Something I’ve observed both in my practice and in my private life is that certain behaviors (and cravings) tend to run together. For example, many of my patients who smoke find that alcohol is a smoking trigger. For them, these two cravings/behaviors have become linked in such a way that it is nearly impossible for them to resist having a cigarette while they are drinking. The alcohol potentiates the urge for tobacco, and in order for such people to quit one habit, they must quit both at the same time which is very difficult to do. I have also noticed that people who exercise regularly tend to have much healthier than average diets, high in fruits and vegetables and low in saturated and trans-fats. For many of my endurance athlete patients, the mere thought of a fast-food burger with fries is enough to make them feel sick.
While not all drinkers smoke and not all athletes have healthy diets, what seems to be clear is that, for most people, certain behaviors are linked together. Snacking while watching television, listening to music while driving, and reading at bedtime are some simple examples. Once behaviors become linked, they are hard to unlink. If it is your habit to light up a cigarette each time you get into the car or to drink a smoothie after a run, try doing the first without the second and see how it feels. Failure to exercise the second behavior creates a feeling of anxiety and discomfort which many people find intolerable.
What’s more, linked and non-linked behaviors alike tend to cluster together, grouping themselves more broadly into one of two camps: unhealthy or healthy. For example, overeating, a fatty and starchy diet, smoking, excessive beer or other alcohol consumption, and erratic sleep patterns tend to form a group of behaviors which run together. Not all people who habitually indulge in one of these behaviors finds themselves addicted to any of the others. But the more unhealthy habits a person has, the more likely he or she is to develop additional ones. Healthy habits seem to work in the same way, with regular exercise, good eating habits, regular sleeping patterns, and lower alcohol consumption seeming to run together as well. Again, not all people who have established one healthy habit go on to incorporate any of the others, but the more healthy habits a person has, the more susceptible he or she seems to be to acquiring others.
The more healthy habits coalesce into a lifestyle, the more they seem to exclude unhealthy habits. For most people who engage in regular cardiovascular exercise, eat healthily, and take the right supplements, the very idea of smoking cigarettes is disgusting. Similarly, for people who smoke, drink beer daily, and regularly eat fast food high in fats and starches, the idea of taking a 30 minute run in the park sounds equally horrible. Healthy habits and unhealthy habits, as they coalesce into lifestyles, seem for the most part to be mutually exclusive of each other.
A Different Approach
Palliative or symptomatic care has become standard of care in the United States. Medicines and therapies which help manage symptoms but do not address the underlying causes which create the symptoms is an easier approach to healthcare in the short-term. With this paradigm, patients can be fit into 5-10 minute office visits which are treatment oriented. But it does not take great powers of observation to grasp the downside of this approach: patients get sicker rather than more healthy, treatments become more complicated and more expensive over time, and we are left with the world’s most expensive, technologically advanced healthcare system and one of the least healthy populations in the Western World. In 2010 the U.S. Center for Disease Control released data showing that 34 percent of American Adults are clinically obese (more than double the percentage in 1980), and the percentage of obese children has tripled over that same time period to 17 percent.
When faced intellectually with a choice of receiving ongoing medical care, either in the form of physical medicine or drugs, or curing the underlying problems and restoring health, most people have no trouble choosing the latter. But engaging with issues of exercise, weight loss, diet, stress-reduction, etc.–issues which entail lifestyle changes–is hard and may be far more than a patient bargained for when she first presented to a doctor’s office with a back strain. From the doctor’s perspective, helping patients regain health require much more time, risks losing patients who are not ready to confront these difficult issues, and is often perceived to work against his own economic interests. Chiropractic doctors are poorly reimbursed by insurance companies, especially when they try to work with patients on improving health, and success in this regard means curing a patient who in turn no longer requires his services.
I made the decision before I ever saw my first patient that I would dedicate my clinical practice toward promoting health, working for cures, and empowering patients not only to get well, but to stay well. That is why dietary management, supervised weight loss, home care exercise and stretching regimens, and stress-reduction techniques are an integral part of my practice. Contrary to the belief that empowering a patient to achieve a higher level of health is bad business, I have found it to be the single best marketing tool of my practice, with most of my new patient referrals coming from other doctors who share this philosophy of truly caring for people and from healthy ex-patients. That being said, I have also learned over the course of my 25 years in practice to respect the timetable and wishes of each individual patient I have the privilege of meeting. Successful care that leads to patients getting control of their migration toward the healthy end of the Continuum means a shared desire undertake change. If a patient, for whatever reasons, is not ready for comprehensive health care management, I have learned that I must respect that decision and help in whatever way I can to meet his/her needs. Approximately half of my practice consists of restorative or palliative care, and while fixing an injury or helping a patient manage with treatments that diminish pain may not be quite as satisfying as helping a patient become truly healthy, it is still a wonderful feeling to be available to anyone in need of help on any level.
We live in a society in which healthcare represents nearly one fifth of our Gross Domestic Product. Last year, more than 300 billion dollars were spent on the diagnosis and care of patients in American hospitals and clinics, and hundreds of billions more went to fill the coffers of insurance companies. We spend more money on health care than any other nation in the world, grossly and per capita. But healthcare is not the same thing as health, and by many meaningful benchmarks, our supremely costly healthcare system has not delivered supreme health to the American people. In terms of prevalence of chronic diseases such as diabetes, hypertension, and heart disease, obesity, infant mortality, and longevity we are ranked near the middle or in the bottom half among industrialized nations, and have even begun to lag behind many poor, underdeveloped countries. Perhaps the most important metric is HALE (Healthy Life Expectancy), which measures the average life expectancy of a population. In 2008, the World Health Organization ranked the United States 27th among industrialized nations on the HALE metric (25 countries make up what is often called the “First World” of industrialized nations). We are living significantly less long than people in countries with socialized medical systems (such as Spain, Italy, Canada, the U.K., France, Germany, Sweden, Norway, Denmark, and Belgium), or people in countries whose healthcare systems are far less technologically advanced than our own (such as Greece, Malta, Singapore, and Andorra). One thing these data make clear is that our costlier, technology-driven healthcare is not correlated with better health.