Public Health vs. the Doctor's Office

The medical view is focused on each individual. The assumption is that medical doctors are available to rescue each person from any and all misadventures. The cost of individual rescues is high and increases every year. The solution in Canada to rising costs is to ration services, punishing  medicalcare workers and many patients who are denied services and have to wait in queues.

The medical view is that expensive measurements have to be made on each person and detailed images taken. MDs have an exclusive interest in drug treatments and may see themselves as drug prescribers and not problem solvers. The cost of individual management is extravagant and many have argued that the results of individualized treatment of obesity, high blood pressure, elevated blood sugar and elevated blood fats are poor. If the results were excellent and the dire consequences of these risk factors were avoided, you could argue that high cost of individualized care was justifiable.

A public health view can be quite different from a medical view. To pursue public health you need tools that re duce or remove the causes of disease. You also want strategies that improve an entire population’s resistance to disease. For example, you set up elaborate infrastructures to assure that the supply of water and food is relatively free of infectious agents. You try to immunize everyone to resist the most common infectious diseases. You pass legislation that reduces tobacco smoking.

When you observe increasing obesity associated with increasing blood pressure, diabetes, heart attacks and strokes, you turn to tools of public education and persuasion hoping to modify the food selection and eating habits of everyone at risk.  You fund public education attempts to alter eating behaviors and increases physical activity. You may pass laws to change food manufacturing practices - ban trans fats, lower the amounts of salt and sugar added to food and require honest statements of nutrient values without unsupportable claims on labels.

If you discover that your public education efforts are not reducing high risk behaviors you begin to wonder what general measures could be taken to mitigate the consequences. Seat belts mitigate high risk behaviors, reduce injury and reduce fatalities in car crashes, for example. Car insurers reward good drivers with reduced costs and hold bad drivers accountable for the costs they incur. Policing is focused on crash prevention by speed monitoring and drunk driver detection.

Nicholas Wald of the Wolfson Institute of Preventive Medicine in London, England suggested that a “polypill” should be given to everyone aged over 55 to reduce heart disease and stroke by 80%. His idea would reduce most of the cost of individualized care. Wald suggested three different drugs to reduce blood pressure, as well as aspirin, a statin to reduce cholesterol, and folic acid to reduce homocysteine levels.  Wald estimated that the polypill could save some 200,000 lives each year in Britain alone. His idea of combining preventive agents is being pursued by drug companies. 

Of course, different opinions about which ingredients should be included in the polypill could be irresolvable. Any move toward public health solutions to expensive endemic diseases would be resisted by all who earn their living by offering individualized care and resisted even more vigorously by the pharmaceutical industry who shares a multibillion dollar market for expensive drugs on the pharmacy shelf. 

Instead of the polypill, I advocate diet revision using the Alpha Nutrition Program, exercise and nutrient support with Alpha DMX a blend of critical nutrients with key nutrients such as calcium, vitamin D, potassium, folic acid, pyridoxine and cyanocobalamin. I would refer people of all ages who are at risk of vascular disease to fitness centers with Alpha Nutrition Program food services. Alpha DMX would be distributed at low cost as a public health measure. Noncompliant people who continued high risk behavior would pay increased premiums for medicalcare. In the US, rational attempts to reform the medical care system are met with  irrational resistance. The idea of self-responsibility is politically unfeasible.

Learn more about self-regulation

The discussion of arterial disease is continued in the book, Heart and Arterial Disease. You can  Order Book  or Download the eBook 

Wald, N. J. & Law, M. R. A strategy to reduce heart disease by more than 80%. British Medical Journal, 326, 1419 - 1423, (2003).

Michael Hopkin 'Polypill' could curb heart disease and stroke.
Nature news 27 June 2003

Medical Care and Planet Ecology is produced by Alpha Education.
These brief essays by Dr. Stephen Gislason are taken from his books and blogs. 
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