Wednesday, July 14, 2010

Dis ease - the idea of diseases as the cause of what ails us

Wikipedia describes disease as follows:

disease is an abnormal condition of the body of organism that is not comfortable for it. It is often construed to be a medical condition associated with specific symptoms andsigns.[1][2][3] It may be caused by external factors, such as infectious disease, or it may be caused by internal disfunctions, such as autoimmune diseases.
In humans, "disease" is often used more broadly to refer to any condition that causes paindysfunctiondistresssocial problems, and/or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuriesdisabilitiesdisorderssyndromesinfections. Isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. A diseased body is quite often not only because of some dysfunction of a particular organ but can also be because of a state of mind of the affected person who is not at ease with a particular state of its body.

Our health care system is built upon the concept and the Merck Manual, a commonly used guide for diseases is used by doctors worldwide.  Disease is regularly used in languages throughout the world and in many cultures, since this is the way we are used to describing a series of symptoms, sometimes with a known cause of pathogen, or sometimes it is just a series of symptoms, named after someone that they described as a new disease or ailment that afflicts us, as well as most living things.  Disease has also been used by drug companies to sell product (eg: seasonal effective disorder, restless leg syndrome).  

In the chiropractic world, using this definition, back problems can be classified as diseases too, however, this is because it is dis  ease or as described above it is a medical condition of specific symptoms of signs.  The problem I have with this is that often, using the term disease describes an affliction, without promoting understanding.  Too often, diseases have been treated with medications to relieve the dis ease, without understanding why the problem exists.  Knee problems are a perfect example of this. We diagnosed meniscus disease, kneecap tracking disease which in no way describes what the condition is or how it got there.  We have trained people to treat these dis eases who could care less why it went bad.  The reason it went bad is the problem.  We teach them to throw therapies and solutions at the symptom which is knee pain which leads to tests and interventions, without the understanding of what we are treating. In the realm of musculoskeletal medicine, this is problematic, expensive, can be disabling (knee replacements gone bad with their thousands of dollars in implementation and rehab.  What the dis ease moniker does not do is promote understanding.  Lack of understanding currently leads to tests, questionable interventions and expensive solutions of limited benefit (knee replacements, which my mother had just undergone can last 10-15 years and then need to be redone). A better paradigm which is functionally based, rather than dis ease classified would lead to better prevention of many of the so called dis eases. Of course, there are many entities in our healthcare system who are profiting handsomely from the dis ease philosophy being used in the musculoskeletal system.  It has lead to unbelievable high costs of treatment, mediocre rehab based on a paradigm that is not meant to promote understanding , unneeded testing and human misery.  Managed care promised to hold the line on these costs but instead has tried to clear a profit without helping the paradigm change to a functionally correct one.  As they have failed, like the government, they simply pass the bill on to us as higher insurance premiums which has lead to more people underinsured with higher out of pocket costs and a health care system very far from cost effective and effective when compared to the rest of the world.

My recommendation is that at least in the musculoskeletal realm, we move away from the dis ease idea and move toward one of function, which will yield to lower costs from better care and more effective treatment and better preventative care.  Other diseases should come under the microscope too since we try to classify things we really do not understand into bite size pieces and then throw therapy regimens about the symptoms so the dis ease process is no longer noticed (not necessarily resolved).