Saturday, February 20, 2010

Prevention vs. Treatment

The global recession was a horrific experience for many people across the planet. The realization that spending beyond your means is a dangerous game with dire consequences was a harsh return to reality for many people throughout the developed world.

Now, more than ever, if I suggested that your current spending was putting you deeper and deeper into a debt that you would have to spend the rest of your life repaying, you would probably rush to your financial planner and reorganize your budget.

So why are obesity rates across the developed world increasing? Why are we so comfortable with the idea of eating ourselves to death?

If most would agree that it is better to stay out of debt than to spend a lifetime repaying debt, why do we not see that overeating is analagous to going into debt and that that chronic illness like diabetes and ischemic heart disease from atherosclerosis is analagous to spending a lifetime repaying that debt?

It is because when it comes to their health, most people lack foresight. Many feel that they can just take medication when they are sick. They don't care to exercise and eat healthy so that they won't need the medication in the first place.

In many ways I understand this thought process. I might even support this behaviour if we actually had pills that would cure disease with no costly or chronic side effects. Unfortunately, that is not the scenario that is available to us. Metformin and glyburide do treat diabetes, but they are not a cure. Diabetics are still chronically ill and face a decreased quality of life despite the availability of diabetic medication, which they will have to take for the rest of their lives. As for atherosclerosis, once your arteries are clogged with fat, your heart will not function to its full potential...ever, regardless of how much nitro you take.

Ignoring prevention in favour of therapy is not solely the fault of patients (it is still mostly their fault; after all, you should take responsibility for your own body and health!). Physicians tend to focus on treatment; they spend significantly more time with the already sick patient than they do with the healthy patient who will be sick in the future if nothing is done now.

I attribute this phyician focus on treatment partially to physician training and mostly to the health care system. Medical school focuses on teaching us how to heal the sick much more than it focusses on how to prevent the healthy from becoming sick. This may be unavoidable because you absolutely need to ensure that your doctors know how to heal the sick and there are so many diseases out there it already takes at least 6 years of training to become competent enough to practice medicine. Does that mean we need another set of health care professionals working on prevention? Or maybe we should have a new specialty physician who focusses on prevention?

The health care system has a role to play in physician interaction with patients because MSP, the government organization that pays physicians for their services, does not provide much financial compensation for preventative treatment. I don't want to get into an argument about how much doctors should/should not care about finances when they are the ones entrusted to care for the sick, but realize that human nature will motivate anyone to act in a manner that maximizes their profit to effort ratio. If we want to see doctors spending more time on prevention with patients, maybe the health care system should value prevention more.

In the end though, as I have already said, you can't blame your doctor or your health care system for making you fat if you are the one eating poorly when you know better... and in this country, most people do know better.

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