A Metaphor for the Healthcare System

I have limited knowledge of the criminal justice system.  What I do know is that many people criticize it, and often their points seem to have merit.  An uncomfortable fact is that there are opportunities at every level of the system for those who work in the system (police officer, judge, attorney, forensic analyst, etc.) to act unethically and cause harm to a suspect or defendant, and that some of the methods of processing and presenting evidence are highly problematic.  Thus, there are people in the system who were convicted of or pled guilty to a crime they did not commit.  That’s an uncomfortable fact we all need to either accept or investigate, or both (look up Josh Dubin and Bruce Bryan for an example).

Lastly, I know that there’s a high rate of recidivism, meaning that once you are IN the system, it can be difficult to FIND your way out and STAY OUT.  Sadly, that reminds me of our healthcare system, particularly when it comes to chronic disease.  When someone visits a doctor’s office and gets diagnosed with a chronic disease, they’re likely to leave the first visit with a prescription – whether it’s for high blood pressure, type II diabetes, osteoarthritis, or an autoimmune condition.  They may be given a piece of advice on changing something in their diet to help, but the pill is the clearly the real solution.  As an aside, if you can remember to put a pill in your mouth every day, can’t you change the food you eat every day, if you’re told that’s what will help you long-term?  In his pull-no-punches book, Metabolical (2021), Robert Lustig, MD says “… taking more than five prescription pills a day is associated with increased mortality risk”.  What else don’t we know about the relationship between pharmaceutical use and health, since big pharma funds most of the drug research?  And if we know that more pills means people are NOT healthier, shouldn’t we be doing something other than prescribing? 

Let’s use diabetes as an example, since 50 million Americans are diabetic or pre-diabetic.  If I visit a physician to treat my type II diabetes, I’m going to become dependent on the prescriptions written by the physician, who is operating within a very flawed system.  If I take the medication for years, but don’t modify my diet, years of elevated blood sugar is likely to land me in dialysis, with potential common complications such as amputations due to peripheral neuropathy and declining vision due to retinal neuropathy.  However, if I actually make lifestyle changes, and increase my physical activity level and decrease added sugar and carbs in general, I have a good chance to not only avoid those complications of diabetes, but reverse the diabetes completely!  If I take 8,000-10,000 steps per day and cut my added sugar in half and my overall carb consumption by one third, that will be enough to have a major impact, and improve my healthspan.  And better yet, it will get me OUT of the system.  That’s worth the effort, and we need to be teaching patients about this.  But the system doesn’t want to set patients free because patients = profit.  That’s part of the criticism of for-profit prisons – if the prisons need prisoners to pay for maintenance and corrections officers, there will be no incentive to do anything to help the prisoners develop skills and perspectives to help them succeed after they serve their time.  While I’m talking about diabetes, Peter Attia, MD, in his book Outlive (2023) points out that insurance companies are not likely to reimburse a doctor to educate a patient on lifestyle changes to improve their blood sugar, but they will certainly pay hundreds of dollars a month for diabetes medication! 

See my piece on corruption, and I maintain that I am an optimist – but I recognize that the larger the organization or the system, the more likely profits will be prioritized over people.  We can do better in healthcare.  We need to stop letting people get sick to profit off their treatment.  I don’t think I can call it “care”, much less healthcare, and that’s why more people are starting to call it the “sick-care system”.  It doesn’t sound great, but wouldn’t you agree that’s a more accurate term?  And now I’m wondering if “criminal justice” is an accurate term for that other system I talked about!