Doctors and Deer in the Headlights

I had an interesting experience yesterday. I went to a six hour, state-mandated training for physicians on recognizing suicide risk factors and treatment of suicidal ideation. And, even though I have mixed feelings about the legislature dictating requirements in medical education (I guess it’s inevitable, but should be kept to a minimum. I believe physicians should be able to self-regulate for the highest good of patients.) it was really quite good. Did you know that over ninety percent of people who survive their suicide attempt change their minds and live on until they die of other causes? And that most suicides are theoretically preventable? Henry Ford Health Systems, a local HMO in the Detroit area decided that the acceptable number of suicides in their patient population was zero and they did staff training and made policy and organizational changes and actually achieved a zero suicide rate for two years so far.

Anyway, what I found interesting is that when the presenter was talking about using antidepressants to treat people under 25 years of age, they are known to actually increase anxiety, agitation and suicidal thoughts. Everyone in the audience already knew this, but when it came to talking about what else to offer these young people as treatment, everyone, including the presenter, looked like deer in the headlights. All he had to offer was to educate the parents that these were known side-effects of the medications and, though they may theoretically increase the number of teen suicides, untreated depression also increases the risk of suicide.

There was no talk about that, well, if kids are getting depressed this young, maybe there is a genetic component and they should have their methylation status checked. No talk about other treatments for depression such as L-tryptophan, 5-HTP, SAMe, homeopathy, acupuncture, removing food reactions, healing the microbiome, relieving cranial restrictions…nothing like that. It was astounding. There were probably a hundred doctors in the room, all intelligent, caring people, yet they were so restricted to only pharmaceutical solutions, that they would stand by and let their patients die rather than research and recommend other options. Of course, they referred to mental health specialists for family systems or psychological problems.

I think that the take-home message for you, the medical consumer, is to know that, no matter what issue you go to them for, conventional doctors are the way they are, and protect yourself. Know that most of the advice you get from them likely comes from that pharmaceutical perspective. Know that there are always several different treatment options for any given person having a given condition. Don’t take a treatment that you are uncomfortable with until you have explored your options. Trust your gut regarding what you are comfortable with. Look into what may be offered for you by integrative medicine, functional medicine, Chinese medicine, mind/body/energy medicine, naturopathy, homeopathy, chiropractic. There are lots of options so you are very likely to find some that are effective and safe for you.

And, of course, Integral medicine has an approach to help people who are at risk for suicide. More about that later.

New Hope for Head Injuries

If you have had a head injury, or what medicine calls a “traumatic brain injury” (or TBI), medicine has had very little to offer you in the way of treatments to improve your chances of recovery…until now. Newer understanding of what goes on inside your brain and its blood vessels when it gets injured has led to the development of some very effective Functional Medicine and Physical Medicine treatments.

Normally, your brain is kept in a much protected, pampered environment. It is covered with a fine, delicate membrane closely applied to all of its convoluted surfaces, floating in a very specific fluid, called cerebrospinal fluid, and encased by a tough fibrous membrane that lines the inside of a hard, boney box called your skull. Even the blood vessels in your brain have a special lining to them that only lets in what the brain needs and keeps everything else out, especially the body’s inflammatory process. This is called the blood-brain barrier (BBB). Tensions in the membranes around the brain or restrictions in the bones of the skull can have a big influence on how the brain works.

When you hit your head, whole cascades of changes start happening. Like shoes in a shoebox when you shake it, the brain can slosh around inside the skull and bang up against the hard, bony barrier, bruising the delicate tissues. The BBB gets disrupted and inflammation can start to develop in the brain. This further breaks down the BBB and a vicious cycle gets started. This is why some people can have more brain dysfunction a month or two after a head injury than right away. It also slows recovery. With repetition and over time, these changes can lead to chronic traumatic encephalopathy (CTE).

To effectively treat head injuries and post-concussion syndrome, the injured brain needs to heal, the BBB needs to be re-established, and the tensions and restrictions in the membranes and bones need to be released. Ideally, it all needs to happen at the same time. A combination of functional medicine and Cranio-Sacral therapy can do this.

Jack was a ten year old boy who hit his head during a car accident two months before I first saw him. He was referred to me by his physiatrist because he continued to have a headache and double vision to the point where he couldn’t read to do his school work. The physiatrist had him on an excellent functional medicine protocol for head injuries that helped his memory, but the headache and double vision persisted. The optometrist was wanting to fit him with prism glasses but the physiatrist and his mother wanted to try a course of Cranio-Sacral treatment (CST) first.

We did have a working hypothesis to explain his double vision. There is a double-layered membrane inside the skull that separates your cerebrum from your cerebellum. It forms a kind of trampoline for the back half of your cerebrum to sit on. Three cranial nerves run the muscles that move your eyes. As you can imagine, their movement must be very precisely coordinated in order for your eyes to track together correctly. These three nerves come out of the brain stem and run a short distance between the two layers of the tentorium before entering the back of the eye socket on their way to their muscles. Abnormal tension in the tentorium can affect these nerves, disrupting their fine coordination and leading to eye tracking problems. Anyone with eye tracking problems deserves a good Cranio-Sacral evaluation.

After his third CST treatment, his double vision resolved and he was able to read again. His headache localized to a place in his right temple where several sutures of the cranial bones come together. Another three CST sessions got all of them freed up and his headache also resolved. Incidentally, his older sister had had four concussions over the past few years and was just living with a constant, dull headache. One session of CST resolved her headache.

Traumatic brain injury (TBI), is a big problem in the US. In 2013, there were about 2.8 million emergency room visits, hospitalizations and deaths due to TBI (https://www.cdc.gov/traumaticbraininjury/index.html). Falls, moving vehicle accidents, and sports injuries were the most common causes. Sadly, in children under 4 years old, assaults are the leading cause of TBIs. TBIs can range from very mild, with no long-term adverse effects, to fatal. The more severe the TBI, the more likelihood of long term effects such as memory loss, emotional swings, learning problems, headaches, dizziness, sensitivity to light and sounds, neurological deficits, and such.

Most medical treatment of TBI is focused on treating the symptoms caused by it (http://www.msktc.org/tbi/factsheets/Emotional-Problems-After-Traumatic-Brain-Injury), but this new approach works to heal the brain and BBB so the symptoms just naturally resolve. Not all brain injury is traumatic (https://www.psychologytoday.com/blog/professor-cromer-learns-read/201203/after-brain-injury-the-dark-side-personality-change-part-i), and not all brain injury can be healed, so having these coping and supporting treatments can come in handy (https://www.brainline.org/people-with-TBI), but more healing is possible than we, as a society, are accessing.

Just learning to cope with the long-term changes caused by TBI isn’t your only option anymore. There is now much more hope for healing from concussions and other head injuries than the medical literature would lead you to believe. Anyone who has experienced a head injury or concussion deserves a good CST evaluation and functional medical support. This combined approach can help speed brain healing and decrease the number of long-term adverse effects of TBI (personal clinical experience). I now offer this complete service in my practice.

The combination of specific functional medicine concepts with Cranio-Sacral therapy can give you the best chance for healing. If you have had any head injuries and you suspect you may still be experiencing any effects from them, there is new hope. Please come in for an evaluation. If you know anyone who has had a head injury, spread the hope: please pass this along to them. I appreciate the chance to help them, too.

Why I Don't Support Medicare For All

I’ve been an advocate for universal healthcare since the ‘70s when I first became aware of such issues. But Medicare for all is a baaaad idea. There are better ways to achieve universal coverage and cost containment. Our federal government cannot be trusted with something as important as healthcare. A perfect example is Trump’s recent unilateral decision to stop paying insurance companies their cost sharing reduction subsidies, causing insurance premiums to soar for millions of people. Just think what he would do to a federally-run single payer system!

Even though there are government run single payer systems in other developed countries, such a system in the US would be a total disaster. Why? Those other systems work in countries where the federal government has the best interest of the people at heart. We have no proof this is the case in the US. Our federal government has the best interest of corporations at heart. (And, even though corporations are people (right?), that’s not going to help you any.)

For example, during the G.W. Bush years, he passed a law prohibiting Medicare from negotiating with drug companies for better prices. That’s pretty blatant. Drugs are so much cheaper in Canada because their medical system negotiates for better prices. (By the way, you can take advantage of that by having the prescriptions you have to pay out of pocket for filled through an on-line, mail-order Canadian pharmacy. Still perfectly legal. Bush tried to make that not so but couldn’t get it through.)

And when have you ever seen a government social program that wasn’t chronically under-funded? With the current conventional medical mindset dominating medicine, there is no way that we would not have rationing of healthcare. And the first to go would be anything conventional medicine considers alternative, the next would be the “less necessary” surgeries, such as those for pain from herniated discs. MRIs and expensive blood work would be regulated and more patients would be harmed and more physicians would get sued for missing diagnoses they couldn’t make because they couldn’t get the tests run.   

How could such a system be protected by the vagaries of whatever administration was in power? What would Regan, the Bushes, and Trump have done to such a system if it were already in place when they took office? What would happen to it if the radical right continues to gain momentum?

A single payer system would stifle medical innovation. If Ma Bell hadn’t gotten broken up, we’d all still be using rotary dialing.

Supporters of Medicare for all are also using funny numbers to support their arguments. They say that Medicare is so much more efficient than private insurances, with a 2-4% overhead compared to the 20-26% overhead for private companies. But that efficiency is achieved because they farm out most of the work to administer their plans to the private companies. And what they pay the private companies for that work is not included in their administrative overhead.

On the possible plus side, with a single payer system, it is easier to see that real wellness and prevention makes sense. It may motivate major societal changes, such as stopping the taxpayer subsidization of junk food, decreasing air and water pollution, outlawing cigarettes, taking real steps to make the workplace less stressful, expand parenting classes, and other such measures. But these advantages can also be gained by other ways to achieve universal coverage and cost containment that are not dependent upon the government. I have blogged previously about such a system.

So, please, give the matter some careful thought. If we adopt Medicare for all, we’d be jumping from the frying pan into the fire. You deserve better.

How to Practice the Ideal Medicine

How Integral Medicine is put into Practice (Please read the blog post "The Ideal Medicine" first. Thank you.)

As I said, Integral medicine is my attempt to give you this ideal medicine. Many people have similar ideas about the ideal medicine. The problem has been, “How to put these ideals into practice?” The medical community’s best attempt so far is integrative medicine.

Integral medicine is my version of integrative medicine. I needed to develop Integral medicine as a distinct practice because there are some major problems with how integrative medicine is getting practiced most of the time.

True integrative medicine is more than just sticking a few herbs on the side of conventional medicine. For example, it looks at you as a whole functioning system rather than reducing you to 12 or 13 organ systems. This results in different ideas about how your variety of problems are interrelated, and such. Conversely, integrative medicine is not just any kind of alternative medicine: it must include the best parts of conventional medicine. So most of the alternative practitioners who call themselves integrative practitioners are not, really. They can be a member of an integrative treatment team, but they are practicing their own specific alternative therapy. If they are not also trained in conventional medicine, what are they integrating?

The Integral World View

The major hurdle that has made developing a truly integrative medicine so difficult has been the fact that conventional and most forms of alternative medicine are based upon radically different world views. And those world views mix like oil and water. To create Integral medicine, I have utilized a third world view where conventional and alternative medicine can meet as equals and the best of all forms of medicine can be synthesized into one seamless, philosophically consistent system of medicine. This third world view is called the “Integral World View” and was developed by Ken Wilber.

A Scientific Model for a Whole Human Being

The next step to developing your ideal medicine, after integrating all of the valid and effective ideas and treatments about health and disease, was to figure out how to treat you as a whole human being. To do that, I needed a deeper understanding of what that is than is offered by the conventional medical model. I found what I was looking for in the concepts of a human being developed by the ancient Vedic sages thousands of years ago. This view underlies Ayurvedic medicine and yoga. They saw a human as being made up of six aspects that are arranged as sleeves within sleeves, like the Russian nesting dolls. The sixth, or inner-most aspect is pure Consciousness, not consciousness as a neuroscientist uses the word (awake, as opposed to being in a coma) but the Consciousness that underlies all of creation. They also called this aspect of you the “true self”.

A symptom is a clue that something somewhere in your system is out of balance. Understanding how these different aspects, like your body, energy, mind, and beliefs, interrelate helps me understand where the primary imbalance is to be found so that you and I can find the best treatment to get that imbalance balanced.

I like this model because it explains many things that are a mystery in medicine. It explains what your mind is, for one thing, (hint: it is not your brain) and it helps to explain the mind-body connection. It sees your energy as just as real as your body. There are many more advantages to this model of a human being that are too numerous to get into here.

How to get to the Root

The next issue to address in developing your ideal medicine, now that we can use any valid treatment and idea and treat you as a whole human being immersed in a social and environmental milieu, is to get to the real root of your problems.

When you are wanting help for your health challenges, you have two major strategies you could pursue. You could work on changing what has already been created (which is what most conventional and alternative medicines do), or you could find and change the determinants of your creativity so that you stop creating what you don’t want and start creating what you do want. You can also do both strategies at the same time, which is what I generally recommend when you are starting on your Integral treatment plan.

What has already been created is being expressed as your symptoms. So trying to change what has already been created would be to use symptom-oriented treatments. This can be helpful when the symptoms are so loud that they are disruptive to your life. It is okay to treat depression while you are rooting out its cause. It is okay to treat pain while you are rooting out its cause. It is okay to treat your high blood pressure, high blood sugar, asthma, allergies, inflammation, whatever your symptoms, while you are rooting out the cause.

The main problem with effective symptom control is it often removes your motivation to root out the cause once you feel better. But you wouldn’t do that, would you? That is so last century. Besides, if you ever want to get off of your medications, you will have to get to the roots of your problems and treat those. There are reasons you are taking those medications. If you simply stop them, you will be back to where you started. To effectively get off of your medications, you need to put some other supports in place first. If you find and treat the root causes, your problems resolve and you won’t need your medications any more. So, what are the roots?

Consciousness

According to the Vedic model we were just talking about, Consciousness is creative. Every aspect of the physical universe is an expression of some aspect of the infinite Consciousness behind it. This Consciousness is timeless, it is outside the laws of physics. It created those laws. Since every aspect of the physical world is an expression of Consciousness, that means that all of your symptoms and the imbalances behind them are also expressions of Consciousness.

As humans, we have access to this infinite Consciousness, that sixth aspect, our true self. Yet, who do you know is fully expressing infinite Consciousness? I’ve not met anyone like that. So, that implies that something limits our access to this Consciousness and determines what aspects of it get to come into material existence as the experiences and stuff of our life. Whatever that something is, that is the determinants of your creativity. The real roots of your health challenges, whatever they are, are whatever allows those particular aspects of Consciousness to be expressed in your life.

What could do that? The Vedic model gives some ideas that are worth exploring. This is what I experience when I work on someone:

·        The inner-most aspect, pure Consciousness, feels like a core of intensely bright white light that runs up and down the middle of the torso.

·        Around that core of light is the fifth aspect that is totally transparent, like the glass around the flame of a hurricane lamp. This is your inner wisdom, your inner watcher, the wise, loving observer of you living your life.

·        Around that glass sleeve is a sheet of black plastic, totally opaque to the bright white light. This is the fourth aspect in the model, your intellect.

·        There are little pin-holes in the black plastic scattered around it that let little rays of light through. These are the contents of your mind, your beliefs and conclusions.

·        Your mind, energy, and body are then three more sheaths created by the light of Consciousness that makes it through the little pin-holes.

Each little ray of creative Consciousness that passes through each pin-hole creates experiences in your life that are consistent with the belief that is the pin-hole. Beliefs are, quite literally, self-fulfilling prophesies. When you change your beliefs, those little pin-holes move around, allowing different Consciousness through, creating different things in your life.

Beliefs

So your beliefs are the determinants of your creativity. “Man is as he believes. As he believes, so he is.” –von Goethe. (I think the same holds true for women, as well.) “If you think you can, you can. If you think you can’t, you’re right.” –Henry Ford. Our society has understood the importance and power of beliefs for hundreds of years. And, it turns out, you get to choose what you believe, with the right practice.

Since you get to choose what you believe, you can heal. To really work on the root causes of your health issues, you would need a way to find the belief that is allowing that issue to exist in your life and change it into a belief that allows you to create more of what you want. Many therapists and health practitioners understand this, yet developing effective, reliable, teachable techniques to change beliefs has been surprisingly difficult. Some, like Byron Katie’s work, EMDR, Focusing, and Emotional Freedom Technique (EFT), are getting pretty good but there is still room for improvement.

When I looked at why finding and changing beliefs was so difficult, I saw that it had to do with two issues: how your mind works and the Laws of Consciousness. Without going into a big, long explanation, basically, you need a way to get to the hidden beliefs in the nonconscious mind and you need a way to get them aligned with higher truth that works within the laws of Consciousness. I have found a way to do both. And I can teach you.

Inner Wisdom

Actually, you already know how to heal, at least your inner wisdom knows. But since it is hiding out behind that sheet of black plastic, your conscious mind cannot readily connect with it. You first need a belief that you can hear and heed your own inner knowing and that opens up a little pin-hole that makes it possible. You can create such a belief in your mind by choosing to have faith that you can do it.

If you do whatever it takes to connect with your own inner knowing earlier rather than later on your healing path, you will save yourself a lot of work, time and money. Imagine, if the pioneers had worked on inventing the helicopter first before heading west, how much easier their travels would have been.

Your inner wisdom is very smart. Not only is it monitoring all of the physiological processes in your body and keeping them in balance as much as it can, it knows when things get out of balance and sends you a message that it needs your help. Learning how to hear and heed your own knowing is the best preventative medicine. It also knows what it needs to correct the imbalance, so it will direct you to treatments that both work and have a low risk of side-effects for you. I’ve seen people’s inner wisdom direct them to try treatments that neither their, nor my, conscious minds would have ever thought to try. And those treatments usually work miraculously.

So, by putting all of this together: an integral world view so that all of your life can be taken into account with respect to your healing, a broad science so that all valid healing concepts and modalities are available if and when you need them, an expanded model of a human being so that you can get treated as a whole person living a full life, and a connection to your own inner wisdom so that you know how to eat, exercise, play and make other important choices in your life to be in your highest interest, we have a pretty good system of medicine to help you with any issues you face. This is Integral medicine as I strive to practice it.

Now we just have to heal health insurance companies…

The Ideal Medicine

If you could design the ideal medicine to help yourself heal and stay healthy, what would it look like?

Integral medicine is my best effort to offer you the ideal medicine. I have been developing it over the last 30 or so years of my career. Since medicine is a practice (some believe that means that we never quite get it rightJ), Integral medicine is a work in progress. I am always learning new things and thinking about how to offer you better service. I would like to hear what you think would be the ideal medicine for you. Below is what I came up with.

Safety

First, you would want it to be safe. Like Hippocrates said, “First, do no harm.” It turns out that going to a conventional medical doctor for conventional medical treatments is now the third leading cause of death in the United States (http://www.bmj.com/content/353/bmj.i2139). So, conventional medicine, as it is routinely practiced, does not meet this safety criteria. I think we can do better.

Conventional medicine encompasses a wide range of ideas and treatment options, not all of them bad. In fact, some are downright powerful and very helpful. When I broke my ankle, I was thankful there was someone around who knew how to screw it back together. But I was even more thankful that there was anesthesia and sterile technique for the procedure. But, once the surgeon was done, I took over with my nutrition and herbs, affirmations, visualizations, and exercises. I healed quickly and got a very good result.

So, for the ideal medicine, we want to be able to include the tools and techniques of conventional medicine but use them with the proper consciousness and in balance with other support. With carefully considered personalized use, you can receive the benefits of conventional medicine and avoid most of the hazards. I have spent years figuring out how to use conventional medicine this way.

Find and Treat Root Causes

Second, you would want your medicine to find and treat root causes of your problems, whenever possible. Most conventional, and even most alternative approaches, just put you on treatments that suppress the symptoms but do nothing for why the symptoms are there in the first place. I think this is due to the fact that our society in general, and the medical community in particular, has a very incomplete understanding of root causes.

I have some dedicated patients who have helped me understand root causes in more detail. They have stuck with me for years as we have peeled down through the layers of their health issues. These layers have a peculiar property: each new layer, when first it was uncovered, felt like the root causes until, with further exploration, deeper layers were found. We kept searching until the level of pure consciousness was reached. So far, we have not found any deeper layers.

What we have learned is that there seems to be some property of the Universe that I will call Consciousness, with a capital “C”, which is at the root of all of physical manifestation. Some properties of you determine what aspects of this essentially infinite Consciousness manifest as your life. Unless you are working with these properties of yourself and aspects of Consciousness, you are not working with the roots.

Whenever you are working to change things that have already been created in your life, you are treating symptoms. This is necessary much of the time and we are fortunate to have a very large palate of both conventional and alternative supportive treatments from which to choose. But don’t stop there. If you don’t also change whatever is determining what you are creating as your life, you will keep creating more of what you don’t want. Integral medicine integrates this two-pronged approach to your health issues: we use the safest, most effective, most natural treatments to support you while we are searching for and changing the determinants of your creativity. You can stop creating what you don’t want and start creating what you do want. I want your treatment plan to be personalized for you, so please let me know if you want to use this two-pronged approach.

Treat You as a Whole Human Being

Third, try to come up with some aspect of your life that has absolutely no impact or influence upon your health. Most people can’t. So, the ideal medicine would be able to take every aspect of your life into account when looking for causes and treatments. How you eat and exercise impacts your health. How you sleep, how you stress out, your relationships, your work, your play, what you think and believe, the environment around you…the list goes on…they all play a role in your health, and imbalances can occur any place in your system and fields, not just in your body. The ideal medicine would be able to treat you as a whole human being (not just a skin-bag of biochemicals) involved in society and immersed in your environment.

Utilize Every Valid Concept of Health and Healing

Fourth, people all over the world have been thinking about health and disease for centuries and some of them have come up with some pretty good ideas. The ideal medicine would have a place in it for every valid concept and every effective treatment that we, as a species, have so far devised. But, to put this noble goal into practice, two major challenges need to be met. First, we need to figure out how to determine whether or not a particular idea or treatment is valid, and then we need to figure out how to fit all of the valid approaches together into one seamless, internally consistent framework.  

Conventional medicine as solved these problems by being exclusive: it defined what it does as valid and excludes everything else. This strategy essentially ignores the challenges and leads to the exclusion of some very safe, effective, and affordable approaches that we would like to be able to utilize. Integral medicine rises to and solves these two challenges.

Integral medicine is inclusive but, obviously, not every idea can be included: there needs to be some validity to it. One of my students summed it up nicely, “I want to be open-minded, but not so open that my brain plops out onto the floor.”

Validity

So, how do we determine whether or not a medical idea or treatment is valid and effective? The materialist science upon which conventional medicine is based has its ideas about what is valid and what is bogus and it steadfastly refuses to accept the validity of any kind of knowing other than the third-person, objective knowing.

That is a problem because, if you want your medicine to be able to take into account all of human experience, humans can know things three different ways, not just one:

1.      You can know something objectively, by looking at it, examining it, and measuring its physical properties.

2.      You can also know something subjectively, your own impression or personal experience of something.

3.      And, it turns out, you can know something transcendently. You can just sit and think about something and a level of understanding of that thing will come to you. Have you ever practiced that? It is called “contemplation” and is a valued method of teaching in many parts of the world.

The scientific process of inquiry can be applied to each of the three ways of knowing, it doesn’t have to be limited to just the objective; and each way of knowing has its own way of sorting the valid from the bogus. So, your ideal medicine would, ideally, be based upon a broad science of all three ways of knowing, rather than the narrow science of only objective knowing. That would make it more able to take all aspects of your life and experiences into account. Integral medicine is based upon such a broad science.

Integrate all Ideas

So, we’ve solved the first challenge: how to determine the validity of all the world’s ideas about health, disease, and healing. The second challenge arises because these ideas and treatments are so varied, how do we get them to fit and work together? Some of them, Chinese medicine and conventional medicine, for example, come from such different world views that, unless both practitioners know each other’s systems, they can’t even talk to each other about a patient.

But every system of healing so far examined can be placed into one of the four quadrants of Ken Wilber’s integral world view. This integral world view provides the framework that can hold all the different healing traditions. If patients and practitioners are willing to adopt this integral world view and learn a bit about other healing traditions, everyone can get along and work toward the benefit of the patient.

I believe that the Integral medicine that I practice solves these two challenges so that we can bring to bear the best the world has to offer for you to use on your healing path.

Preventative

Fifth, you’ve probably heard the saying, “A stitch in time saves nine.” I don’t know if this has been scientifically proven: in my experience, sometimes it saves a lot more than nine. The point is that prevention is often a better strategy than needing to dig yourself out of the pit once you’ve fallen into it. So, again, you would like your ideal medicine to be focused on prevention at least as much as it does on treatment. “Prevention” to the conventional physician usually means “immunizations”. But there is so much more to real preventative medicine. Learning how to listen to the messages coming to you from your life and taking actions when the warnings are little whispers generally prevents the need for a 2x4 upside the head. You don’t want your life coming after you with a 2x4, believe me.

Participatory

Sixth, if you’re like me, I bet you don’t like being told what to do. I bet you like understanding the reasons you ought to do something and would like a say in the decision-making process. Your ideal medicine would be fully explained to you and encourage you to participate in the decisions and treatments, as much as possible.

Personalized

Also, no one size fits all, so your ideal medicine would be personalized for you, for your unique genetic makeup, your personality, your life. You would be in the driver’s seat. Your practitioners are your advisors, not your dictators.  

A Healthy Delivery System for a Healthy Medicine

Medicine is also dependent upon the social systems used to dispense it. I bet you would also like your ideal medicine to be accessible and affordable. Unfortunately, but not surprisingly, the healthcare delivery system in the US is as sick as is conventional medicine. I have tried many different practice formats over the course of my career, looking for the best way to dispense Integral medicine. In order to get insurance coverage for you to see me, I have had to make certain compromises to stay within the requirements put forth my your insurance companies. But I keep searching and, for now, the compromises are working fairly well.

Summary

So, let’s summarize. You would like your ideal medicine to be:

·        Safe

·        Effective

·        Comprehensive

·        Preventative

·        Participatory

·        Personalized

·        Available

·        Affordable

Did I leave anything out? Please let me know if you would like to add anything to this list.

A Brief Introduction to Integral Medicine: Part Three

Last week I began to explain the five aspects of the philosophical underpinnings of Integral Medicine:

1. The Integral Worldview
2. Broad science
3. An expanded model of a human being
4. A definition of health
5. The education metaphor

We got through the first three aspects in Integral Medicine: Part Two. Today I’ll discuss the fourth and fifth aspects.

A Definition of Health

In science, we usually define our terms. Science needs a precise language with which scientists can communicate with each other and the public. If healthcare were to be truly scientific, we’d need a definition of health and the healing process.

In fact, searching for just such a definition has defined the direction of my professional life.

Ever since the sixth grade, when I started wanting to be doctor, I’ve carried this image in my mind that doctors help improve people’s lives. When I was a resident and seeing my own patients in clinic, I was already bumping into the limitations of applying what I’d been taught to help my patients. I didn’t even know at the time what I was expecting to see in my patients’ lives, I just knew I wasn’t seeing it. I was asking myself why it is that people even go to the doctor. There are lots of reasons, but ultimately, I thought they were coming in to heal their lives.

“Heal their lives.” What did that mean? It was then that I was struck with a lightning bolt. There I was, in my seventh year of training in a discipline that prided itself on being scientific, yet no one to that point had defined healing or health. We all just talked like we knew what it was. But upon closer observation, doctors usually only use the word “healing” with respect to fractures or incisions. Not to people’s lives. They might cure an illness or treat a condition, but that’s about as far as it goes.

Why is that? Does it reveal an unspoken belief that healing can’t happen? That healing is too complicated, too capricious, too mysterious? Has the medical profession resigned itself to treating symptoms, thinking that root causes are somehow unfathomable or unreachable? I can’t speak for others, but I do have a difficult time understanding how a physician can really listen carefully to their patients, strive to truly help them and remain conventional at the same time, unless you see yourself as a technician, like a surgeon. (Although I’ve met some surgeons who are surprisingly good at working with their patients on very deep levels.)

Anyway, I thought the whole situation ludicrous, so I started on a search for the definition of healing. Seven years later I started to appreciate why the medical profession had left that question alone.

I started my search with Webster’s, whose definition is actually fairly good, the World Health Organization, the AMA, the American Holistic Medical Association (AHMA) and such. Each had attempted to define healing but relied on words such as “balance” and “harmony”: words which themselves needed defining. I needed a practical, boots-on-the-ground definition I could take into an exam room and actually do with a patient. The AHMA, for example, defined health as a state of balance and harmony with the Cosmos. Now go do that with a patient.

I thought perhaps other systems of healing might have some better answers. I looked into nutrition, herbs, Homeopathy, lay midwifery, Naturopathy, Chinese medicine, Ayurvedic medicine, Native American Shamanism, Buddhism, Chiropractic and some other forms of bodywork. I found they all have pieces to the puzzle that can be brought to the Integral Worldview, but none had what I was looking for.

About this time, I’d integrated much of what I had learned into my Family Practice, in what today would be called an Integrative practice, and I noticed that sometimes one of my patients would heal a bit. Even though I didn’t have a rigorous definition of it, curiously, we can recognize it when we see it. Perhaps that is why we can get by to some degree without defining. I reasoned thusly: “If a symptom is a clue that healing needs to happen, then the resolution of the symptom is a clue the healing has happened (assuming one has not just used a suppressive therapy), it is not the healing itself.”

So I started looking at my patients who healed to see what else, besides the resolution of their condition, had changed in them. What I saw was that they had learned something. And that something usually related to the understanding they had of themselves.

I wondered if that learning was the healing.

So I asked, “What if I define the process of healing as the process of us finding out who we really are and then acting in ways that are consistent with that?”

So far, that definition has been holding up pretty well. Ultimately, healing is mysterious and we cannot hope to control all aspects of it. But I think we doctors, as a profession, could do a much better job helping you use your health experiences to deepen your understanding of yourself.

For example, if you look again at Figure 5 below from Part Two, beliefs have creative influence over the body, mind, energy, how we behave in society and in how society and the environment influence us. Therefore, symptoms or imbalances in any of those horizontal aspects are clues to the underlying beliefs. Once limiting beliefs change, an entirely different experience in the body, mind, energy, etc. can be created.

IM_Figure 5_500

Each illness you experience has consciousness behind it. You can work with the physical, mental, emotional, social and such aspects of the illness and make some impact. But you can also work with the consciousness of it and make deep and lasting change in the illness.

These approaches are not mutually exclusive. But working with the horizontal aspects of the illness is generally supportive while working with the consciousness behind the illness is curative. Using Integral Medicine, we can work effectively with all aspects of you depicted in Figure 5 above.

Over many years of searching, I’ve developed good, practical ways to work with people on all of these levels at once. And I can teach other practitioners how to do that.

The Education Metaphor

You can generally tell a lot about the underlying assumptions and world view of a discipline by the metaphors it employs.

Conventional medicine uses two dominant metaphors: the war metaphor and the machine metaphor. In the war metaphor, the illness is the enemy to be fought and either vanquished or you become a victim of it. We develop new drugs in our armamentarium against cancer, for example. Your body is the battle ground, often trampled and scarred and even destroyed during the battle. The doctors delusionally think they are the Generals in the battle, but actually they are just the foot soldiers. The CEO’s of the large medical corporations such as the drug and insurance companies are the real Generals. The soldiers just do as they are told or they are dishonorably discharged.

Very early in my search for a definition of healing I observed that healing is not about war. No one actually wins a war. There are always casualties on both sides. One cannot heal if they are at war with themselves and one has a very difficult time (not impossible) healing if they are at war with others or the environment.

One of my first jobs when a new patient starts seeing me is helping them stop the war that they are having with themselves.

The machine metaphor likens your body to a machine. Your heart is a pump, your brain a computer, your joints are hinges, your lungs bellows and so forth. But, as the Vedic model points out, we are more than machines. Our bodies have consciousness, intelligence, wisdom and loving compassion. We do not just have to order our bodies around. We can develop a more collegial relationship with it: listening, dialoguing, working things out.

Natural medicines of several types often use a garden metaphor for health and the body. You prepare the soil, plant seeds, pull the weeds, avoid toxins, nurture and support and Nature does the rest. This metaphor is much gentler than the war metaphor but a garden is still a controlled, human-ego created environment. It does not have the same Spirit and sustainability as does deep wilderness. Many of the greatest teachers in human history gained their critical insights while in wilderness. Is that just a coincidence? If you listen to the stories of people who have experienced spontaneous remissions from cancer or HIV, for example, many of their critical insights happened when they were with Nature. What is that about?

Integral Medicine uses what I call “The Education Metaphor.” If healing is the process of us finding out who we truly are and then living in a way that is congruent with who we are, that is a learning process. Seeing all of life as a chance to learn helps that process.

In the Education Metaphor, the “student” is you…your conscious sense of who you are. By definition in psychology, this is your ego: whatever comes to mind when you say the word “I” to yourself. The teacher, then, is pure consciousness, your Atman, God, your Higher Self, whatever concept of your deeper wisdom that works for you. The classroom is all of creation, the curriculum is all of your experiences, both conscious and non-conscious, and the learning objective is answering the question: “Who am I?”

This is and has been the perennial question in mythology, literature and the arts.

In ancient Greece, the famous seer the Oracle of Delphi used to hang out in the temple of Apollo. On a column leading to the door of the temple there was a plaque with an inscription on it that explained everything you needed to know in order to accurately interpret what the Oracle told you. It said, “Know Thyself.” Some of the best Greek tragedies that survive today are about what happened to people who mis-interpreted what the Oracle told them because they did not know themselves well enough.

As your education proceeds, who you think you are (your ego) gradually starts to look more and more like who you really are (your deep wisdom) until they become indistinguishable. Spiritual traditions have a name for this: enlightenment.

So you don’t want to kill your ego (as some misdirected people talk about), that’s pretty stupid and uncompassionate. Good teachers don’t generally kill their students during their education. But if the student learns well, they can grow up to be teachers in their own right.

From this perspective, your health challenges can be viewed as stepping stones on your path to deeper understanding of yourself, on your path to enlightenment. Suppressive therapies and other therapies that just treat symptoms – that just shut the body up-bind and gag the teacher and throw her in the closet. This generally impedes the progress of the class. Most of what conventional and alternative medicines do today actually slows down your learning, in reality prolonging your suffering.

How do you think your inner teacher feels about you? Is s/he going to give up on you if you don’t learn the lesson the first time? That’s not been my observation. Lessons not learned in one relationship show up in the next. Lessons not learned in one health crisis show up in the next, usually with louder volume.

The converse is also often true: once you learn a lesson, the teacher doesn’t have to keep presenting it to you over and over, you can move on to the next lesson. (The lessons seem to keep coming as long as we’re breathing.)

No matter what is happening to us, potentially we can learn from it. Therefore, I believe healing is always possible.

We want our bodies to work well, our minds to be sharp, our energy to be abundant, our relationships to be loving and supportive and our environment to be non-toxic, but we are bound by the laws of physics in this: I’ve not yet witnessed someone grow back an amputated leg, for example. But healing in a higher sense is always possible. I like to always leave the door open for miracles, but it may be true that while there is always a possible relief to suffering, there may not always be relief of pain. But I don’t know this for a fact yet.

Keep Searching

Remember, healing has very little if anything to do with the functioning of your body, the workings of your mind, the robustness of your energy and such. But before you start thinking that I’m a therapeutic nihilist, remember that we barely have an inkling of who we really are and how powerful we are as divine beings. The creativity that we have potential access to is limitless. In fact, it is only limited by our own imagination, and much more is possible along the lines of physical, mental and energetic balancing than we yet understand.

For these reasons, never give up.

Keep searching for answers to your questions, to solutions to your health problems. Search outside yourself in the world around you for therapies, treatments, supplements and such that are helpful.

But also search inside yourself for the opinion of your own wisdom. How does it want you to be with yourself, with your problems and challenges? What is the consciousness creating your illness and is that the only consciousness you have access to? What are the beliefs that are allowing that illness-consciousness to flow into your life and are they really true? If need be, find a practitioner, friend or some other person who can help you explore questions like these.

Copyright 2012 Steven M. Hall, MD

A Brief Introduction to Integral Medicine: Part One

I met a woman recently who had been insured by Anthem for twelve years. Within three weeks of her diagnosis of a brain tumor, Anthem notified her that they would no longer cover her. Can you imagine having to deal with the news that you have a brain tumor then have your health insurance yanked out from under your feet? This happened to her in 2010. Luckily, she’s survived her brain tumor and now Obamacare has made such reprehensible behavior by health insurance corporations illegal. Obamacare patches up a few things but Conventional medicine still has a terminal illness. If not for the dedication and humanity of most of the people working within that sick system, it would have collapsed long ago. Doctors, nurses, pharmacists and the like are carrying the burden of the healthcare system on their backs, but they are burning out at an ever increasing rate. We can’t keep propping up Medicine while medical corporations continue to run amok.

I don’t need to elaborate the symptoms of Medicine’s illness, we know them all too well: the run-away costs that are breaking the financial back of the industrialized world; going to your conventional doctor for treatment is now the third leading cause of death in the US; we spend the most per capita on our healthcare yet we rank around 40^th on most measures of health, such as infant mortality and such; millions of people are uninsured…the list goes on.

We all know the symptoms of the disease. People are proposing solutions that attempt to treat the symptoms. No one is talking about the cause. Changing the way we pay for healthcare will not cure the system: that just treats some of the symptoms. When I look at the healthcare crisis, I see two causes: 1) the corporatization of healthcare and 2) the science upon which medicine is based. In this blog, I want to address the latter and come back to the former.

Clinical Medicine is not a science. It is a discipline based upon a science. Doctors are fond of saying that the practice of Medicine is both an art and a science. They are flattering themselves: the clinical practice of Medicine is engineering. The practice of medicine is not science. When that anesthesiologist is putting you to sleep, you hope the science has been done and that he’s not experimenting on you. And art is…well, how do you define art? Engineering can be defined as the artful application of scientific principles toward the solution of problems. And that is definitely what most doctors want to do with their patients if the System would just let them (see previous blog posts).

The problems that Medicine is trying to solve are those of human disease and suffering and the creation and maintenance of health. Medicine needs to be based upon a science that is appropriate to the task. The science upon which Conventional medicine is based is too limited to encompass all of human experience. Yet we have good data to support the idea that all of human experience impacts health. We need a medicine that is based upon a broader science, one that can explore all of human experience, not just the physical, biochemical level or our experience.

Integral Medicine is based upon such a science.

The purpose of science is to understand Nature (so that we can ultimately bend her to our will.) Over time, the discipline of science has developed a strategy, called the Scientific Method, which is arguably the best method we have for sifting out the truth from a lot of different possibilities. The Scientific Method is not perfect, for it is performed by human beings. But, when followed properly, it is self-correcting. Interestingly, a method of inquiry akin to the Scientific Method is one of the seven classical pathways to enlightenment.

The Scientific Method has several defined steps that we are all supposed to learn in High School science classes. The first step is to pick some part of Nature you want to study, for example, an ant hill. The next step is not mentioned much but is more or less assumed: look through the published literature and see what others have already learned about ant hills. The next step is to observe an ant hill and collect some raw data. Then you look at the data and try to make some sense out of it. You propose a theory that tries to explain as much of the data as possible. Here is where it gets interesting.

Since we don’t know Nature, we need to propose a model of Nature, or at least of that aspect of Nature that we’re studying (scientists are still working on a Unified Theory of everything). The model, by definition, needs to be a simplification of Nature. In order to make that simplification, we must make some assumptions, usually called “simplifying assumptions”, about our system of study. Every scientific discipline has its model. Conventional Medicine, for example, has its medical model.

Ideally, your theory fits within the current prevailing model for that scientific discipline. On rare occasions down through history, Science has had to make major modifications to foundational assumptions underlying the predominant model and a Scientific Revolution ensues. (http://www.amazon.com/Structure-Scientific-Revolutions-Thomas-Kuhn/dp/0226458083) But this is rare. The bulk of scientific work entails discovering new and useful details that help to “flesh out” the prevailing model.

So let’s assume that your theory about your ant hill fits within the prevailing model of life currently held by most biologists. The next step, then, would be to pose a question and make a prediction: “If I dropped some bread crumbs here, this is what I expect the ants to do.” This is called developing an hypothesis. (If this is triggering PTSD from your high school science class, I apologize. I’m laying a foundation to get to my point.) Once you construct your hypothesis, you design an experiment to test your hypothesis. In your experiment, you have to try to anticipate and adequately control possible confounding variables, that is, other things that might happen that would make interpreting your results more difficult or less reliable. For example, every time you dropped bread crumbs, you want them to be the same kind of bread crumbs.

Then you actually perform your experiment, collect the observations and see how they compare with what you predicted. You also compare your results with others who have performed the same or similar experiments to see how your results stack up to theirs. The more experiments you do that match the prediction you made based upon your theory, the more you start to have confidence that your theory actually captures and represents some important or vital aspect of Nature.

In medicine, the aspect of Nature that we’re exploring is you. Some people would use scientific information about you to bend you to their will (http://www.huffingtonpost.com/warren-adler/keeping-the-sheep-dogs-at_b_950151.html) but in Medicine we like to think that we’re high-minded enough to use science not to bend you to our will but to help you improve your health, which, hopefully, is bending yourself to your own will. In Medicine, the data that we need our model to explain is all of human experience. How is that so? Well, try to think of one experience you’ve had that has absolutely no impact whatsoever on your health. Pretty hard to do, I expect. Everything in your life influences your health. Everything in your life is fair game when it comes to looking for the root causes of your health problems. We need a medical science and a medical model that can take all this kind of information into account.

In The Structure of Scientific Revolution, Kuhn elaborates on several symptoms a particular branch of science will exhibit when the pressure for a scientific revolution is building. Conventional medicine exhibits all of them. There is a great body of human experience that lies outside, that is, cannot be adequately explained by conventional medicine. A large number of alternative models of healing and health are being put forward. More and more practitioners are becoming aware of the limitations of conventional medicine (lagging somewhat behind the awareness of the general population.) The predominant underlying assumption upon which the conventional medical model is based says that you are but a skin-bag of biochemical reactions and all diseases are an imbalance of those chemical reactions, injuries or natural aging. If we but knew what those reactions were, we could pour in other chemicals and you could then be the person you want to be or we could sew you back up, wire you together or replace worn-out parts.

More than Biochemistry

You are indeed a skin-bag of biochemistry. But is that all you are? Are you a victim of your genes and environment, merely reacting to and from them all the time, or do you have consciousness, identity, creativity, volition, free will? Do you have meaning in your life? Do you see meaning in some of the events around you? How can there ever be spontaneous creativity if we’re all locked into a physical deterministic chain of cause and effect? I think it is high time we make a new medical model.

Kuhn also elaborated some of the characteristics that the new paradigm replacing the old ought to have. It needs to first adequately explain all the data and observations covered by the old model and it ought to also be able to explain and incorporate most of the observations that were out-lying to the old model. It also ought to be amenable to the process of science fleshing it out. Integral Medicine is based upon such a science. It is able to take into account and make sense out of most human experiences that lie outside of the current medical model, such as mind-body connections, placebo effect, spontaneous healing, shamanism and such.

The framework of Integral Medicine has five parts:

1. The Integral Worldview
2. Broad science
3. An expanded model of a human being
4. A definition of health
5. The education metaphor

Let’s explore this framework in Part 2.

Copyright 2012 Steven M. Hall, MD

A Better Way to Pay for Healthcare

The insurance mindset is the wrong perspective to use to pay for healthcare. Insurance was designed to be a way to help people, corporations (I know it is redundant to list them separate from people) and other interests “manage” risk. Insurance is for situations that are supposed to be fairly rare but would have catastrophic consequences if they happened to you, such as your house burning down or suffering a long-term disability. The idea is to spread the risk out over a large number of people, charge each person covered a defined amount of money each month and pay out when a covered loss happens. These situations lend themselves to probability theory. Statisticians calculate the probabilities of said events, their projected costs and set the rates so that the company is assured a profit. Conceivably, you could go your entire life without your house burning down, getting in a major car accident or suffering a disability. But you buy insurance to cover your bets. The job of the insurance company is to take in as much as possible in premiums and pay out as little as possible in damages. That is why they often put up so many hoops to jump through when you have to make a claim.

But what are the chances that you’ll need healthcare at some point in your life? If you include preventative services, the screening tests that we’re all supposed to get, for example, the chance is 100%. So what is the risk that is being managed? Perhaps the insurance mentality got applied to healthcare in the early days because at that time people didn’t go to the doctor that often. They were much more versed in home remedies and many believed that hospitals were places to go to die.

Early health insurance plans were almost exclusively catastrophic. Regular healthcare wasn’t that expensive and wasn’t covered. Over time, our society’s relationship with healthcare has changed, and what we want our insurance to cover has changed. Health insurance is no longer just covering catastrophic events; it is paying for regular services. By moving toward larger and larger deductibles, insurance companies are trying to move their role back to that which is more appropriate for insurance, only covering potentially ruinous catastrophes, but is that what we want?

Goals to Aim For –  

Healthcare costs have increased. People’s expectations have increased. It is time to reassess what we are doing and devise a better, more appropriate way to pay for healthcare. These are the goals I think we should aim for:

• Universal access – that is, everyone is covered
• Everyone has access to the same quality of care. No one gets discriminated against because of how their care gets paid for.
• The cost gets spread out over the entire population
• People who utilize more healthcare pay more
• Financial incentives for everyone to be healthy are built-in
• Competition and innovation are encouraged and rewarded
• The system remains in the private sector and is not run by the government
• Health insurance companies as we know them go away. They have done incalculable damage to our society and have abused too many people. For them, we need to institute a corporate death penalty.

Communal Services –  

There are several communal services that we as a society have decided to offer to each other and pay for communally. We have public roads, public education, public water, public utilities, public transportation, public libraries, police and fire protection and a public military. What would it take for us as a society to decide that healthcare is also something we are going to offer to each other?

If you look at any given stretch of road, you don’t know when or how it is going to need to be repaired, but you know that it is going to need to be repaired at some point. So government agencies in charge of that stretch of road set up a repair fund. Every time you buy gas, a certain percentage of what you are paying for the gas goes into that road repair fund. When you buy your gas, do you feel like you’re buying road insurance? (Public tax money also goes into those funds.)

A similar argument can be made for an individual. We don’t know when or how much healthcare that person is going to need, but we know that they are going to need some healthcare at some point. Instead of private health insurance companies to pay for healthcare, we ought to have public utilities that pay for healthcare.

One Idea –

One idea is to divide the country up into five or six geo-cultural regions. Within each region, three public utilities would be licensed to offer healthcare plans. The utilities would be not-for-profit and would be run by public boards and all their financial records would be open to the public. Each utility would devise plans that they think would meet the needs of people. The bare minimum plan would offer the same level of services that Congress votes for themselves and get fancier from there.

We would achieve universal access by compelling each person in each district to choose the utility and plan that best suits their needs. (Such compelling has already passed Supreme Court scrutiny.) Then each person, each month, would get their “health utility bill.” If your employer wanted to give you a perk, it could pay your health utility bill for you. If you qualified for public assistance, the government would pay your health utility bill.  There would not be different coverage for different classes of people, just as rich and poor alike drive on the same roads. We would be able to do away with Medicaid, Medicare, the VA, Basic Health and many of those similar levels of complexity that just add cost to the delivery of healthcare.

A simple way to build in “user pay” and at the same time financially incentivize healthier lifestyles would be to add a “poor choice tax” to foods, alcohol, tobacco, motorcycles and such in the amount statisticians calculate that using that item adds to the burden of healthcare for the population. For example, the lifetime healthcare cost of a pack of cigarettes is estimated to be around $10 per pack. That tax would be added to the price of the cigarettes. Each month, the poor choice tax that was collected in each region would be divided among the health utilities proportionately to the percentage of people in that region that are signed up with that utility. This money would be used to help defray the cost of healthcare for everyone. Organic fruits and veggies would have no or low poor choice tax, while foods full of processed junk would have a higher tax. We have the data now to calculate lifetime healthcare costs of most lifestyle choices.

When we all have healthcare and it is easy to trace the money through the system, the financial incentive of the whole society would shift to real prevention. Right now, nearly every player in the healthcare system profits more the sicker you are. This is the real, unspoken reason for run-away healthcare costs that no one can seem to get a handle on.

Could something like this really work?

For a system like this to really work, though, we would have to also heal healthcare. People would need choices. I do not think it is right to compel people to participate in a system of healthcare that is currently the major cause of death in our society. That’s right. Today, going to your doctor for conventional medical treatment is now the third leading cause of death in our society. What would the medical profession look like if it were ethical to compel us all to participate in it? To be continued.

Copyright 2012 Steven M. Hall, MD

Insurance Companies and Healthcare

There are powerful and wealthy forces within the Healthcare industry that are working hard to keep your healthcare costs rising and the quality of your care substandard. And they’ll keep doing it as long as we all put up with it. Drug companies are one of those forces and it’s easy to understand their motivation. They are about sales. If you get better and don’t need to take medicine, they don’t make any money off of you. Therefore, they like treatments that reduce symptoms but don’t heal and resolve the core issues. That way, you get relief from the drug so you have good reason to take it, but then you have to keep taking it. Allergies, asthma, diabetes, hypertension, heart disease, strokes, hypercholesterolemia, osteoporosis, auto-immune diseases, thyroid problems, Alzheimer’s, depression, addictions and such fall into the category of conditions for which you would be given medications for the rest of your life even though there are proven cures and/or preventions that are steadfastly ignored (and even demonized) by conventional medicine.

As part of their business plan, the drug industry now has major control over medical research, the medical literature and medical education. It is an ingenious and very successful business plan. Train a carefully selected corps of caring practitioners to follow your every order then tightly control what information they have access to and manipulate your market to suit your purposes. Your poor health is their market.

But even though the tactics of the pharmaceutical industry are deplorable, their motivation is clear from the perspective of corporate behavior. But there are many more players in the healthcare industry who are equally responsible for the healthcare crisis but are even more devious in their tactics.

Hospitals, pharmacies, drug companies, surgical and medical supply houses, labs, physicians, naturopaths, chiropractors, rehab centers, supplement manufacturers and distributors…these are also obvious players who make more money the more people are sick and the longer they stay that way. And we wonder why healthcare costs are so hard to control.

I used to think that the only factors in the healthcare equation that wanted to cut costs and increase quality were 1) the people who bought their own insurance and/or healthcare, 2) the employers paying for insurance and 3) the insurance companies. I was wrong.

(People who get their insurance paid for have no incentive to save medical resources. As an extreme example, here in the Northwest, people with Microsoft’s Cadillac plan are at high risk for being over-tested, over-exposed to x-rays, over-scoped, over-surgerized and over-medicated. Microsoft is self-insured and they’re getting taken to the cleaners, not only by their employees and their families, but also by the medical community.)

I thought it was strange that the insurance companies didn’t do what the drug companies did and take control of medical research and education, pay for studies of the preventative strategies and start to really support preventative measures that are proven to keep people healthy and reduce healthcare costs. They certainly give a lot of lip service to cost containment. But I recently had an experience that opened my eyes to another major corporate force working to increase healthcare costs and degrade care. They’ve pretty effectively stayed hidden behind the smoke screen they’re spreading with all of their advertising.

My practice is very different from most physicians’. I’ve gotten interested in getting to the root of people’s problems and searching for ways to treat those roots so that people’s issues resolve. I’m not satisfied with just helping someone limp along with their health issues if there is anything in our power that will help that person.

Over time, I’ve moved away from the regular family practice model: running madly between exam rooms; to spending an hour with each patient, deeply listening, tackling multiple, complex and interrelated issues, doing a lot of education and such. As you might imagine, my practice stood out in the insurance companies’ data mining. They audited me to see what was going on. They couldn’t understand the one hour visits. They wanted me to do the ten-fifteen minute visits like everyone else.

I told them that I was saving them a lot of money, that when these complex patients started seeing me, they often didn’t have to keep seeing their expensive panel of specialists. I thought they’d be happy to hear that. I was shocked by their response. When they heard that the way I practice might be decreasing how much their enrollees are spending, their faces actually blanched at the idea. After that meeting, they redoubled their efforts to drive me out of their networks.

In that moment I realized just how wrong I’ve been all these years. I learned that the insurance companies make a percentage of what you spend on your healthcare, especially if they just administer the plan, as with Microsoft. All of their “cost-saving procedures”, such as prior authorization, just add layers of paperwork and administrative overhead to the costs of healthcare, giving them the public image of wanting to cut costs, but in reality just giving them a bigger slice of the pie. Arguably, the most powerful and most subversive force keeping your costs high and eroding the quality of your care are the health insurance companies, not the drug companies. 

If you’ve ever gone to your practitioner with a list of problems and been told to pick one to work on today and come back another day for the rest, thank your insurance company. If, during your visit, your practitioner interacts more with their computer than with you, thank your insurance company. If you’ve ever felt herded through your doctor’s office, thank your insurance company. If you feel like your physician never has time to really consider the details of your case, thank your insurance company. If your physician has low morale and is over-burdened with paperwork, thank your insurance company. Short of corporate profit, there is no excuse for the damage they’ve done to the healthcare profession.

And if your insurance company calls themselves non-profit, don’t believe it for a moment. All that means is that they keep all the money for themselves. Those executives are paid exorbitant salaries and bonuses. Most insurance companies run a 26-28% administrative overhead. Obamacare is going to require them to keep it to 20% (still much higher than most other industries). That is one reason the insurance companies are fighting Obamacare so vigorously.

If your insurance company is for-profit, well…there are lots of other ways to make money in this economy, why should some investor be getting a share of your hard-earned premiums? The answer is absolutely clear in my mind: health insurance companies need to go away. There are much better ways to deliver healthcare, ways that incentivize wellness and high-quality healthcare. We’re not a third-world country. Why do so many Americans continue to suffer from a lack of quality healthcare as if we were? I see two reasons: corporate greed and a kowtowed populace.

Corporations’ primary purpose for existing is to make money. Any product or service they provide to do that is secondary. Greed is in their nature. It’s not bound to go away any time soon. But just like any good citizen of the community, corporations need to learn to control their bestiality. That’s what laws and regulations are for. If, on one side of the equation, a corporation doesn’t want to be regulated, then, on the other side of the equation, they have to choose to do the right thing. I’ve got some ideas about how to help corporations do that, but that’s a topic for another blog. Right now, I’d like to speak more about the kowtowed populace. That is something we can all do something about.

When insurance companies misbehave and screw you over, they protect themselves by throwing up as many paperwork roadblocks as possible. Millions of hours are spent each year by people just trying to get their insurance companies to meet their obligations. The insurance companies set up a gauntlet, hoping that you won’t survive the running of it and thus give up and go away.

Don’t give up. If you have a grievance with your insurance company, please make it your business to be the biggest burr in their bra they’ve ever seen.

• Write formal letters to the state Insurance Commissioner (One of my patients did that during my audits and the insurance company actually wrote their own letter to the Commissioner asking him to please disregard my patient’s letter. It was groveling and pathetic. If the Commissioner received dozens of similar letters asserting the same complaint, they’d investigate.)
• Lodge a complaint with your employer and their benefits department, if you have insurance through work.
• Write letters to your state and national representatives.
• Write letters to the editor of your newspaper.
• Write a blog.
• Post on your Facebook page.
• Get the word out any way you can about how your insurance company is treating you.

Stories have power. You have power.

Believe it or not, medicine is a consumer-driven industry. If enough consumers demand it, eventually medicine will change.

Steven M. Hall, MD

Copyright 2012 Steven M. Hall, MD

Healthcare Crisis Solution - Letter

During President Obama’s mid-term State of the Union address, he issued a call for ideas about how to heal healthcare. The following is a letter I sent him. I have no idea who read it, all I heard back was a form letter. But this outlines the basic ideas I think could cure our healthcare system. Please let me know what you think. Thanks. 1/30/10

President Obama 1600 Pennsylvania Ave Washington DC,

Dear Mr. Obama,

You issued a challenge during your state of the Union speech that I’d like to accept. I have been in practice now for over 25 years and have spent a considerable amount of time thinking about the terminal illness that is afflicting our healthcare system and how to treat it at its root causes.

Unfortunately the root causes of the healthcare crisis, as I see them, are beyond the reach of public policy. But public policy is what we have to work with and the right public policy can create the right environment and motivation for the healing of the healthcare system.

I believe that the solutions I’m about to propose would give all Americans good coverage, fix Medicare, the VA and DSHS, lower the cost of healthcare, keep the paying for healthcare in the private sector, keep competition and innovation alive, allow everyone to have the physician and hospital of their choice and motivate Americans to live healthier lifestyles. Please bear with me as I explain because, like the solutions to most complex problems, these ideas cannot easily be reduced to sound bites.

I believe that universal access to healthcare would not only benefit individuals but also society as a whole. This puts access to healthcare into the same category of social needs that we as a society traditionally meet through social solutions, e.g., public roads, public water, libraries, public education, electricity, trash collection and the most socialist of all organizations, the Military. Most often, the solutions to challenges that we all have in common are solutions that we all share.

I propose that we move the paying for healthcare into the public utility sector of the economy. The country can be divided into five or six geopolitical regions. Within each region, three public utilities would be licensed by the government to manage healthcare payments. The regions would have to be large enough that each of the utilities could be financially sound. Three utilities would balance the need for competition and innovation without excessive duplication of administrative costs. Each utility would be not-for-profit, run by public boards, transparent to the community.

Each utility would devise perhaps three to four coverage packages, the simplest being a minimum agreed-upon level of coverage (I might suggest that be the level of coverage Congress has chosen for itself) and then other combinations of coverage the utility might think would be popular to people. Each person in each region would be required to choose one utility and one of their plans. This would achieve universal coverage. The plans would have to compete with each other to get people to choose their plan. By providing universal coverage this way, there would be no need for Medicare; we would “fix” Medicare by transcending it. The same goes for the VA and DSHS. The rates for each plan would be set by the public board of each Utility.

The utilities would then contract with providers, hospitals, labs, pharmacies, home-health agencies, etc. just as insurance companies do now. Since there would only be three organizations to contract with, providers would be highly motivated to sign up with each one, thus helping to contain costs. And just reducing the administrative duplications from so many insurance companies offering so many plans could potentially free up 10-11% of the current healthcare budget to help cover the presently uninsured.

Then, each person, each month would get their “healthcare utility bill.” (HUB) If an employer wanted to give their employees a perk, they would offer to pay their employees’ HUB. If a person was on public assistance, the government would pay that person’s HUB for the base plan. If a person were retired and needed the assistance (not all retired persons do) there could be a program to pay part or all of that person’s HUB.

By spreading the cost of healthcare over everyone, the cost for each person goes down. People who can’t afford it could then get public assistance to pay for the lowest-tier plan. I don’t have access to the financial data to do the calculations, but my gut sense tells me that this approach would not cost the government any more than it now pays for Medicare, DSHS, the VA, State health insurance pools and the like. Perhaps many of the people now employed by private health insurance companies could work for the utilities.

There is currently a grotesque and horrific form of discrimination being practiced in the United States that is receiving very little discussion: people are treated very differently by the healthcare system depending upon their insurance coverage or lack of it. This discrimination results in many preventable deaths and untold levels of human suffering. Also, I watch as my patients spend dozens of hours of their time just trying to get their insurance companies to meet their contractual obligations. In this plan, everyone from the homeless to the wealthy would have nearly the same insurance. Veterans, the elderly, rich or poor, everyone would be treated nearly the same by the medical profession. This plan would free practitioners to focus on caring for patients, not worrying about reimbursement rates. Since the health payment utilities would be not-for-profit and the rates they charge and pay would be publicly and transparently set, there would be no financial incentive for them to try to wriggle out of paying for care. This would save millions of hours of people’s time and the administrative costs in every doctor’s office would decrease, realizing further savings.

The defined benefit packages would be de facto rationing of care, but no different than we have in our current system. To avoid the need for further rationing, we need real wellness throughout the entire population. How to accomplish this? By my observation, the threat of potential disability and disease is not, by itself, enough to motivate many Americans to take good care of themselves. We Americans are more motivated by our wallets.

We now have the actuarial data to calculate the lifetime healthcare costs of many products and practices. For example, the last figure I heard, the lifetime cost of a pack of cigarettes is around $7. Similar costs could be calculated for beer, wine, Twinkies, donuts, motorcycles, etc. This amount would then be added to the purchase price of the product as a “poor choice tax.” I envision the poor choice tax posted on the grocery shelf on the same label that says how much per ounce, etc. so people can make informed decisions at the point of product selection. No poor choice tax would be levied on products such as organic produce. The numbers could be calculated to level the playing field between junk food and nutrient-rich food. One might also consider stopping the public subsidies to crops that make junk food so cheap. Suddenly…eating well would make financial sense to people.

Then, the money within each region that is collected from the poor choice tax would be divided among the three Utilities proportionally to the percentage of the population from that region that is signed up with that utility. That money would go to lower the cost of everyone’s HUB. This system builds in a statistical probability of “user pay.” As the population starts making healthier lifestyle choices, the revenue from the poor choice tax would decrease, but so would the level of healthcare utilization thus decreasing the cost of healthcare for everyone.

Once we commit to universal access, then society is suddenly motivated to optimize everyone’s health. Right now, there is no financial incentive within the healthcare industry for wellness. I think that the medical profession would respond by being less reliant on the pharmaceutical industry to tell them what to do and more become more interested in pursuing real preventative medicine. Currently, most physicians think preventative medicine means immunizations and statin drugs. During my career I’ve been led to explore not only conventional medicine but also the wide range of concepts and treatments encompassed by what we refer to as “alternative medicine”. Believe me, there are some valid concepts not currently embraced by conventional medicine that, if they were, would save the national healthcare industry billions of dollars. I believe universal access would give us the social will we need to overcome the profit-motive grip that healthcare corporations have on the practice of healthcare and really heal the healthcare crisis. The cure is out there. We just need to take it.

Thank you for listening. I realize that eliminating private health insurance companies and instituting something like the poor choice tax would mean that you’d be fighting a third war, but it is one that is worth fighting. I would love the opportunity to discuss these ideas further with anyone you think might be able to help use them.

Sincerely,

Steven M. Hall, MD

Copyright 2012 Steven M. Hall, MD