Good Medicine

Clinton Doc: This Is How We’ll Fix Health Care

Americans are sicker and taking more pills than ever, and our doctors are miserable. But not all is lost. Here’s how we can fix it.

06.12.14 9:45 AM ET

If you happen to walk onto a medical ward and see a dead-eyed nursing assistant shoveling spoonfuls of pills into an elderly patient’s dry mouth, you might begin to get an idea of what’s wrong with our medical system. It’s a sight so commonplace that one young nurse turned to me recently and said, “I feel like they’re kept alive just to shove pills into them.”

But it’s not just the elderly. We’re all shoveling pills alarming rate. While Americans make up 5 percent of the population, we consume 75 percent of the world’s pharmaceuticals, The Daily Beast recently reported, and 7 out of 10 of us take prescription medicines. We take more pills than other industrialized countries, and yet we have worse health outcomes. With an approach like this, many people predict that health reform will fail simply because this medical model is so broken—expanding it will do nothing but explode the cost of care.

A lot of patients are fed up with being plied with pharmaceuticals and are turning to alternative practitioners. But many conventional doctors are also fed up and are jumping on the “alt med” bandwagon. Unfortunately, a lot of alternative medicine is indeed deeply unscientific, and deserves to be treated with skepticism. But there is a little known group of doctors who are taking a “functional” approach to the patient—by using basic science to seek out and correct the root cause of disease.

This kind of approach could revolutionize the way we treat some of the most common medical problems—and save money in the process. Take, for example, irritable bowel syndrome (IBS), a condition that affects some 15 percent of Americans. Instead of initiating the usual protocol of trying a series of medicines, functional practitioners would look for food triggers first. It seems logical, but shockingly this is not the standard-of-care. While much of the reasoning behind this “functional” medicine is sound, critics malign it as ”Quackademic medicine”

Mark Hyman, MD, best-selling author, and current chair of the Institute of Functional Medicine, sees it as anything but quackery. “The outcomes in Functional Medicine are much more dramatic and much faster than conventional treatments, like days to weeks, and [it] gets to the root cause—it doesn’t just suppress symptoms,” Dr. Hyman, who also consults Bill and Hillary Clinton, told The Daily Beast. “That’s what we’re proving for inflammatory bowel disease, migraines, asthma, and things like autoimmune disease, gut issues, type 2 diabetes—all reverse very quickly… [for example], normal glucose in three days, whole body psoriasis gone in three weeks. Those results just don’t happen with drugs.”

Dr. Marcia Angell, after seeing the influence pharmaceutical money had on science during her two decades as the editor of the New England Journal of Medicine concluded, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”  She’s not the only respected establishment voice sounding the alarm. Dr. John Ioannides concluded much the same thing, as was highlighted in The Atlantic article “Lies, Damn Lies and Medical Science.” Even the casual observer has to be aware of the pharmaceutical scandals involving recalls of pills like Vioxx.

Now, preventive protocols—like mammograms, colonoscopies, and Prostate-Specific Antigen tests—are being questioned. (And that’s the stuff we are supposed to be doing right!) But for years, many independent-minded doctors have been calling preventive protocols “disease mongering,” claiming the medical system has been doing little more than beating the bushes for business. Suffice it to say that many dedicated doctors feel there’s enough evidence that our entire approach is not only expensive but also corrupt—and we shouldn’t be expanding it, we should be dismantling it.

Of course, there will be formidable opposition from our own medical leadership who won’t be likely to reverse themselves on the protocols they’ve created. How can they? They call the guidelines they set in place “evidence based medicine” (EBM), even though, as we’ve seen in many cases, the evidence is pretty thin—and possibly even fraudulent. But it’s a brilliant strategy for controlling not just how practicing physicians think, but also what they do and say. After all, what doctor is willing to speak out against “evidence”?  

Yet at its heart, all science begins with careful observation. You could say that science should begin in the exam room—not end there—because no one has a more vested interest in the patient getting well than a clinician and the patient. It was, after all, in the offices of Dr. Barry Marshall—an obscure Australian Internist who was desperate to understand why his stomach ulcer patients were failing to respond to conventional therapy—that the ulcer-causing bacterium H. pylori was discovered.

Marshall single-handedly reset our understanding of how ulcers are created, and won a Nobel Prize for his efforts. But now that it’s been decided that the only acceptable medical evidence comes out of a boardroom, observations and patients’ experiences are condemned as anecdote, and reasonable working theories dismissed as “woo.”

This has had an exceptionally negative effect on the practice of medicine and is particularly hard on our patients, who don’t feel listened to. It’s all exacerbated, of course, by the increasingly short doctor visit. Indeed, it was the embrace of evidence-based dogma that facilitated the creation of the 10-minute encounter. Why not? If we think we already know everything that is knowable, it shouldn’t take more than 10 minutes to deal with anyone.     

Good science will always be relevant to the practice of medicine, but we’ve found we can’t trust “the science,” we can’t even trust the experts. The healing arts will be advanced not by the big science of pharmaceutical companies, but by the “little science” of the exam room—and through accepting that the patient will always be part mystery—beautiful and complicated—that a good physician will be alert and responsive to. It’s precisely this “little science” of the patient encounter that Dr. Hyman wants to capture. Today, he is working with the Cleveland Clinic to develop a Functional Medicine Institute to demonstrate how well the approach can work.

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Critics of Functional Medicine claim that they too are interested in curing, not palliating disease. This may be true for infectious disease and cancer treatment, but it is demonstrably false for disorders like autoimmune disease that are on the upswing—and for which the conventional response is still, “We don’t know why patients have it.”

To be sure, Functional Medicine or related fields like Lifestyle Medicine may not have all the answers. But by addressing lifestyle issues first, physicians can help patients implement enduring low-cost fixes—and conventional medical leadership would do well to implement them into their protocols. In an era where we are pouring patients into the system, lowering physician pay, and increasing time pressures, without rethinking our entire approach we will do little to control costs or improve the nation’s health. (And I’m not just saying that to be provocative. Studies have shown that access to traditional care does little to improve population health.)

We’ll need to change the kind of medicine we practice to do that, and that will take some doing. Powerful forces—the pharmaceutical industry and an entrenched medical leadership come to mind—will want to keep things exactly as they are, while conveniently blaming individual physicians for the failure of the system they created—and calling anyone who steps out of line a “quack.”

Even with the backing of the Clintons, Dr. Hyman knows what he’s up against. But, in the face of all that, he thinks he can turn the tide. “If we can show that we have better outcomes and it’s cheaper to take a functional approach,” Dr. Hyman said, “in the end, the doctors who adopt this model—and their patients—they will be the ones who win.”