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.
Alternatives
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.
