Deifying Disease By Design
In a recent video released to the world, top experts have revealed their agenda for making progress with regard to disease focus. Local and state have not been enough. National is not enough. They want the entire world to focus upon eradication of thousands of diseases which they conveniently categorize into just a few - or actually one disease.
In the video there is a first a comment about the problem of the term “non-communicable disease” (a negative term), and then there is adoption of the term “NCD.” This is a continuation of a process to make thousands of heart, lung, and other diseases into Four Diseases Focus and then into just one - NCD.
Those in charge are very effective with regard to focusing attention upon disease (not better health, not better health care, not health care for entire populations). They have been first to call for a UN summit on the problem of non-communicable diseases.
Forget the fact that the nations left behind mostly need clean water, sanitation, better housing, decreases in massive pollution, and other basics.
Forget the fact that the major problem for nations such as the United States is a disease focused design that results in 20% of all dollars sent to health care – crippling the economy and resulting in ever more stress and more disease and poorer health as a result.
Forget the fact that most Americans have limitations with regard to basic health access in one or more dimensions - because so much is spent upon disease focus.
Forget the fact that disease focused health spending crowds so many dollars into so few diseases with care delivered in very few locations.
Those in charge that are disease focused are not happy with just the domination of medical journals or government reports. They are not yet pleased with their ability to get ever more disease focused testing and ever more disease focused training and ever more disease focused treatments.
Forget that they have the ability to convince legislators to do what they want even when the evidence is poorly supportive - because those that sell tests and equipment and research harvest vast sums of money by disease focus.
Forget that they accepted billions of dollars of government, drug company, and foundation dollars spent on disease focus - dollars that shaped their admission, their training, their advancement and promotion, and their thinking.
They are not happy controlling government health leaders and panels. They plan to get above the health ministers to heads of government and finance ministers.
Remember that they do not understand that their single-minded focus on disease eradication is breaking the bank of government at all levels (school districts to federal) and businesses of all types already (that pay more and more each year for health care insurance). Forget that school districts have to cut teachers and education focus to balance health care spending or that governments cut public servants to pay for ever increasing health insurance costs and insurance companies just pass disease focus back to us with higher costs of insurance.
The disease-focused see the need to spend ever more on costly tests and treatments that look good on paper but are actually even more costly and less effective in actual result.
How many more times will we need to see failures when moving from paper to populations before we decide to apply the recommendations to 1 to 2 million people before applying them to 300 million?
Application to entire populations is a process, not a concept. Concepts are easy, process is hard. Is it a surprise that the US failed to understand Deming and fails to understand quality with a focus on concept rather than process? Application of health concepts to process has yet to be captured on paper or even in reports or entire books.
An example of disease focus is seen in diabetes - or rather the several diseases that are combined under the term diabetes.
- First, the definition is changed and results in substantially more found with "diabetes".
- Second, economic conditions result in more stress and more difficulty addressing the root causes of diabetes. Eating too much and drinking too much and poor diet are just a few of the behaviors people turn to when stressed. Those most stressed also find it harder to get health care and the best health care.
- Third, diabetes is declared as epidemic, because of the direct and indirect influences of disease focus.
The disease focused are not bad people. They are actually quite nice. They are among the brightest on the planet. They are also passionate about what they do and how they hope to help others. It takes more than best and brightest or the most passionate. It takes practical and relevant to lead health care effectively for entire nations.
Process is far more important than concept. The health of entire populations is all about process and little about concept.
Like nearly all of us, those passionate about diseases are frustrated with politicians. They are also certain that their approaches will work, just like any number of interventions that failed to work well beyond the basics of food, sanitation, water, housing, and immunizations. After all they were doing disease focused research before medical school and during medical school long before they even had any clinical training. Disease focused research shaped their path to medical school. The influence continued in the first two years before there was much in the way of clinician training at all. If you do not understand this, just pick up any of the 30,000 applications for medical school each year and compare how much space there is to pointing out just how much research focus their is in applications.
The disease focused will also be more frustrated as progress is gained in evidence-based medicine – indicating that their plans for disease focused domination can be exposed as wrong. In fact the very word non-communicable disease is a separation from communicable diseases that still kill millions a year and the youngest and some of the most important for nations - like parents.
The disease focused will also be frustrated by those that point out that health and health care delivery outcomes are more about people and the conditions of populations – not disease-focused care.
How will the disease focused react when more and more evidence points out that disease focused care is what is breaking the bank and causing stress, obesity, mental health problems, lack of focus upon children and those newest to life (where interventions are most effective), and more focus on those at the end of life where little real gain in life is possible at increasing cost?
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Clinician Specific Medical Education
Dr. Bowman is the North American Co-Editor of Rural and Remote Health and a Professor in Family Medicine at A T Still University School of Osteopathic Medicine. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association, he was the long term chair of the STFM Group on Rural Health, he is the founding director of Priority Infrastructure at http://www.infrastructureamerica.org/ and he is the author of the World of Rural Medical Education, and Physician Workforce Studies
Clinician Specific Medical Education