FUTURE of MEDICINE

The current system of Health Care in the United States is broken!

The current system of Health Care in the United States is broken. Physicians are overworked, overstressed, with an aging patient population and are seeing more patients per day while trying to pay increasing malpractice insurance fees and with declining revenue from third party payers and Medicare. In some states surgeons are going on strike because of the rising cost of malpractice insurance and inability to even get insurance. Trauma centers have been closed and Neurosurgeons and Ob- Gynecologist in some areas are non- existent. In Pennsylvania, a statewide shut down of medical practices was narrowly averted when the new governor promised tort reform and a decrease in medical malpractice fees. Furthermore doctors are changing professions when dissatisfied with their career choices in increasing numbers, or are going on disability for rather minor health problems. Physician burnout is on the rise and drug abuse by doctors is becoming more of a problem.

Patients are dissatisfied with the current system. Their HMO’s are restricting care, making referrals to specialist difficult, and appointment time with their primary care provider shorter and more confrontational. In increasing numbers, they are turning to alternative health care providers such as chiropractors, acupuncturists, message therapist, colonic therapist, health food store clerks and even seeking medical advice from their beauticians.

In 1993 David Eisenberg’ MD published in the Jan 28th New England Journal of Medicine that year, that a sizable portion of the public was using alternative medical providers. The surprise was in just how large a portion this was - one in three, or 33% of the population -- and the amount of money this group spent out-of-pocket -- more than 10 billion dollars, exceeding what was spent on all hospital visits throughout the country. This was ten years ago, and obviously, the proportions have grown. Motivated by this startling fact, established medicine jumped on the band wagon by starting alternative programs in their hospitals and medical centers, and programs for medical students in the medical schools and courses for mainstream physicians.

In the Journal of The American Medical Association (JAMA) of April 15, 1998, was an article on the incidence of serious and fatal adverse drug reactions in hospitalized patients. This study indicated these reactions represented between the fourth and the sixth leading cause of death. These startling statistics did not include information on many patients who are taking medications at home.

Regina Herzlinger, Nancy R. McPherson Professor of Business Administration at the Harvard Business School has been analyzing health care for 25 years. She has written a book, Market- Driven Health Care – Who Wins, Who Loses in the Transformation of America’s Largest Service Industry (Addison-Wesley Publishing Company, Inc. 1997).

Ms. Herzlinger envisions the consumers as a predominant market force in the shaping of the healthcare system. The healthcare consumer of today is well-educated, assertive, pragmatic people who are unhappy with the managed-care movement. Employers are paying for a large share of the healthcare bill also represents a significant force. Professor Herzlinger believes the notion that some third party knows better than the physician how to provide healthcare is ridiculous. She goes on to state that doctors will eventually experience a reaffirmation of the patient/ doctor relationship and will assume responsibility for delivering healthcare, as they deem appropriate.

The public long tired of their dependence on prescription drugs and surgery had since the seventies became enamored with self- help health care and nutrition. By the eighties alternative and nutritional guru’s like Jonathon Wright MD and Andrew Weil MD were publishing books. Acupuncture, homeopathy, and naturopathy were gaining strength and acceptance. By the late 1990’s Andrew Weil MD became an alternative medical icon along with Depoke Chopra MD and Dean Ornish MD. Unknown to many of the general public, the real break through in healthcare innovation began in the Northwest by a biochemistry professor who was a protégé of the late Linus Pauling.

Starting in 1982, Jeffrey Bland PhD. a Professor of Biochemistry at Puget Sound University in Tacoma Washington began an educational program for some healthcare providers with lectures and a monthly audio- tape series called “Metabolic Update.” Nutritional, biochemical and new developments in medicine were reviewed and put into a context that a health practioner could put to work in their practices This grew with an ever larger subscription audience and evolved into “ Preventive Medicine Update” and finally into Functional Medicine Update.” Functional Medicine” was chosen instead of “Preventive Medicine “a term that became synonymous with public health care.

The term "functional medicine" was coined in 1993 to describe the integrated medicine of the future. Functional medicine links research in basic sciences with emerging options in clinical care to create safe and effective treatment of complex, chronic medical conditions. It is a patient-centered approach, yet it can be successfully incorporated into today's complex managed care/managed cost environment. A combination of elements comes together in the functional medicine model:

A new book was written by the Committee on Quality of Health Care in America at the Institute of Medicine in Washington DC entitled Crossing “The Quality Chasm; A New Health System for the 21st Century.” To summarize, “fundamental change is needed in the American healthcare delivery system. Strong evidence indicates that Americans are frequently not receiving care that meets their needs. Quality concerns are now the leading cause of illness, disability, and death. Care is often provided without complete knowledge of the patient’s condition, medical history, services provided in other settings, or medications prescribed by other clinicians. Studies of patient experience the health system for some is a nightmare to navigate.”

One of those solutions is to now embrace “Functional Medicine,” Twenty- first Century Medicine Today. Why, you may ask is Functional Medicine any different from the conventional practice of medicine or alternative medicine?

Functional medicine is the most comprehensive form of medicine ever developed. It is based on the understanding that every human being is biochemically unique, and it addresses health and illness on the genetic and cellular levels, as well as on the level of organs and organ systems. It allows truly personalized diagnosis and treatment, and optimal wellness.

· Functional Medicine incorporates the best techniques and therapies from both mainstream and alternative/complementary medicine. It utilizes nutritional and supplement approaches to staying healthy, as well as cutting-edge diagnostic and therapeutic modalities such as gene testing and bioelectromagnetic therapy.

· Functional Medicine is a science- based field of health care that emphasizes “ patient care” rather than” disease care, ” following Sir William Osler’s admonition that “ It is more important to know what patient has the disease than to know what disease the patient has.”

· Functional Medicine emphasizes the dynamic balance of internal and external factors.

· Functional Medicine examines web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without affect on each other.

· Functional Medicine views health as a positive vitality – not merely the absence of disease.

· Functional Medicine looks at the promotion of organ reserve as the means to enhance health span.

Individualized Medicine of the Future
In summary, the medicine of the future will be built upon the concept of biochemical individuality, that no one patient is the same as another and that each patient's biochemistry is unique. The emphasis will be on prevention of dis- ease and not on treating every symptom with a pharmaceutical agent after a 15 minute office visit. Patients will need to be self educated by visiting web sites such as Revolutionhealth.com with quality information on nutrition, alternative therapies, and conventional medicine, both diagnostic and therapeutic. Armed with this information, the patient's will benefit from their visit with their physician as a proactive, well educated medical consumer.

In the near future, regenerative medicine by means of bioelectromagnetics or stem cell therapies will become commonplace. Minimally invasive surgery will totally eclipse incisional surgery and the advancement of NOTCH endoscopic surgery using natural orifices via the stomach will begin to replace laparoscopic approaches.