Modern Medicine: The "alternative" that was destined to fail.
It's just a matter of when.
Recently, I announced a couple of new goals on the horizon for this online publication.
One of these is the composition of a book.
The primary objective of this book is to show people how to lead a life that breeds vitality, resilience, and joy for life.
Why else would you want to be healthy, or free of illness?
In the years spent writing online, one of the things I’ve learned from readers is a misapprehension of where the problems in modern medicine lie.
Some believe it’s because of “big pharma.” Others blame insurance companies.
There’s this idea that if we just solve this one problem, or reform this one organization…the modern allopathic industry will be good for the population.
This is a mistake.
A big mistake.
In fact, the propagation of this idea by talking-heads, online commentators, and newly appointed officials into our health regulatory apparatus…is a trap.
A trap designed to lull you into a sense of security and complacency. The reality, however, remains the same.
Nobody will care more about your health than you.
Anyone pretending to, must draw your suspicion.
It seems to me that for this book to be maximally effective, people must first understand where the real problems in medicine lie. With this approach, I hope I can help people avoid falling into these traps.
Define Some Terms
To avoid arguing over definitions, let’s set some things clear.
Modern medicine is the current Western allopathic medical model that continues to be exported to the rest of the world.
Although we commonly include surgery in this industry, in my opinion surgery is a separate field.
Often times, surgical interventions do not fall within the scope of allopathy. Allopathy is the practice of medicine by which illness is treated with opposites.
This is in contrast to homeopathy, which is the practice of medicine by which illness is treated with similars.
Surgery, more often than not, is concerned with taking things out of the body or removing body parts. I don’t think this neatly fits into either mode of medicine.
Furthermore, according to the Hippocratic Oath, surgery is not the concern of the physician.
Further, I will comport myself and use my knowledge in a godly manner.I will not cut for the stone, but will commit that affair entirely to the surgeons.
What’s Wrong With Medicine
People often talk about incentives as the unseen factors contributing to the rot in many organizations and institutions. Everyone I talk to in my day job knows this.
Observers from within and outside the industry are prepared to lay the blame at the feet of incentives.
Show me the incentive, and I will show you the outcome.
-Charlie Munger
So, to understand what’s wrong with medicine…maybe we should start talking about the incentive structures that permeate the industry?
What if we ask a question like…
What is Western Allopathic Medicine Optimized for?
As I’ve written about before, I believe the path to optimal health is through an understanding of one’s self (via temperament and heart), as well as optimization of habitat, activity and consumption.
Unfortunately, this is not what modern medicine is optimized for.
Modern medicine is optimized for revenue generation, risk mitigation, and product utilization.
This optimization manifests in the interaction of four distinct industries.
Insurance: centralized determination of medical practice through billing codes and risk pooling.
Pharmaceuticals (and biotech): product creation and packaging to optimize revenue.
Academia: production of information that aligns with financial incentives of benefactors.
Law: shielding and reinforcing of industry practices codified by the above, and punishing deviation from the centralized dogma.
Let’s dig a little deeper into all of these.
Insurance Companies
When people discuss “insurance” they often refer to health insurance companies, and sometimes the publicly funded equivalents (like CMS in the US).
However, there are other insurance companies which influence healthcare decisions, such as life insurance. In fact, life insurance companies may be masterminds behind much of the grief in our industry.
After all, they are the underwriters of not just health, but life itself. I would be surprised if they play no role in how “healthcare” is defined and practiced.
But, let’s set that aside for now and discuss the commonly referred to “insurance companies.” What is their role?
In short, insurance companies determine how medicine is practiced.
If you as a hospital or doctor would like to be reimbursed for your efforts, you must get along with the people who pay you. Otherwise, good luck getting paid.
Insurance companies reimburse based on diagnostic and billing codes (e.g. CPT and ICD-10 codes). If you do not make diagnostic or therapeutic efforts aligned with these codes and their pre-requisites, chances of appropriate reimbursement is low. This practice alone is responsible for many of the incentive games that healthcare providers and entities have to play.
These coding practices generate additional games of their own.
For example, one of the things we’ve observed in recent decades is the creation and expansion of diagnostic criteria. Or, the moving of diagnostic goalposts.
e.g. the diagnostic criteria for hypertension has gotten lower and lower over the years (systolic blood pressure > 140 vs > 120).
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