This is Why Western Healthcare is Failing

Western healthcare is failing its purpose—to treat. Sure, we’re great at management. But what does that really mean? Lifelong medication whilst ignoring the elephant in the room. As with many things, the solution is simple yet not easy.

The real pandemic was never, and will never be, COVID. The true pandemic is metabolic dysfunction and preventable diseases of affluence¹. Foundations of modern medicine were set up hand in hand with the first pharmaceutical companies, the first processed food companies owned by cigarette companies, and models of healthcare developed that promote profit over prevention. In this model, cure is at the cost of the bottom line…so it is inherently not the desired outcome.

Meanwhile, we remain the only animals that rely on experts telling us what to eat. We’re also the only animals with soaring metabolic dysfunction and obesity. It should be common sense, then, that the answer remains in the environment…or, more aptly:

Look deep into nature, and then you will understand everything better. — Albert Einstein

The Flexner Report

Healthcare changed forever in 1910. A little piece of academia became the foundation for modern medicine: the Flexner report². Commissioned by the Carnegie Foundation in 1908, it aimed to assess the quality of medical education in the USA and Canada. Its recommendations for reshaping medical education led to a shift to focus on scientific research and biomedical knowledge³.

The report’s effect has many criticisms. It has led to a medical system focussed on specialisation and sub-specialisation⁴. It has narrowed the focus to disease management, leaving prevention and public health in the rearview mirror⁵. The new emphasis on scientific research has caused increased collaboration between medicine and industry and rapid growth in the pharmaceutical industry. We’ll explore why this isn’t necessarily good later in this article.

Modern medical education teaches a patient-centred approach, ironic given the conflicts of interest in Western medicine’s for-profit systems. A management, over cure, approach continues to predominate, aided by specialisation and subdividing of the human body.

If all this wasn’t enough, the changes propagated by the Flexner report are repeatedly criticised as the catalyst for systemic racism and sexism in the medical industry⁶ ⁷. Also, considering the decline of alternative medicine⁸, it’s clear why an industry-centric healthcare system with systemic sub-specialisation can become so narrowly focused that it misses the larger issues at hand.

Disadvantages of Specialisation

Specialisation and sub-specialisation are the lynchpins of fragmented patient care⁹. They involve doctors choosing a speciality from which they can further specialise (for example—sleep medicine, neuro-ophthalmology, interventional cardiology).

This approach has clear efficiency and organisational benefits. It is easily arguable that the cons outweigh the pros. Overspecialisation narrows areas of expertise to the point that the bigger picture is lost. We end up with a reduced number of generalists. Healthcare costs increase—subspecialists cost more in referrals, tests, and procedures¹⁰. Communication between multiple care providers becomes more challenging, and coordination can be lost¹¹. All this can lead to overtreatment, polypharmacy, and a lack of actual treatment of the cause.

Take metabolic syndrome as the obvious example. You could treat the root cause (e.g., obesity) or have a cardiologist treat hypertension, hypercholesterolaemia, and ischaemic heart disease; a respiratory physician treat obstructive sleep apnea; an endocrinologist treat diabetes… Whilst no one treats the root cause.

Importance of Nutrition

Now, a further example of the narrowed focus of modern healthcare is nutrition. Nutrition is becoming increasingly understood to be the fundamental pillar of human health. Food is the most common medicine consumed, influencing gut health, mental health and physical well-being. Proper nutrition provides the essential nutrients, pro-biotics and pre-biotics, required for peak bodily function. On the flip side, malnutrition increases and directly causes disease.

So, if nutrition is central to health, it would be sensible to study it extensively at medical school…right? Wrong¹². From personal experience, and research of other medical schools, it constitutes a single-hour lecture at worst and a single module at best. This lack of nutrition knowledge is indescribably problematic. A whopping 40% of hospitalised patients have malnutrition…and yet their main clinician knows the square root of fuck all about it. Instead, clinicians primarily rely on allied professionals, namely nutritionists, to cover for medical education’s shortcomings.

Medical education still has its foundations within the Flexner report. Despite the rise in science detailing the importance of nutrition, medical education focuses on treating disease rather than prevention through lifestyle change. Especially prevention or treatment through nutrition. Admittedly, nutrition science is complex and rapidly evolving—so it is a challenging knowledge base to integrate into an already-packed medical curriculum. But it certainly illustrates where the priorities remain.

Cigarette Companies and Processed Food

Two main drivers of corporate consumerism on population health are processed foods and pharmaceutical companies. Interestingly, cigarette companies acquired and expanded some of the first highly processed food companies (for example, Philip Morris acquired both General Foods and Kraft; R.J. Reynolds acquired Nabisco)¹³.

Foods produced by these tobacco-owned companies were designed to be addictive through high combinations of fat, sugar and salt (aka ‘hyper-palatable’). They were 29% more likely to be classified as hyper-palatable and 80% more likely to be ultrahigh in carbohydrates and salt than non-tobacco companies’ foods¹⁴ ¹⁵ ¹⁶.

These companies also used their leading expertise in marketing addictive products and applied it to the food industry…even using child-focused strategies with cartoon characters and vibrant colours¹⁷.

Whilst they have since divested from the food industry, the legacy of these tobacco-owned food companies left a lasting mark on society. They helped popularise the widespread consumption of ultra-processed foods. This has contributed to the growing obesity pandemic the world continues to face.

Pharmaceutical Industry Influence

Unfortunately, there seems to be a bull in the china shop. And it is not going anywhere. Substantial evidence links pharmaceutical companies influencing medication approval and physician prescribing practices—through grants, research funding, consulting payments, and other financial relationships¹⁸ ¹⁹.

The influence of pharmaceutical companies on physician prescribing behaviour is deeply concerning. An investigation by Science found that many FDA advisory committee members received significant financial support from pharmaceutical companies after voting to approve their drugs²⁰.

Unfortunately, financial relationships between physicians and the pharmaceutical industry are widespread. Numerous studies have shown a consistent association between industry payments and increased prescribing of the paying company’s drugs.

And it’s not limited to the USA or private healthcare systems. Payments to influential doctors, such as those involved in NHS projects, have continued to raise concerns over blatant conflicts of interest²¹. This murky relationship between pharmaceutical companies and healthcare systems is a clear source of bias hindering clinical judgment and affecting patient care.

TLDR;

The deep flaws in Western healthcare will leave you behind if you don’t take control. By embracing holistic and integrated approaches, we can challenge this paradigm and advocate for a healthcare model prioritising prevention, nutrition, and well-being. Now is the time to take charge and reclaim your health; start by cultivating mindful awareness and taking proactive steps in your daily life.

References

[NB. All images created using MidJourney]

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