Can Medicine Finally Begin to Focus on Health?
A ray of hope has poked through the winter of our discontent with the medical industry. The light arrived via an e-newsletter from the $30-billion center of medical research in the United States.
The US National Institutes of Health (NIH) funds research that becomes a gatekeeper to the kinds of care people can use. Without supportive research, insurers typically will not cover a procedure, approach, or practitioner.
Many view the NIH as misleadingly titled since the agency leans almost entirely toward funding research relevant to the pharmacological- and device-based industry of condition management. More than one observer has suggested that a more fitting handle would be the “National Institutes of Disease.”
As such, NIH may be best viewed as an “enabler” of our $2.8-trillion disease-treatment industry. The powerful agency supports and enhances the disease-orientation of our hospitals, insurers, and the manufacturers involved with them.
Now we see this hopeful star in the east—a.k.a. Bethesda, Maryland, home of the NIH. Fifteen of the NIH’s 28 institutes and centers, including the National Center for Complementary and Alternative Medicine (NCCAM), announced a proposal for “Dissemination and Implementation Research in Health.”
The news hints at the dawning of a new day as millions will be available to further our understanding of the complex systems and practices to help people toward health and keeping them healthy. The program “encourages investigators” to submit proposals across an array of health-related pursuits. These include methods, interventions, monitoring, and dissemination of strategies. They urge scientist applicants to focus on “patient outcomes” rather than biomedical markers that may or may not make a positive difference in how a person feels.
Shift metaphors now, from the coming of light to strategic force. Picture a tugboat shouldered against the bow of a huge tanker. That’s what altering the course of research can mean for what we call healthcare in the US. That’s what it will take to shift from enabling a disease-management industry to stimulating and enabling one focused on health.
The integrative health and medicine community has pushed policy in this direction for many years. In 2001, recognizing the nation’s challenges, a multidisciplinary group of colleagues and I gathered in a chamber of the US Congress’ Rayburn House Office Building. In a process facilitated by renowned futurist Clement Bezold, PhD, we developed a document called the “Design Principles of Healthcare Renewal.” In it we declared—and later delivered to a White House Commission on Complementary and Alternative Medicine Policy—the need to “create a thriving industry of health creation.”
The 2012 Great Challenges of Medicine and Health program promoted by billionaire Jay Walker’s TEDMED and the Robert Wood Johnson Foundation pushes this same focus. One challenge asks “how can we unlock prevention as a trillion-dollar business in America so we spend less on ‘sick care’ and get Americans to ‘buy’ healthy lifestyles?”
Major employers are also weighing in for health. They are demanding that the education of health professionals focuses on real-world issues such as keeping the population, and the workforce, healthy. Some are angry with the medical industry’s infatuation with high-cost interventions. Paul Grundy, MD, MPH, leader of global health for IBM, recently blasted academic health centers as “milking machines.”
Politicians have also taken on the cause. The Affordable Care Act promoted health as an objective. The new law promotes “patient-centered medical homes” and “accountable care organizations” (ACOs) that help shift medical payment incentives away from churning more procedures.
A health system leader recently captured the change eloquently. Ken Paulus, CEO of Minnesota’s Allina Hospitals and Clinics, announced that under ACO structures, for the first time in its 100-year history, Allina “can get paid to keep the village healthy.”
Research is required to develop a system in the US that actually could be called “healthcare.” Yet it is other stakeholders weighing in that creates hope that this program may signify a shifting course for the NIH. Sustaining this focus in the culture of disease at the NIH will require the external pressure of many.
Employers, health systems, consumers, and politicians must each let the agency know that they expect this funding program to be the first of many throttle-down bursts of health-focused research announcements.
John Weeks is the editor of “The Integrator Blog News and Reports” (theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community, and a columnist for Integrative Medicine: A Clinician’s Journal.