Health care for the 21st century
What does it really mean to be healthy? How should health care be optimally provided?
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” For the most part, the current health care delivery system conceptualizes disease as derangement in one part or a few parts of the human body, which is likened to a machine with smaller and smaller fixable parts.
Disease treatment in conventional medicine primarily relies on the use of medications or invasive interventions to treat the dysfunctional body part(s). It generally does not address the health of the whole person at the root level. Such a peripheral approach to health care overlooks the fundamental causes of disease and misses opportunities to realize true healing and health.
To achieve truly successful health care, we need to emphasize the primacy of healing the whole person on a fundamental level. This will catalyze a paradigm shift in the way health care is provided and consumed. Research has shown that such an integrative medicine approach, which considers the mind-body connection, lifestyle choice, social and environmental influence, individuality of body constitution, and the therapeutic relationship, not only yields good health outcomes but is cost-effective as well.
As a physician, I see on a regular basis the inadequacies of the current medical paradigm in addressing the chronic conditions often observed in aging. But I am inspired, as often, by the power of a whole-person approach to health restoration and creation.
Shift toward whole-person care
Modern medical advances have led to the discovery of lifesaving therapies. However, for most people with chronic medical conditions, is taking daily multiple medications the optimal long-term solution to maintain health? Should we accept the spending of hundreds of dollars a month on treatments that might not truly cure diseases as the inevitable path of health care in the 21st century?
Clinical training in medical school and residency focuses on fixing those parts of the body that are seen as diseased. By contrast, focusing on healing the whole person on a fundamental level means addressing the underlying interplay of lifestyle choices and psychological and social factors that ultimately contribute to health or disease. To heal the whole person, a paradigm shift in health care delivery is needed, in which the primary focus is on healthful lifestyle choices that create true health of mind and body.
Evidence from clinical research has already given us a glimpse of how a wholesome, mind-and-body healing approach leads to changes in the body, which are measurable with laboratory tests and lead to better health outcomes. In a randomized, controlled trial led by Dr. Dean Ornish, men with early stage prostate cancer who followed a lifestyle change program that included a plant-based diet, meditation, yoga-based stretching and moderate aerobic exercise had decreased blood PSA levels overall (1). Men who did not follow the program had increased PSA levels (suggesting progression of prostate cancer) and were more likely to undergo conventional cancer treatment.
Remarkably, blood from these men who made lifestyle changes inhibited the growth of prostate cancer cells in the laboratory almost eight times more than the blood from men who did not make changes, suggesting that lifestyle changes resulted in the presence of substances in the blood that have anti-cancer effects (1).
Shorter telomeres (regions with protective functions at the ends of chromosomes, and the subject of a 2009 Nobel Prize) are associated with aging and disease, and men with early prostate cancer who made lifestyle changes favorably increased the telomere lengths in their blood cells over five years, while men who did not make lifestyle changes had decreased telomere lengths (2).
In taking care of people with diabetes, I have repeatedly witnessed the reversal of elevated blood sugar levels in those who make earnest dietary and lifestyle changes, without the need to take any diabetes medications or with a much-reduced need for medications. Lifestyle changes (in a program covered by Medicare and major insurance carriers) have been shown to reverse the atherosclerotic narrowing of coronary arteries (blood vessels supplying the heart) in people with coronary artery disease, which can lead to heart attacks (3).
Dr. Caldwell Esselstyn’s work also demonstrates that a rigorous whole-food, plant-based diet can reverse coronary artery disease, the leading cause of death worldwide (4).
Evidence expands on mind-body connection
Also, a growing body of research evidence supports the benefits of mindfulness practices on physical and emotional well-being. Importantly, the effects of mindfulness practices can also be measured by objective laboratory tests. In a study involving breast cancer survivors, mindfulness meditation improved fatigue and reduced fear of recurrence (5).
While it is not surprising that mindfulness meditation reduces anxiety (6), an eight-week mindfulness meditation practice led to increased density in the left hippocampus (7), a region of the brain involved in memory (and damaged in individuals with Alzheimer’s disease). Mindfulness meditation also resulted in improved responses of the immune system to influenza vaccine (8). A review study found that the practice of tai chi, which combines meditation with slow, graceful movements and deep breathing, is associated with improved memory-related function in both healthy older adults and those with memory impairment (9).
Such holistic approaches to health also reduce health care costs. A study by Harvard researchers showed that a mind and body training program reduced the need to utilize health care resources by 43 percent after one year and decreased emergency department visits by half (10).
In a Medicare-sponsored demonstration study, patients with coronary artery disease who participated in lifestyle change programs were hospitalized less often (by 30-46 percent) than those who did not participate in such programs, and the lifestyle-change participation resulted in health care cost savings of $1,000-$3,500 per patient over three years (11).
We all have a role to play in our health
The concepts discussed here are not new. The field of integrative medicine and functional medicine, which champions healing of the whole person in mind and body and views health and disease through the unique bio-psychosocial determinants of each person, has much to teach the remainder of the health care system about how best to treat disease at the root of the problem, prevent disease, and create health.
The Institute of Medicine (now the National Academy of Medicine) had already warned, more than a decade ago, that the current health care system is inadequate in addressing the needs of the aging population and the growing epidemic of chronic diseases (12). A fundamental change in how all of us (health care consumers and health care providers alike) view health and disease is direly needed to usher in the health care system of the 21st century that we all have the right to have.
(The above opinion piece by Dr. Wang was originally published in The Conversation.)
1. Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. J Urol, 2005. 174(3): p. 1065-9; discussion 1069-70.
2. Ornish, D., et al., Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol, 2013. 14(11): p. 1112-20.
3. Ornish, D., et al., Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 1998. 280(23): p. 2001-7.
4. Esselstyn, C.B., Jr., Is the present therapy for coronary artery disease the radical mastectomy of the twenty-first century? Am J Cardiol, 2010. 106(6): p. 902-4.
5. Lengacher, C.A., et al., Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol, 2016. 34(24): p. 2827-34.
6. Goyal, M., et al., Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med, 2014. 174(3): p. 357-68.
7. Holzel, B.K., et al., Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res, 2011. 191(1): p. 36-43.
8. Davidson, R.J., et al., Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med, 2003. 65(4): p. 564-70.
9. Wayne, P.M., et al., Effect of tai chi on cognitive performance in older adults: systematic review and meta-analysis. J Am Geriatr Soc, 2014. 62(1): p. 25-39.
10. Stahl, J.E., et al., Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization. PLoS One, 2015. 10(10): p. e0140212.
11. Zeng, W., et al., Benefits and costs of intensive lifestyle modification programs for symptomatic coronary disease in Medicare beneficiaries. Am Heart J, 2013. 165(5): p. 785-92.
12. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century. 2001, Washington, DC: The National Academies Press.