Easing back into writing from my home office (at last) after months of travel is always welcomed--but a bit unfamiliar. Working between meetings, conferences, and scheduled collaborations requires a level of discipline not typically required from your home base. I do well if I remain on my east coast time zone regardless of where I end up (within reason). I always walk to my destination whenever possible (within 3 miles) and carry healthy snacks such as avocados, jerky, or nuts.
As many citizens can attest, the U.S. is a great place to get sick, but a terrible place to stay well. This requires a shift in the way both doctors and patients approach health maintenance and disease prevention.--Rob Wittman
Most of us do the best we can. Our lives are busy and our responsibilities are many. The easiest thing to do is to sacrifice a work-out, grab a quick snack--albeit not the healthiest option, or cut back on sleep to meet busy deadlines. But what about "staying well"?
From a historical perspective the US healthcare system had stellar results when the assaults were tuberculosis and acute infectious agents. The discovery of antibiotics provided small molecule solutions for acute disease. One pill could save large numbers of patients reliably and consistently.
Unfortunately we seem to apply that model of research and pharmacology to chronic disease. Chronic disease demonstrates inherent complexity not likely solved by a monotherapeutic cure. Metabolic derangements are common to heart disease, diabetes, and Alzheimer's disease. We search for cures that mirror successes from our past. We fund research for symptom management but not at the necessary scale for prevention.
Unfortunately we seem to apply that model of research and pharmacology to chronic disease. Chronic disease demonstrates inherent complexity not likely solved by a monotherapeutic cure. Metabolic derangements are common to heart disease, diabetes, and Alzheimer's disease. We search for cures that mirror successes from our past. We fund research for symptom management but not at the necessary scale for prevention.
If you are a data professional you might enjoy FlowingData. Jonas Scholey re-envisioned data to demonstrate the relationship between cause of death not only as we age but also as a historical perspective.
An immediate observation is that as we age the predominant cause of death is chronic disease. Just 20 or 30 years ago we had more infectious disease in the top 5, now the majority are chronic in nature. Click on the interactive image below. It will take you to The Burden of Disease and the Changing Task of Medicine 200th anniversary article in NEJM.
An immediate observation is that as we age the predominant cause of death is chronic disease. Just 20 or 30 years ago we had more infectious disease in the top 5, now the majority are chronic in nature. Click on the interactive image below. It will take you to The Burden of Disease and the Changing Task of Medicine 200th anniversary article in NEJM.
In many respects, our medical systems are best suited to diseases of the past, not those of the present or future. We must continue to adapt health systems and health policy as the burden of disease evolves. But we must also do more. Diseases can never be reduced to molecular pathways, mere technical problems requiring treatments or cures. Disease is a complex domain of human experience, involving explanation, expectation, and meaning. Doctors must acknowledge this complexity and formulate theories, practices, and systems that fully address the breadth and subtlety of disease.--NEJM Jones et al.
The advancement in preventing or curing chronic diseases like Alzheimer's disease reside in adaptive clinical trial designs and modernization of how we cure advanced disease frameworks with complex deranged pathways. Prevention clinical trials are not well funded but their findings are important. We are ready for a new model of health--not just symptom relief but a "realistic understanding of determinants of disease".
Disease is always generated, experienced, defined, and ameliorated within a social world. Patients need notions of disease that explicate their suffering. Doctors need theories of etiology and pathophysiology that account for the burden of disease and inform therapeutic practice. Policymakers need realistic understandings of determinants of disease and medicine's impact in order to design systems that foster health. The history of disease offers crucial insights into the intersections of these interests and the ways they can inform medical practice and health policy.--NEJM
