Two Approaches to Pain and Illness

iPad and stethescope

In the West we are divided about healing pain. We take two approaches and rarely integrate them. One approach to pain and illness is a technological approach. This the “we’re going to go in and we’re going to fix you” approach. It’s often done later in the disease process, is often high-cost, and it usually is quite manipulative. It over values the physical things you can see and do. For example, people in pain often get drugs, but also surgery or implantable devices.

The other approach is less visible.

It’s not seen unless it’s named, unless it’s looked for, unless it’s cultivated, unless it emerges out of our perception and relationships. It’s about the mind, feelings, behavior and the spirit. It might mean that what is needed is enhanced caring social connections or learning how to handle stress or making diet changes rather than the insertion of a device or undergoing surgery.

A hundred years ago, the kinds of illnesses that were killing us were infectious diseases and the consequences of trauma and childbirth. The average life expectancy at that time was 45 years old. With the development and application of public health efforts, with vaccines and antibiotics, we developed technologies to control those illnesses, and medicine was highly successful. In fact, it was so successful that it has resulted in the dilemma that we have today – a dramatic rise in the chronic, lifestyle related diseases of aging.

It is the victim of its own success.

A hundred years later, we now have an aging population. We now no longer die as often because of diseases such as pneumonia, infections and epidemics. The primary causes of death are heart disease, cancer, diabetes. We suffer from arthritis and depression, and the average life expectancy now is 78. Clearly the model we have been applying in the last hundred years has been successful. If you look at developing countries that don’t have these modern interventions, you see the same things you saw a hundred years ago in the United States: infectious disease, the consequences of trauma, maternal and infant mortality and overall low life expectancy.

Is the model of the past, the model of our future? It cannot be.

The problem is that the old model doesn’t work anymore for the conditions we are left with. We’ve pushed that model to its limit, and we’ve now built a system that can’t stop no matter what illness or cause.

The 2013 Institute of Medicine (IOM) report Shorter Lives, Poorer Health, summarized data well known to public health officials, but dove deeper and longer into this data. This report asked the questions: Are we really healthy in this country? Is our medical system working? Is what we’re doing today in the medical system actually worth the investment? How have we been doing compared to other similar countries.

Next week I’ll explore the challenges to the current health care system and describe the system we need for the future.