can come close to spending the money that the medical and pharmaceutical interest groups have to spend. The money is in acute care, not corrective or preventive care. The solution to the healthcare crisis in the U.S. lies in corrective and preventive efforts. Therein also lies the conflict.

Approximately eight years ago, I met with the chief of medicine and the CEO of our local hospital to discuss the possibility of moving my office into the hospital. Both officials were looking at the potential merger solely from an economic perspective. I met with them on several occasions to discuss the goals and protocols that we used in my office. I told them how we change people’s lives. After several weeks of negotiations, however, the hospital executives decided that the model of healthcare that I practice was not complementary with the model they were looking for. “We need to expand our acute care model”, they said. “That’s where the money is.”

Lesson learned.

Three Stages of Degeneration

Dr. William Kirkaldy-Willis, a world-renowned orthopedic surgeon, wrote an excellent book, The Management of Low Back Pain, in which he discusses in detail the three stages of spinal degeneration (see Figure 1). The first stage typically occurs during the first 25 years of life and is called dysfunction. Dysfunction includes the typical injuries and physiological responses that occur from injuries, stresses, physical activity, poor postural habits, etc. The body naturally responds to all of the above, and there are specific treatments, exercises, and preventive measures that will help to reduce our dysfunctions. In addition, there are specific treatments and exercises we can do to arrest the destructive physiological changes.

If we ignore dysfunction, the second stage of degeneration arrives prematurely. This is called instability, and it occurs significantly between the ages of 25 and 55. This is the time when many would-be athletes or exercisers bow out of specific sports or activities because of a bad knee, a bad hip, a bad low back, etc. They say, “I used to be able to do that.” This is also when costs begin to soar. Because pain meds and treatments are more expensive than they need to be, activities and exercises begin to seem harder on the aging body, and all of the other costs of healthcare take a major upswing. People begin to gain weight, and diseases and conditions like heart disease, diabetes, obesity, arthritis, increased cholesterol, high blood pressure, anxieties, and sleep disorders begin to increase.

The third stage of degeneration is to be expected after the age of 50, as nothing corrective has been done during the first or second stages. The third stage, stabilization, is inevitable. We might also call this the “rusted up” or “degenerated” stage, or use any other phrase that describes mechanical negligence under long- term stress. The body’s natural response is to break down, rust up, stop moving properly, and lock up. What causes these things? They’re just what happens to the human body. As we age, we move less freely. Our joints become fixed. We lose mobility. The loss of mobility in a joint creates an irreversible situation. But the goal in our society that sees only symptoms is merely to relieve pain, so doctors prescribe joint replacement surgeries, daily pharmaceuticals, palliative (and limited) care with the physical therapists or chiropractors. What we get is an extreme loss in the quality of life.

This is what occurs in the profit-based, medical model system we’re living with.

Ironically, according to Kirkaldy-Willis, during this degeneration process, the symptomatic picture doesn’t mirror the degeneration process (see Figure 2). We can see, especially during the first two stages of degeneration, that the symptoms are minimal or absent much of the time. But we have a healthcare system that addresses only symptoms, and insurance reimbursements are shrinking, yet the degeneration of the human body is continuous and doesn’t take periods of rest as the symptoms appear to. Our system will only pay while the patient is symptomatic, so by the time the symptoms have been treated and the patient is released from care, with or without improvement, technically speaking, he is more degenerated than when he started treatment.

No comments:

Post a Comment