Does Medicine Make a Difference or Impact?
Does medicine make a difference?
We all know the person who spends every waking moment focused on staying healthy; making sure they eat well, get the right kind of exercise, get proper sleep, avoid unhealthy habits, keep unhealthy stress to minimum, follow all the recommend guidelines for preventive care and vaccinations, and so on. In fact some of us are that person.
We are all going to die whether you take meticulous care of your health or totally neglect it. Medicine gets the worst results of any industry or profession. We have a 100% mortality rate.
In some ways it’s hard to argue with the person who says, “Screw it” when it comes to living a healthy lifestyle. But there is a way to respond to that person that I will mention later.
So does medicine make a difference?
One way to answer that question about how much health care or medicine matters, is to ask this question. What is the impact of having no access to healthcare on premature death? You would think premature deaths would rise, possibly skyrocket in the absence of healthcare. But do they? I will come back to that.
Looking at data on life expectancy and premature death and the impact of medicine has led me to this final analysis or conclusion. Medicine follows Pareto’s Principle
Pareto’s Principle
For those of you unfamiliar with the Pareto Principle or the 80/20 Rule, it means that 80% of the consequences or outcomes come from 20% of the causes. The principle can be applied to nearly everything including the economy, investments, farming and crop yield, and coaching.
Here are some examples of Pareto’s Principle
- Some coaches will spend 80% of their time with the 20% of the athletes that will have the most impact on a team’s success.
- 80% of profits come from 20% of products. The McDonald brothers noticed this and trimmed their menu to just a few items.
- We only wear 20% of our clothes 80% of the time.
- 80% of increase in investment portfolio comes from 20% of the investments.
Let’s zero more on health.
You do not need to do a thousand things every day to stay healthy, just five or six good habits, practiced daily, will take care of about 80% of your health needs.
Regardless of a physician’s specialty, about 80% of any specialty revolves around five diagnoses. The goal is to get very good at managing those five diagnoses, and you will provide excellent care to 80% or more of your patients.
About 21% of Medicare dollars are spent on 5% of the patients during their last year of life. That is not exactly 80/20 but it is still a 4 to 1 ratio.
To improve health outcomes, we should zero in on the few things that make the most difference and guess what? We can do that without much healthcare.
The result of our efforts in medicine is this. We help a small number of patients much, we help many patients a little, but we also hurt some patients along the way.
Now how did I come to that conclusion?
The pathway to good health is more behavior determined than related to healthcare and its interventions. We seem to want to credit healthcare anytime we see life expectancy go up or improvement in quality of life, but much of such improvements are more behavior driven and the result of public health measures.
Healthcare has much less impact on the extreme health-conscious person but will potentially haver greater impact on the person who is more neglectful with his or her health. There is more opportunity to intervene with the neglectful person. In a system like we have in the U.S where the emphasis is on treatment rather than prevention, it is the neglectful person on which medicine feasts – because it is more lucrative.
If the extreme health-conscious person lives to be 100, that improves life expectancy numbers, but that improvement is due to behavior and not healthcare.
Impact of No Healthcare on Premature Deaths.
Let me get back to the earlier question. Does medicine make a difference?
What is the impact of no access to healthcare on premature death?
The answer is 10%.
This means that 10% of premature deaths can be attributed to no access to healthcare. In part using previously published data from Mokdad, Schroeder studied factors from five domains contributing to premature death. These included no access to healthcare, genetics, environmental exposure, social circumstance (socioeconomic factors), and behavioral patterns.
Genetics accounted for 30% of premature deaths, environmental exposures accounted for 5%, social circumstances 15%, and behavior patterns accounted for the largest cause of premature death at 40%. And no access to healthcare accounted for the remaining 10%. And behavior patterns caused 48.2% of all deaths.
Behavior patterns included drug use, alcohol use, motor vehicle accidents, guns, sexual behavior, physical inactivity/obesity, and smoking. If we look at just the behavior pattern factors, smoking accounted for 18.1% of all deaths but 44% of premature deaths, inactivity/obesity accounted 16.6% of all deaths and 37% of premature deaths, alcohol 3.5% of all deaths and 8.6% of premature deaths, and lesser percentages for the other factors.
Some Cold Hard Facts
Here are other cold facts.
Despite being one of the wealthiest nations, the United States ranked 31st in the world for life expectancy at birth in 2015 despite ranking first in the world for healthcare expenditure. Our system has focused on new drug discovery and disease treatment rather than prevention.
Healthcare spending is not factor in determining life expectancy. We seem to think throwing money at a problem is all we need.
A more recent meta-analysis of 15 studies on 17 countries estimates that 60% of premature deaths could be attributed to unhealthy lifestyle factors like smoking, excessive alcohol consumption, physical inactivity, poor diet, and obesity with a healthy lifestyle increasing life expectancy from 7.4 years to 17.9 years (varied by country).
How many drugs are going to add nearly 18 years to your life expectancy?
All of this seems to support this notion that medicine or healthcare follows Pareto’s Principle. If our goal is to improve life expectancy, we should focus more on behavior than medical treatment.
We spend 18% to 20% of our nation’s GDP on healthcare. Healthcare is the single biggest item we spend money on. It’s debatable they we get our money’s worth when considering behavioral changes are not expensive.
Why don’t we focus more on behavior than treatment?
It seems such an obvious conclusion that we should, yet we don’t. In my opinion, I think the fact that we focus more on medical treatments reflects the firm grasp Big Pharma has on healthcare and medical education/training.
What Do Patients Want?
Let’s go back to the extremely health-conscious person. What is that person really looking for? What is the result of his/her effort to stay healthy?
What do patients want? What should be the ultimate goal of medicine?
I can distill that one goal into one word and that word is ENERGY. That is what the person who is meticulous with his or health habits is trying to do. Make and maintain a high level of energy.
When you have energy, you simply feel much better. You can do more. You want to do more. You find yourself in an upward spiral when you have unlimited energy. Living is much different when you have boundless energy. It is more enjoyable. You look forward to the next day and the opportunity that awaits.
Problems seem smaller, you brush off stress easier, you can do what brings you the most joy in life longer when you have energy. You live longer giving you more time to spend with close friends and family and more time to influence those who matter most to you.
With energy, you have more time to make a difference, more time make an impact, more time to experience all that life offers.
That is what we should say to person who is inclined to say, “Screw it.” Even if you don’t live one day longer, the days you do live will be more impactful and enjoyable.
You may not recognize it or articulate this way but what you want is ENERGY. Life literally stops the moment your body no longer produces energy.
Does medicine make a difference in your health? Yes, to some degree, but you are the real difference. Take charge of your health. Exercise and nutrition that is where the differences reside.
References:
- Schroeder, MD, Steven A. We Can Do Better- Improving the Health of the American People. The New England Journal of Medicine, September 20, 2007;357:1221-1228
- Mokdad, AH, Marks, JS, Strop, DF, et al. Actual Causes of Death in the United States, 2000. JAMA. January 19, 2005; 293(3):298.
- Yanping Li, Pan, An, Wang, Dong D, et al. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. Circulation. April 30, 2018;138:345-355.
