Friday, July 27, 2012

Cells and people behave the same--the Aurora, Colorado tragedy

Our 50 trillion cells work together and cooperate with each other. Even though the networks appear complex, they are ultimately under a central control,[1] which is based on a few simple concepts:

It is a mistake to imagine that complex disease may not be solved by simple approaches or that their causes are not simple. The grave danger that terms such as ‘multifactorial’ or ‘complex’ is that they may justify the belief that solutions will come only from large and expensive managed projects rather than from simpler approaches…Diseases don’t exist in their own right but as alterations in complex systems of homeostasis. Medicine has little regard for complete description of how a myriad of pathways result in any clinical state.”[2]
True, but even so, research studies on isolated parts of the whole are still beneficial and have significantly contributed to our society; hopefully, they don’t lose track of the “forest.” The latter point was sadly exemplified at a recent meeting of doctors I attended; one esteemed and intelligent colleague expressed his opinion that the word “holistic” conjures images of someone trying to cure brain cancer with Gingko baloba. Granted, some have imbued that word with unsubstantiated claims of fantastic cures. Nonetheless, retreating to the other extreme does not serve us well:       

The current discourse on clinical medicine is dominated by a mechanistic, deterministic, and reductionist world view and has much to gain by embracing the concepts in complexity science.”[3]

Fortunately, top researchers do understand what “holistic” truly means:

 Biologists are struggling to move beyond a “part list” to more fully understand which network components interact with one another to influence complex processes... The idea that molecular signaling cascades share fundamental properties with ant colonies and internet communication systems is adding new meaning to the idea of interdisciplinary science.”[4]

Scientists are going as far as stating that our society must emulate the 50 trillion cells that constitute our body; they work together in a perfect symphony of cell communication.[5] The same cooperative work is vital if people are to survive in the long run, a subject that is discussed on the cover of the July 2012 issue of the Journal Scientific American. “Scientists are pushing network analysis to its limits across disciplinary fields” to work on societal problems, climate change, sustainability, ethnic strife, internet users emotions, behavioral norms, terrorists activities, monetary exchanges, viral transportation systems, cellular circuitry (cell communication), DNA sequencing, and economic recession.[6]
So, “ourselves, and our interactions are the ultimate physics problem.”[7] We were brutally reminded of this fact by the tragedy in Aurora, Colorado in July. That bell tolled for all of us.
Have we grown too isolated from one another? Was the perpetrator a sick individual who felt himself detached from society at large? There will always be “cancerous” cells/individuals who will not hesitate to hurt the organism they are a part of. Still, we would do well to revise our view of our body/world and strive to work as cooperative societies, not competitive ones.[8]
“No man is an island,” but most of us, from time to time, may feel like one. Perhaps the sick young man in Colorado felt extremely isolated, and due to unresolved inner demons, went over the edge. Adding the fact that our mental health system is broken,[9] we end up with a dangerous mix that will likely result in similar tragedies in the future. This is why I believe we must stand strong by the Second Amendment and preserve our right to bear arms. If a few of the victims, particularly the 3 Armed Forces veterans, had been carrying a lawful concealed weapon, the consequences may have been less devastating.
To protect themselves from inside and outside threats, some of our 50 trillion cells have a specific defense function, immuno-detoxification. These cells are “allowed” to destroy any wayward cell, toxin, or organism that threatens the survival of the whole organism. These immune system cells are responsible, well trained and seldom misfire. Of course, it would be best to prevent problems from arising altogether with holistic approaches like nutrition and clean environments, but, sometimes “lethal radiation” is necessary to treat a wayward cancerous cell.

[1]Controllability of complex networks,” J. Nature 2011;47::167
[2]The puzzle of complex diseases,” J. Science 2002;296:699. Cover issue
[3]Complexity Science to Conceptualize Health and Disease: Is It Relevant to Clinical Medicine?”
            Journal Mayo Clinic Proceedings 2012;87:314
[4]Life and the art of networks,” J. Science 2003;301:1863
[5]Mapping Cellular Signaling,” Cover issue J. Science, May 31st 2002;296:1632-1635
[6]Connections: complex systems and networks,” J. Science 2009;325:405
[7]Ourselves and Our Interactions: the ultimate physics problem?” J. Science 2009;325:406
[8] Cover issue Journal Scientific American, July 2012
[9] National Council for Disabilities (9/16/2002) report: “The U.S. mental health services is in crisis,” The American Enterprise Institute, J. Family Practice News, January 1st, 2004, p82, New England J. of Medicine 2004;350:507 & J. Archives of General Psychiatry 2005;62:629

Friday, July 6, 2012

On the Supreme Court Ruling on the Affordable Care Act (AFA): An Integrative View

Usually “Integrative” means a middle of the road approach. In this case it means both Republicans and Democrats will be equally offended by reading this blog.

Since the main goal of any Health Care system should be to serve the public, let us start by contemplating the fact that the top 5 countries in health care outcomes do much better than the USA and at ½ the expense per person per year. How do they do it? They provide the most basic services through a SINGLE PAYER system. Doctors work for themselves, but are paid by a single insurer, thereby reducing overhead, paperwork, and exclusionary regulations. As bad as state-run programs are, keep in mind that Medicare-Medicaid have an overhead of < 5%; private insurance companies’ overhead costs are >20%. No doubt this is offensive to Republicans.

If you disagree with the statements above, could you compromise if each state regulated its own Single Payer program, thereby eliminating Federal intrusions while focusing on each State’s idiosyncrasies?[1] An integrative, middle-of-the-road solution is more likely to succeed in view of the changes being implemented in those aforementioned countries. For example, the English National Health Service Embarks on Controversial and Risky Market-Style Reforms in Health Care[2] as General Practitioners are making more decisions, patients choose who they see and local governments exercise more control.

Now, let’s offend Democrats: whether we call it a “penalty,” or a “tax,” I do not want to pay into a system that is rigged in favor of Pharmaceuticals, Insurance companies and other Big Business Corporations who have practically taken over Health Care. The whole thing has become big business with only peripheral platitudes about serving people. Sure, the system “does” a lot to people; unfortunately, only 80% of it has any validating scientific evidence and seem to be driven by profit only.[3]

The ACA only allows more people to have their “symptoms managed,” not the root of their health problems. The Act perpetuates a “Disease Care system” while doing very little for true primary prevention, or the factors that lead to disease, like nutrition, mind-body, and environmental issues.[4] Sure, secondary prevention, like mammograms and bone densitometries are covered, but, they only “prevent” disease after they have started. Besides, tests like those are not only overdone but unnecessary in many patients under 50 and under 65 years of age respectively.

For years I have lived without health insurance, refusing to cave in to fear and misinformation. I have felt fairly confident (knock on wood) that I am likely to avoid disease by eating a ton of vegetables, exercising and living a clean, relatively balanced lifestyle. Of course, not everyone may be able to do this: let them join any health plan THEY CHOOSE. Or, better yet, help them study this whole matter and vote for politicians who in the future may support a State-based Single Payer system. With savings from overhead, paperwork and those accrued from bulk drug purchases in other countries, which are not allowed in the USA presently, such a system would not force anyone to participate, yet allow anyone to buy up better coverage beyond the bare necessities provided to all.

The argument that such a system would be unfair competition to existing insurance companies is not backed up by history. Is not the US Post Office struggling against FedEx and UPS? And the argument that we need to force everyone to participate in order to lower cost by spreading it out is not valid, either: cost went up in Massachusetts with an approach similar to the ACA, because a significant number of those who joined were desperate to use services. Insurance companies were hoping for healthy, young patients to offset the additional burden, never mind the inherent unfairness. By the way, most doctors in Massachusetts preferred a single payer system.[5]

The 4 million Americans who feel robbed of any choice will likely pay that “penalty,” or “tax,” if getting Health Care coverage they do not believe in nor plan to use, is cheaper.

[1] State-Based Single-Payer Health Care? A solution for the USA? “ New England J. of Medicine 2011;364:1188
[2] NEJM 2011;364:1360
[3] J. Business Week, May 29th 2006, cover story. The article is written by David Eddy, a Heart Surgeon trained in Mathematics; he is the chairman of the Center for Health Policy Research & Education at Duke University
[4] Book “The health care mess: how we got into it, and what it will take to get out,” reviewed in JAMA 2006;295:331
[5] J. Archives of Internal Medicine 2004;291:164