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Preventive Healthcare: Shifting the Self-Care Paradigm

Charles Bens, Ph.D.

Self-care at the window.

The existing healthcare system is based on the treatment of symptoms, even though 80 percent of illness is preventable. That means simply that individuals and their doctors are doing precious little to prevent disease, even though they could. This has led to a declining state of health for our population, as well as outrageously high health costs, which are rising every year. More than 60 percent of adults have a chronic illness, and this represents a six-fold increase over the past 60 years. Cost in that same period of time has tripled from 7 percent of our Gross National Product to about 20 percent; some economists indicate that this could increase to 100 percent of GNP by the year 2065.1

How did this happen, and can anything be done to reverse this very serious situation? The literature identifies several specific factors that have contributed to this disappointing state of affairs. Following is a partial list of contributing factors:

  1. The general public learns very little about health and prevention in the educational system, the media, or the workplace.
  2. Conventional health practitioners learn very little about prevention or natural approaches to reversing chronic disease.2
  3. The existing health insurance system is almost exclusively focused on treatment, with rules and regulations slanted in that direction.3
  4. Scientific studies clearly show that conventional medical treatments are effective only about 20-25 percent of the time.4
  5. Prescription drug companies have amassed billions of dollars from their treatment-based approaches and then use this war chest to keep the treatment-based system intact and keep the money flowing to company executives and shareholders.5
  6. The media plays a big role in supporting the treatment-based system by virtue of the rich advertising budgets provided to both electronic and print media by “Big Pharma.”6
  7. Governmental agencies play an important role in this support of treatments when political campaigns are funded by drug companies, among others, to ensure that rules by agencies such as the FDA require strict legislative guidelines and expensive clinical trials that can only be paid for by rich drug companies.7

It is very clear that the current healthcare system is stacked very much in favor of treatment, with prevention given very little attention. This is in spite of the fact that scientific evidence is heavily weighted in favor of the prevention — and even the reversal — of chronic disease.8 The “system” simply ignores this fact and allows the financially lucrative treatment-based system to continue to have its way.

Is there any hope that this situation can be changed in the near, or even the distant, future? Perhaps it is time to consider self-care as one of the options that warrant further attention.

Self-care can probably be best described as common sense healthcare, whereby people take more responsibility for their health with an emphasis on prevention. Unfortunately, too many people pay very little attention to prevention, instead of waiting until a health problem of some kind occurs. This results in a medical response and a treatment of some kind by our conventional healthcare system. Besides being very expensive, this treatment-based approach represents the number one threat to the health of our country.10

About 95 percent of all health expenditures are related to the treatment of illness; only 5 percent is spent on prevention.10 This is very disturbing, because over 80 percent of all illness is preventable. This means that, in the purist scenario, over 80 percent of healthcare costs are also preventable.11 This is one of the reasons why the United States has the most expensive healthcare system in the world, and it will likely bankrupt our country if this lack of prevention is allowed to continue.12 Too many people have become “addicted” to the treatment of disease; this addiction will eventually make many people sicker and cause them to die sooner than they should.13

Self-care can be defined in many ways, and we should carefully consider its many variations in order to optimize the opportunity for illness prevention and cost savings.

What are some of the levels of self-care?

  1. Passive self-care – This might be the type favored by many conventional doctors. It could involve asking some very general questions about the diagnosis as well as the recommended treatment for a particular illness. Some doctors do not even want to entertain questions since they feel that patients know so little about medicine that they are not qualified to challenge or question a doctor’s diagnosis or treatment.
  1. Curious self-care – In this case, patients may ask some questions of their primary care physician and, if not totally satisfied, might seek a second or even third opinion. This level of self-care usually kicks in when a more serious illness is diagnosed, and the patient wishes to avoid an operation or an invasive treatment, such as chemotherapy. The patient may also be frightened enough to ask about less invasive treatment possibilities, and may actually identify some if one of the doctors contacted has taken the time to study complementary or alternative treatment modalities. However, at the conclusion of this discussion, the conventional doctor’s opinion would probably prevail. 
  1. Inquiring self-care – This level of self-care is similar to “curious self-care,” with the exception that individuals, in this case, would do some research in order to prepare better questions, especially for the second and third opinion doctors. They may even suggest some complementary or alternative treatments, but would not press for them if their doctor discouraged their use. The other distinguishing characteristic of this type of self-care is that it is mainly reactive rather than proactive or preventive.
  1. Consultative self-care – This is the first self-care level that includes active prevention and consultation between doctor and patient on how to prevent illness, as well as how to treat conditions that have been diagnosed. Patients at this level are likely engaged with conventional as well as alternative practitioners on a regular basis or have found a holistic M.D. who incorporates many medical modalities. Some medical offices now have a full range of integrative practitioners available for patients to consult.
  1. Assertive self-care – These individuals are often called self-healers.

They usually consult with several alternative health practitioners on a regular basis. They will sometimes consult a conventional doctor in a true medical emergency, but would much rather research their condition and find one or more alternative treatments for any chronic illness. They are also very engaged in illness prevention. In fact. some people are borderline hypochondriacs. They tend to believe that they will get various diseases and will take many different approaches to avoid them, including restricted diets, regular nutritional supplementation, and regular tests to ensure that nothing has actually changed in their body.

We can see from the preceding discussion that self-care can be defined in many ways, but we should be careful not to see these definitions as comprehensive or rigid. People may move from one level to another over time or change approaches depending on their situation. Some people may think that they are engaged in prevention because they eat what they believe to be a “balanced” diet, don’t smoke, get some exercise, and take a multivitamin. More detailed definitions are a starting point to determine where you are in terms of personal responsibility. The following chart illustrates the main points of these different levels of patient self-care.

Shifting the Self-Care Paradigm

Passive Self-Care Curious Self-Care Enquiring Self-Care Consultative Self-Care Assertive Self-Care
Conventional M.D. Conventional M.D. Conventional M.D. Conventional and Natural Doctors Holistic or Functional M.D.s
Asks few questions Asks questions about options Researches other options Collaborates with doctors Creates holistic plan for doctors
Reads very little Reads mass-media stories Reads specialty health media Reads health and medical articles Reads all books and articles available
Takes meds faithfully Takes meds with some caution Takes meds and supplements Takes meds temporarily Takes supplements first if possible
Eats whatever tastes good May reduce fat and sugar Tries some health recipes Eats whole food diet primarily Eats nearly perfect for his genes and metabolism
Gave up exercising years ago Walks the dog and bikes in the community Increases heart rate almost daily Goes to the gym often Aerobic resistance and stretching daily
Doesn’t think about stress Aware of need to avoid stress Uses music or hobby to avoid stress Reads about stress and manages it Does meditation or yoga every day

 

Beginning to Further Define Self-Care

Several factors contribute to self-care in its highest and best form.

Here are some of the basic criteria:

  1. Lifestyle Factors – At the outset, a healthy lifestyle is the most fundamental need. This includes no tobacco, very limited alcohol consumption, seven to eight hours of sleep per night, managing stress, and avoiding as many toxins as possible. Eating according to the Mediterranean or Asian food pyramid is very important, and taking quality nutritional supplements according to your needs is also vital. Information on each of these topics is readily available, and without a sound program in each area, advanced self-care is simply not possible.
  1. Information Sources – Where do you get your health information? If you get most of your health information from commercials, conventional doctors, and “old wives’ tales,” then your self-care prospects will be very limited. If on the other hand, you rely on magazines, websites, and doctors featuring evidence-based healthcare, you will be utilizing the best quality healthcare information. Web MD, Pub Med, and Doctor Oz are sometimes good sources, but not always the best. However, if you refer to Life Extension Magazine, Dr. Michael Murray, Dr. Joseph Mercola, Dr. Mark Hyman, and Green Med Info, you are more likely to get leading-edge, evidence-based health and medicine information.
  1. Doctors, Tests, and Treatments – Unfortunately, the current healthcare system is not as prepared as it should be for the most advanced version of preventive self-care.
    • Doctors – Most doctors are treatment-based and have limited knowledge on preventive medicine. Doctors practicing Holistic, Functional, or Natural Medicine are better trained and skilled in this regard. Unfortunately, many of these “natural” doctors may not be included in your health insurance plan. If you can afford to utilize one of these natural doctors for prevention and reversal of chronic illnesses, it would be better for you and your family.
    • Tests – Many standard health tests do not catch disease soon enough to be prevented. One example is mammograms, which usually catch breast cancer too late. Thermography is better.14 Another test called the A1C is not the best for diabetes. A better one is the glucose tolerance test.15 Likewise, a blood test for cholesterol is not usually the best test for heart disease. Better tests measure C-reactive protein, homocysteine, and fibrinogen.16 There are many books and articles on these “better” tests, and advanced self-care should encompass them.
    • Treatments – Most conventional medical treatments for chronic illness are based on the treatment of symptoms, not the reversal of the disease. In the world of conventional medicine, managing the disease is the goal; however, the side effects and the long-term negative consequences are often not good. Arthritis patients still end up getting knee and hip replacements, diabetes patients still have higher rates of stroke and heart disease, and patients with the cardiac disease still end up with high rates of stroke, bypass surgery, and stents.17 On the other hand, doctors using Functional Medicine can reverse many cases of diabetes, arthritis, and heart disease with plant-based diets, exercise, and nutritional supplements such as magnesium, fish oil, vitamin C, and CoQ10, just to mention a few important supplements. The science behind this reversal of disease is absolutely undeniable.18 And yet, conventional medicine continues to ignore the evidence being produced every day with thousands of holistic doctors, including prestigious institutions such as the Cleveland Clinic.19

It is clear that self-care goes well beyond what happens between people and their doctors; it involves a full range of activities that can dramatically influence a person’s overall health and wellness. Self-care includes many lifestyle changes and educational initiatives, which some people are more willing to pursue than others. This, more than any other single health factor, is what separates a low-risk person from a high-risk person.

Far too many people take a laissez-faire attitude with their health. They don’t eat as well as they should. A recent study of more than 16,000 people aged 2 to 80 did not find even one person who followed a healthy diet.20 This study, from the National Cancer Institute, actually revealed that a vast majority of people were deficient in 11 out of 14 nutritional categories. That would seem to explain why over 60 percent of adults are chronically ill, compared to only 10 percent 60 years ago.21 It would also explain why the generation of children born after the year 2000 will be the first generation that will not live as long as their parents did.22

Why is it taking so long for people to pay attention to these very serious health problems? Articles about this health crisis appear nearly every day, and yet most people remain surprisingly unaware about how they need to change their behavior. Following are some possible reasons why the current level of self-care is so low:

  1. A vast majority of doctors still treat symptoms.23
  2. Insurance companies pay for treatments and very little (less than 5 percent) for prevention.24
  3. Big Pharma influences politics too much, through extensive advertising dollars.25
  4. Only 20-25 percent of treatments by conventional medicine are supported as effective by scientific evidence.26
  5. Workers are too busy to find time to research and implement a good disease-prevention program.27
  6. Many workers do not have the financial ability to pay for organic food, nutritional supplements, holistic doctors, and other out of pocket health expenses.28
  7. People tend to think they will live a long and healthy life in spite of emerging health concerns.
  8. People feel that their doctor will find and control any health problem if it does happen. This attitude prevails in spite of the evidence to the contrary in study after study.29

The existing healthcare crisis facing our country will not be resolved anytime soon. As previously stated, a recent issue of The Economist indicated that the U.S. will likely spend 100 percent of its GNP on healthcare by the year 2065.30 If 80 percent of disease is preventable, then the only feasible solution is to dramatically increase and improve patient self-care. This requires a revolution of new thinking on the part of most people. The following chart depicts the relative cost impact of the five levels of patient self-care discussed previously:

Costs and Benefits of Self-Care

Passive Self-Care Curious Self-Care Enquiring Self-Care Consultative Self-Care Assertive Self-Care
Higher employee health premiums Premiums somewhat lower Premium stable Premiums getting lower Lower employee health premiums
Higher absenteeism Absenteeism slightly better Absenteeism somewhat better Absenteeism is lower Much lower absenteeism
More frequent colds, flu and sickness Slight improvement in overall health Healthier most of the time Much healthuer consistently Vitrually sickness free
Time on health much higher Time on health issues is too high Time on health issues a little less Time on prevention better Time with prevention higher
Quality of life much lower Quality of life lower after age 40 Quality of life lower after age 50 Quality of life lower after age 60 Quality of life much higher

  

Possible Reforms to Increase Self-Care

Here are a few examples of some of the reforms that would help to shift the preventive healthcare paradigm in the direction of better health and lower cost.

  1. We need the media to pay serious attention to disease prevention.
  2. We need politicians to create strategies and incentives for prevention and better patient self-care.
  3. We need insurance companies to dedicate more time, effort, and resources to prevention.
  4. We need much better health education and nutrition programs in our schools.
  5. We need better workplace wellness programs, with tax incentives for employers and employees who practice prevention and use evidence-based natural treatments.
  6. We need to reduce the stress levels for many people because stress is implicated in 80 percent of all disease.31 This should involve the reduction of stress in our schools, our families, and the workplace.
  7. We need doctors to learn more about nutrition and holistic medicine. The government and the American Medical Association should require this change.
  8. We need hard prevention targets to improve overall health. Everyone needs to buy into these targets in much the same way that we target species extinction and global warming.

The current debate about healthcare costs has centered on such things as the availability of insurance or whether prescription drugs are covered or not. There are endless debates about HMO approval of certain treatments and the lack of time doctors have to spend with patients. While these are important issues, they pale in comparison with the importance and significance of the self-care issue. Fixing all of the technical, administrative, and coverage issues would not begin to improve health or reduce costs as much as a shift in the self-care attitude of our population.

A majority of our population is in the passive or curious self-care categories. Moving them to the inquiring or consultative categories would save billions of dollars within a matter of months. This is where our effort should be concentrated, not in the debate about how much drugs cost, or which treatment should be covered by an insurance plan. By tinkering with the symptoms, instead of attacking the root cause of our health problems, we continue to give in to the pressure of the almighty dollar. The protection of profits for drug companies, doctors, and certain parts of the food industry is put ahead of the health of our population every day. The power to change this sad state of affairs may be partially addressed by the government, the medical establishment, and the insurance industry; however, it can be much more quickly and effectively resolved through the decisions made by each and every person as they decide how they will define their own self-care.32


About the Author

Wellness champion, Dr. Charles BensCharles Bens, Ph.D.

Healthy at Work

Sarasota, Florida

Charles K. Bens, Ph.D. 

Charles Bens is an internationally recognized author, speaker and consultant specializing in the field workplace wellness. Dr. Bens has written nine books and over two hundred articles, and he was recently named the Vail Visiting Professor by the Ottawa Regional Cancer Foundation. He has a small wellness company, Healthy At Work, Inc. in Sarasota, Florida.


References

1) “Patient Heal Thyself.” (2011, March 19). The Economist.

2) Devries S., J. E. Salen, D. M. Eisenberg, et al. (2014). “A Deficiency of Nutrition Education in Medical Training.” AM J Med 127 (9), 804-806. Alliance for a Healthier Generation, American College of Sports Medicine, Bipartisan Policy Center. (2014, June). “Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention Oriented Care” (white paper).

3) Frost B., A. Rivlin. (2015, May 28). “The Power of Prevention: US Health Care Reform Should Focus on Prevention Efforts to Cut Skyrocketing Costs.” US News and World Report. Lavizzo-Mourey, R. (2012, May 30). “We Must Focus on Preventing Disease If We Want Our Nation to Thrive.” The Atlantic.

4)Carey, J. (2006, May 29). “Medical Guesswork.“ Bloomberg Business Week.

5)Angel, M. (2005). The Truth About Drug Companies; How They Deceive Us and What To Do About It. New York: Random House.

6) “How Big Pharma and the Media Sell Junk Science.” (2014, April 22). Alliance for Natural Health, ANH-USA.

7) Life Extension Foundation. (2010). FDA: Failure, Deception, Abuse. Mount Jackson, VA: Praktikos Books.

8)

Available at: http://www.cdc.gov/clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html. Accessed January 6, 2015.

9) “Healthy Living May Reverse Cellular Aging, Study Suggests.“ 2013, September 16). HealthDay. Available at https://consumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/healthy-lifestyle-may-reverse-cellular-agingstudy-suggests-680221.html. Accessed January 6, 2015. Rustum, R. (2010). “Integrative Medicine to Tackle the Problem of Chronic Disease.” Ayurveda Integr Med, Jan-Mar;1(1):18-21.

10) “What Conclusions Has ‘Clinical Evidence’ Drawn About What Works, What Doesn’t Based on Randomised Controlled Trial Evidence?“ British Medical Journal. Available at: http://clinicalevidence.bmj.com/x/set/static/cms/efficacycategorisations.html. Accessed January 6, 2015. “Healthy Living May Reverse…“ Op Cit. and Rustum R. “Integrative Medicine…” Op cit.

11) Ibid.

12) Ibid.

13) Ibid.

14) Belluck, P. (2015, March 17). “Children’s Life Expectancy Being Cut Short by Obesity.” The New York Times.

15) Northrup, C. “Best breast test: The promise of t” Available at http://www.drnorthrup.com/bestbreast-test/. Desaulniers, V. (2014). Heal Breast Cancer Naturally. TCK Publishing, pp. 232-234.

16) Hyman, M. (2012). The Blood Sugar Solution. New York: Little Brown and Company, p. 25.

17) Sinatra, S. (2012). The Great Cholesterol Myth. Beverly, MA: Fair Winds Press, pp. 171-175.

18) Carey, J.(2006, May 29). “Medical Guesswork.“ Bus Week Mag. Available at: http://clinicalevidence.bmj.com/x/set/static/cms/efficacycategorisations.html. Accessed January 6, 2015. [start with author or title] Available at: http//www.consumer.healthday.com/senior-citizeninformation-31/misc-aging-news-10/healthy-lifestyle-mayreverse-aging-at-cellular-level-study-finds-680221.html.Accessed January 6, 2015. Rustum, R. “Integrative Medicine…” Op cit.

19) Ibid.

20) Krebs, S. et al. (2010, August). National Health and Nutrition Survey, National Cancer Institute. Journal of Nutrition.

21) Centers for Disease Control and Prevention. The Power of Prevention: Chronic Disease: the Public Health Challenge of the 21st CDC.gov., National Center for Chronic Disease Prevention and Health Promotion.

22) Belluck, P. (“Childrens’ Life Expectancy…” Op cit.

23) Visscher, M., et al. (2009, November).“Five Steps to Better Health Through integrative Medicine.” Ode, pp. 45-53.

24) Willett, W. C., J. P. Koplan, R. Nugent, et al. (2006). “Prevention of Chronic Disease by Means of Diet and Lifestyle Changes.” Disease Control Priorities in Developing Countries (2nd ). Washington, DC: World Bank.

25) Abramson J. (2004). Overdosed America. New York: Harper Collins, pp. xiii-xiv. Life Extension Foundation. (2010). FDA: Failure, Deception, Abuse. Mount Jackson, VA: Praktikos Books.

26) Carey J. “Medical Guesswork.” Op cit.

27) Person, A. L., S. E. Cody, and J. W. Eubanks. Barriers to Participation in a Worksite Wellness Program. Available at Nutrition Research and Practice, Department of Nutrition and Dietetics, East Carolina University, Mail Stop 505-333 Rivers Building, Greenville, NC, 27858.

28) Ibid.

29) Saul A. (2010). Doctor Yourself: Natural Healing That Works. North Bergen, NJ: Basic Health Publications, Inc.

30) “Patient Heal Thyself…” Op cit..

31) Salleh, M. R. (2008, October). “Life Event, Stress and Illness.” Malaysia Journal of Medical Sciences (15) 4, pp. 9-18.

32) Begley S. (2011, August 22 & 29). “One Word That Will Save Your Life.” Newsweek, pp. 30-35. Global Health Report: Prevention vs. Treatment: A False Choice. (2009). Originally from Don Wright, M.D., U.S. Department of Health and Human Services.

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