Admin: August 2009 Archives

The current debate over healthcare reform has been about politics and money. There is no escaping either factor. Huge vested interests are spending millions of dollars a day to pressure Congress into minimal reform. But even if the political system were pure as snow, an aging American population makes it inevitable that the healthcare system is going to grow more and more expensive. These external factors fill the news every day, obscuring a simple fact: Your health depends far more on the healing system than the healthcare system. The healing system is inside your body. Its intricacies are just now being fully explored, but certain broad trends have become clear.
-- The healing system is more flexible and powerful than previously thought. For example, the brain can heal itself, a finding that seemed impossible a few decades ago.
-- The healing system is highly sensitive to outside conditions. Stress and emotional discomfort, for example, can severely compromise your ability to heal.
-- Healing affects your genes and how they are expressed. An expressed gene is an active one, and this activity turns out to be far more responsive to your state of mind-body health than previously thought. The old image of fixed genes is rapidly changing to a conception in which the body's genetic material is eavesdropping on all the experiences in your life. In short, a gene isn't a thing; it's a process.
-- The healing system is automatic, but your lifestyle choices make a huge difference in the efficiency of healing.
These factors hold true throughout your life, and if we simplify them to one sentence, this would be it: Change your life and you change your healing system. That may sound like the advice we get constantly about proper diet, exercise, and stress management. But with new evidence showing up every day that lifestyle affects an incurable disease like Alzheimer's, for example, it's becoming clear that your own healing system will always be the front-line defender of your well-being, not your doctor or the drug companies. So-called lifestyle diseases used to be restricted to conditions like heart disease, obesity, and type II diabetes, where a link with improper diet was easily demonstrated. Now a wider range of disorders is being linked to lifestyle choices, not by one-to-one correlations but through more general trends. That is, no one can predict exactly which disease you might contract due to poor lifestyle choices, but at the same time, reversing those poor choices has a broad effect in improving your power to heal.
Some recent statistics bring home how crucial it is to rely on the healing system rather than the healthcare system:
• 58 million Americans are overweight; 40 million obese; 3 million morbidly obese
• Eight out of 10 people over 25 are overweight
• 78% of Americans don't meet basic activity level recommendations
• 25% are completely sedentary
• 76% increase in Type II diabetes in adults 30-40 years old since 1990.
The statistic that really jumps out has to do with sedentary lifestyles. We are addicted to sitting on the couch watching beautiful, slim, fit actors and athletes on television, with a steady increase in other sedentary activities like surfing the Internet and playing video games. In addition, these activities are reaching into younger age groups, making children less active and therefore more inclined to obesity. Yet the simple fact is that the alternative to being sedentary isn't joining a gym. The greatest benefit of exercise occurs when you move from being sedentary to light activity like walking, doing housework, gardening, and climbing the stairs. Exercise at higher levels will bring increased benefits, certainly, but this first step brings the biggest single improvement in health. Being sedentary is more harmful to you than forgetting to jog three times a week. In addition, at least one study has shown that when overweight adults are put into groups that walk, jog, or run every day, the group that lost the most weight were the walkers.
Thrashing out healthcare reform is a defining issue for the coming decade and an inescapable duty. Having said that, I urge you to look inward rather than outward. The most perfect healthcare system can't do as much for you, on a daily basis, or do it as cheaply as your own healing system. The evidence is there, waiting to be acted upon.

Published in the San Francisco Chronicle

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Scotland freed the terminally ill Lockerbie bomber last week so he could die at home in Libya. "Our beliefs dictate that justice be served, but mercy be shown," a Scottish official said. Did Scotland do the right thing? Should we have any mercy for mass murderers who are terminally ill?

I have hesitated to comment on the release from Scottish prison of Abdelbaset Ali al-Megrahi, because there is no clear moral line that I can see. The facts are well known, and by now most people have made up their minds. But on what grounds? Of the 270 people killed in the 1988 bombing of Pan Am flight 103, 189 were U.S. citizens. Libya didn't formally admit to planting the bomb, yet the Qaddafi regime has paid $2.7 billion in restitution to the victims' families. Despite the assumption that the attack must have involved any number of conspirators, only Megrahi was convicted. He has always proclaimed his innocence, and some of the victims' families believe him while others call him a mass murderer.

All the moral choices are cloudy and tangled in this case. When the Scottish secretary of justice decided to grant Megrahi a release -- the prisoner is in the final stages of advanced prostate cancer -- he cited "compassionate grounds." Even though Megrahi showed no mercy to his victims, the secretary said, Scotland was bound by its own values, which include mercy, not the values of the convicted criminal. This seems like a position Christians would endorse, but in the U.S. the teaching of "forgive your enemies" hasn't prevented avowed Christians on the right from being among the strongest advocates of the death penalty and harsh sentences for drug crimes. In a sense the justice secretary was using the term mercy in a very narrow sense. Pure mercy would have been not to send Megrahi to jail, an abhorrent choice to most people -- even Jesus speaks on both sides of the issue in the New Testament. Forgiveness is clouded by other references to punishment, both divine and secular. At one point Jesus even says, "I bring not peace but a sword." In many places he has no tolerance for sinners. Yet there's no doubt that forgiveness stands out as a major tenet of the faith.

So what is justice? On religious grounds an eye for an eye settles the matter for millions of devout believers, while others struggle between mercy and vengeance. That's why secular society has turned justice, for all practical purposes, into a technicality of the law. Whatever the law says to do, that is just, even when the law changes (thus the debate over the death penalty in this country has gone back and forth several times, with yes and no standing for justice if it happens to be in force). How are laws made? With great fickleness, depending on the public's mood, recent events, political ideology, legislative horse trading, racial and class prejudice, and religious tradition. The ideal of making the punishment fit the crime has been achieved only sporadically, and there are stretches of history, as when the courts upheld that escaped slaves should be returned to their masters, when the law has sided with gross immorality.

If I've described a tangled situation, it also happens to fit reality. It was more realistic for British Prime Minister Gordon Brown to wash his hands of the Lockerbie controversy and give it back to those in Scotland who made the decision than for President Obama to issue a blanket condemnation. The public doesn't agree, however, since as so often happens, those who cry for vengeance the loudest tend to win the most support. There is another path. Instead of wrestling with flawed choices, you can go deeply into how justice affects you.

As bystanders to tragedies like the Lockerbie disaster, you and I have no moral weight; we are outsiders. But we aren't outsiders in our own lives, where we face moral choices that are just as tangled as this one. When you go inward with honesty and clear sight, you see in yourself all the elements that clash here: mercy, anger, compassion, revenge, high-mindedness, impartiality, bias, and fairness exist side by side. Just this realization brings you out of the illusion that justice is simple. Then you have a choice to empathize with everyone concerned, and step by step you arrive at the ancient principle of non-violence as a living part of your own consciousness. Having achieved that stage, daily situations will look very different from how they look now. One sees that Jesus wasn't really contradicting himself -- a universal empathy allowed him to feel what it was like to be both the judge and the condemned. Until you and I expand beyond the narrow limits of our own consciousness, our moral judgments will be very imperfect. Seeing this, you can't help but stop judging other people so quickly, and at the same time, the desire to reach higher consciousness grows stronger, because that is the only way out of impossibly tangled questions.

Published in the Washington Post

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A doctor who's in the thick of the current health-care debate made a crucial point when he told me that the real issue shouldn't be limited to medical insurance reform rather an entire medical-care reform. It's been rightly said that the most expensive technology in American medicine is the doctor's pen, because with a flourish of the hand he can order an unnecessary test or surgery. Some kind of insurer must pay for that, so simply providing more coverage will not bring healthcare costs to economically sustainable levels, nor will it ensure better health to society.

It's estimated that 2.5 million unnecessary surgeries are performed each year, with hysterectomies, heart bypass grafts, lower back surgery, and angioplasty leading the list. Just two procedures alone, coronary artery bypass grafting (CABG) -- known in the trade as cabbage -- and balloon angioplasty cost $100 billion annually. With long waiting lists for CABG, you'd think it was vital for prolonging the lifespan of heart patients, but that's a mistake. Current statistics suggest that about 3% of bypass surgeries extend life expectancy, with angioplasty scoring even lower at zero percent.

On all sides the "more is better" cult cripples and bankrupts the American health-care system. If you pay your doctor a visit tomorrow, you have a 43 percentchance of being given an unnecessary test. Stress-related chest pains that are muscular in origin can still wind up leading to a battery of expensive cardiac tests, including risky catheterization. If you have a cold or flu, there's a 73 percentchance that you will be prescribed an antibiotic, which is useless against viruses, including cold and flu viruses, but which carry risks of allergic reactions and other side effects, not to mention weakening of the immune system.

The U.S. ranks 37th in overall health system performance in the world by the WHO while paying far and away the biggest bill. What we need is not more unnecessary tests, which cost an estimated $700 billion dollars a year, but more intelligence. The Obama administration has rightly focused on the three main points of reform:

1. Provide coverage for the 47 million citizens who don't have insurance. Their health care is being paid for through public funds when the final bill comes due -- no one gets treated for free -- so it's absurd to hide the cost when it can be borne by those who need the care and have a duty to pay for it.

2. Provide a public option so that private insurers don't have the profits game entirely to themselves. Not only will a public option be cheaper, but it starts to remove the cutthroat profit motive in healthcare insurance to a more sensible and ethical motive of improving people's health and wellbeing.

3. Bring down medical costs, which involves two main fronts of attack. First, stop the "more is better" ethic (or rather, lack of ethics) that is tied to doctors' profit motive. Second, bring malpractice coverage and lawsuits into line with reality, since many medical tests are motivated by physicians protecting themselves rather than protecting the patient's health.

A great deal of fear and misinformation has been stirred up recently about end of life care in regards to health care reform. From my experience as a physician, efforts of extend life indefinitely through resuscitation and respirators usually only extends the patient's suffering and extends the hospital bill thousands of dollars a day. While there are important exceptions, nevertheless it is vital that patients have the opportunity to discuss and make these critical decisions for themselves before they are incapacitated and force their families into a decision fraught with guilt and uncertainty.

Anyone who wants to delve into the truly dismal state of health-care economics has a wealth of sources at hand. Read the excellent articles now online at the Atlantic Monthlyand The New Yorker magazines for a starter. You will quickly realize that this isn't an issue where the already insured are altruistically passing reform to benefit "them," the incapacitated elderly, the chronically ill, and the under-insured, all of whom have the smallest voice in Congress while health-care lobbyists actually outnumber members of Congress six to one. We have arrived at a generational crossroads where wasteful, inefficient medicine meets an aging population. We must make it through to the other side as a whole nation.

Otherwise, consider what looms ahead. The present generation of young children might become the first to live shorter lives than their parents thanks to runaway childhood obesity and lack of exercise. Fast foods continue to zoom in popularity, and sodas and sugary drinks are now the main source of calories in the American diet . Health-care costs could cripple American industry by amounting to 50% of overhead by mid-century. Even if those dire possibilities don't faze you, consider one of Pres. Obama's most basic points: compared to other countries, the richest nation in the world is paying more for less when it comes to health care. That alone is reason enough to quash the myth of "more is better" right now, while we have the best chance of real reform.

Published in the San Francisco Chronicle

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Follow Deepak on Twitter

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