Economies and government coffers are groaning under the load of escalating medical and healthcare expenditure. Some medical authorities claim that many of the thousands of Australia’s medicare funded procedures are useless and even harmful. The health minister has announced a review. There are solutions but they just might lie elsewhere than where we are looking.
The problem is not new. In 1974 philosopher Ivan Illich, in Medical Nemesis, argued that modern technological medicine was causing much harm and alienating us from a proper understanding of our health issues. He predicted spiraling costs, in financial and wellbeing terms. Since then many critics have complained that the medical enterprise goes about medicalizing more and more human experiences that are just ‘a part of life’. Some see this as wonderful progress, but there is no doubt there are heavy costs.
Tens of thousands of people with sore backs are being subjected to high-tech scanning followed by surgical procedures that mostly don’t work. Similar numbers receiving knee arthroscopy every year do not get any better result than a placebo would give, according to leading surgeons on ABC television’s 4 Corners program (Sept, 2015). For decades antibiotics have been grossly over-prescribed to adults and children, with dangerous consequences.
In cancer medicine there has been progress towards cure in some of the more rare cancers. With the commonest cancer types, particularly when the disease has spread, the regimes of expensive, invasive treatments used have not resulted in significant improvements in survival over recent decades. Few studies are done to compare the results of aggressive, expensive treatment to cautious, minimal treatment.
Every area of healthcare suffers these problems. Could some of these money drains in healthcare be due to a failure to look with open mind at novel, low-tech, inexpensive possibilities?
Australian author and cancer survivor Dr Ian Gawler talks of an ignored area of promise in his writing and public and private talks, that of ‘remarkable recoveries’ – people who recover when the best medical opinion suggested they were terminal or incurable. His own experience in the 1970s was of “terminal”, metastatic osteosarcoma, with a prognosis of less than a month to live. The months stretched on and on while he married his partner and undertook a disciplined self-help, lifestyle based healing regime. Today it is approaching 500 months survival (recovery) and he has established a foundation for cancer patients, written books and still runs retreats and seminars.
And Gawler’s question that might help with our healthcare crisis: why aren’t extraordinary survivors like him and others studied in depth? He has expressed astonishment that cancer specialists he talks to show so little curiosity about the many documented cases of ‘remarkable recovery’. What might it reveal if a fraction of the massive cancer research budgets went into study of the biology, psychology, habits and responses of these people?
One researcher who has taken on this unpopular line of study is Kelly Turner PhD, a psychologist working with cancer patients. Her book Radical Remission (2014) examines over 1000 cases of people who have defied a serious or even terminal cancer diagnosis with a complete reversal of the disease. Turner found a number of common factors running through these cases, particularly in the areas of attention to diet, stress resolution, emotions and spirituality. Not just ‘good luck’ but things that the person can choose to examine and address.
However Turner’s work is not the sort that doctors and their educational programs respond to; not a Randomised Controlled Trial. It sits on the sidelines – brilliant work, fascinating, challenging and screaming for further research. It is an elephant in the room, bellowing at medical associations, Medicare and governments that we could manage and cure some serious illnesses in low-tech, inexpensive ways. If only we could shift our mindsets and redirect some serious research priority.
No doubt powerful medical-pharmaceutical interests don’t support turning attention to lower-tech, lifestyle type therapeutic approaches. That is an issue – the problem of who makes money out of managing our health. Doctors too fear being sued and may believe that most patients want them to “do everything you possibly can”, so they over-order scans, tests and procedures.
Nature did give us an immune system and an array of body-mind processes oriented to healing, and restoring balance. We learn little about supporting these functions though, neither from doctors nor medical media releases, beyond the very standard, limited messages of don’t smoke, exercise and eat sensibly. But if I believe those surgeons on the recent 4 Corners show who outlined the excessiveness of many high-tech interventions, there must be millions of patients who could have made a gradual recovery or accommodation by doing far less and being patient. Such a process happened for me several years ago.
In 2010 I developed two ‘frozen shoulders’. The pain was excruciating with movement restricted to very little in all directions. This was the full-blown, nasty ‘frozen shoulder’, diagnosed as adhesive capsulitis, with small tears in several tendons and an out-of-control inflammatory, adhesive process.
The orthopedic specialist offered two kinds of surgical intervention: capsular release in which the joint capsules are cut, or a procedure in which he would forcefully manipulate the joints while I was under full anaesthetic. From his point of view these were the two options I had, and many people would doubtless choose one.
I determinedly asked a lot more questions as is my custom in health matters, and discovered that a third, quite viable option was to do nothing and wait. Most cases, he told me, do come good over about two years. The downside was that the pain might remain severe for three to six months. The upside was you avoided the possible intervention side-effects of broken bones or irretrievable damage within the shoulders. The ‘do nothing and wait’ option looked pretty okay to me.
After two years one shoulder was almost completely better and the other 70 or 80 per cent better; good enough. There are some things I can’t do and I can adjust to that change. The pain was awful for six months. I managed it the best I could with meditation, massage, sparing use of panadol and my DVD player – comedy and laughter in the middle of the night helped. It all cost me a moderate amount of money while costing the medicare system very little. Choosing one of the orthopedic procedures may have gone well or it may have become an expensive disaster – there are such case reports. I will never know.
Can we create a culture in which we are sparing and wiser in our use of expensive, high-tech interventions? It will take fundamental changes, in fact a medical revolution:
(1) Study and learn from the remarkable recovery cases from all diseases, not just cancer. Too often these reports are tucked away in letters in medical journals and written off as ‘unexplained remissions’. If corporate funding can’t be found it should be made a highest priority in government funding and charitable fund-raising. This field could be made exciting, prestigious and sexy.
(2) Learn to harness ‘placebo power’. We are told many commonly used operations and treatments work no better than placebo; then let’s use placebo more. It’s cheap and it won’t kill you. Placebo essentially means confidence and faith that you are doing what needs to be done, whether that is associated with a pill, procedure or a lifestyle change. We must learn what it takes to have our minds work with our healing, which leads to …
(3) Attitudinal therapies – meditation, mindfulness and related strategies need to find a bigger place in medical care. A body of research shows them to have great value for a range of conditions. They work as anti-stress and anti-anxiety therapies, and as such can help with the many conditions that are worsened or caused by these factors. In the same vein laughter and humour has great therapeutic potential – there are case histories and research suggesting it can initiate recovery from serious illness. This was predicted several thousand years ago by the writer of the book of Proverbs in the Bible (probably Solomon):
“A merry heart doeth good like a medicine, but a broken spirit drieth the bones”.
We need to improve at identifying which patients are good candidates for using attitudinal therapies as their frontline treatment rather than as an optional extra. Meanwhile doctors who see medicine as an art as well as a science use them, but you are lucky if you find such a one.
(4) Exercise and nutritional therapy have the capacity to be the main treatment for many conditions, from heart disease to depression, especially when combined also with mindfulness training. This combination, with other factors, can be called ‘Lifestyle Medicine’. Currently in most medical thinking and therefore in media presentations they are just an extra, with drug and and surgical treatments way at the forefront. The cost of this imbalance may be harm to many patients.
All of the above are tools to enhance the ‘do nothing and wait’ approach; to turbo-charge it. Of course it is not ‘do nothing’ at all, but it may seem like that to a doctor or patient who believes that high-tech or aggressive interventions are the only real medicine. This attitudinal shift might be subtle but is truly a revolution in medical thinking, education and messaging to the public. It seeks to integrate the best of older, traditional knowledge with the cutting edge science of the future. How many medical students are taught anything of the value of minimal treatment, patience and working with nature?
Can this revolution pick up steam? It has been simmering, gently bubbling for decades. Now and again I have made my own tiny contribution to it like lecturing to medical students at Monash University in the 1990s. The forces arrayed against it are imposing. Radically improved public health and health resilience is against the interests of many people and organisations in the medical-pharmaceutical conglomerate system, those who provide continuing professional education to doctors.
And yet even in this essay several stories highlight that nothing is impossible; extraordinary things happen. A small Indian man of meagre resources, Mohandas Gandhi, step after step with fierce resolution, mobilized the whole of poverty-striken India to seize independence from their British rulers in 1947. From Mandela to Martin Luther King we see hugely committed people who prevailed against mighty powers and vested interests.
Every new person who learns more about their own potential for health adds to an impetus for transformation that may yet prove unstoppable. It could take just one ‘Gandhi’ of the medical world. More likely it will be thousands, then tens of thousands of professionals and patients being willing to channel a little of Gandhi or Mandela whenever they face arrogant thinking and over-commercialization in the healthcare system.