These findings serve as background for the observation that our massive societal increase in resources devoted to health over the past several decades is not really paying off for us in terms of improved outcomes. (This appears to be true despite the fact that our life expectancy increased dramatically in that same time frame.) Diet is undoubtedly playing a large role here, as is the increased problem of contagion. Both of these factors are reminiscent of our earlier history. We are subject to stealth malnutrition that is occurring in the midst of plenty, as well as lapses in sanitation and hygiene as our nation slides back into Third-World status. Additionally we may be suffering from toxicities attributable to modern chemicals and pesticides. And a growing fourth factor may very well be iatrogenic effects of health care itself├ éČ"the adverse consequences of depending upon the health care that we have.
The obvious factors responsible for ├ éČ┼"Medicine├ éČ Ł having become the largest cause of premature mortality were already discussed in a prior newsletter. These are the medical errors, the drug-induced side effects, the adverse drug interactions, and the risks of surgery and of anesthesia, etc. Beyond that, there are the expensive treatments that afford only marginal benefit. For example, the United States spends the most on treatment of chronic kidney failure, and yet it has the world's highest dialysis death rates. Counting also in the balance of costs and benefits of medical care are the many things that are done simply because we can, not necessarily because they help. Monitoring for the recurrence of rapidly growing tumors such as melanoma or large B-cell lymphoma gives us essentially no advance notice, and besides, in the case of melanoma there's no treatment anyhow. We do it because we can"
Back in the sixties an MD reflected on the state of medical care as follows (I'm going on memory here): In viewing the past history some fifty years prior, he thought it doubtful that a typical patient visiting a typical doctor for an arbitrary condition would, on balance, be better off for the experience. What changed things for medicine was mainly the discovery of antibiotics. What changed things for the public at large was mainly public sanitation and improved personal hygiene. Reflecting on the state of medicine in his own time, he said that the right patient going to the right doctor for the right condition would indeed be much better off than in the past. But alas, the typical patient visiting the typical doctor for a common condition would arguably not be much better off than before. So where are we now, some forty or fifty years further on? There have been additional isolated breakthroughs, such as the eradication of polio and the discovery of the antipsychotics. But on the downside, we have thoroughly abused our antibiotics, to the point where hospitals are once again the very dangerous places they were before antibiotics were discovered. And pandemics are a much greater threat than before.
Beyond these disagreeable realities, it may be even more important to look for less obvious factors that wreak their havoc more surreptitiously, contributing to premature morbidity. What problems do we run into when Big Medicine actually does precisely what it hopes to do, when things are working just as intended? This is surely the last place one would look for problems"
The Management of Symptoms
When the courts liberated commercial speech some years ago, the pharmaceutical industry took advantage and started advertising majorly to the public, with a budget currently running at some $20B per year. Doctors were no longer driving the demand for the advertised drugs, but rather the potential clients. Naturally the marketing of drugs targeted the most common conditions, in particular those that were of the most immediate concern to the public. These related to sleep, pain, appetite regulation, digestive function, anxiety and depression, mood regulation generally, vigilance, etc.
These drugs were not directed at known disease processes but rather at lifestyle concerns. Most people troubled by depression don't ever bother to seek help, so the MD is not even in a position to exert his influence. Direct advertisement to the public could therefore be defended as actually meeting a need. But nearly all of these drugs can be seen as an attempt to suppress symptoms or to re-regulate in some fashion a disregulated system. The question should be asked whether these objectives are actually being accomplished.
Take pain, for example. Just to belabor the obvious for a moment, pain is entirely self-generated as a signal for us to take notice. It is an imperative that is hard to ignore. Sometimes, of course, one wishes the brain weren't quite so insistent. Successful pain suppression allows us to ignore the cause and move on with life. In the case of head pain, a broader disregulation status of the brain is usually being indicated. Pain suppression clearly does not resolve the underlying issue. And so it may be in some generality.
Sleep medications almost never resolve the underlying issue when disregulated sleep is a persistent problem. Anxiolytics just have a transient effect, and there is no expectation of a good long-term outcome. Anti-depressants function barely above placebo, it now turns out, and in the various studies have largely reflected the natural ebb and flow of depression. During any given six or eight-week period, some significant fraction of depressives will show at least a partial remission of their symptoms. (Others will get worse, but these are not accounted for in the studies.)
The Disregulation Cascade
We propose the ├ éČ┼"dire hypothesis├ éČ Ł that if the condition of disregulation is not addressed at its core, then a strategy of mere symptom suppression allows it to persist and even to amplify over time. For the substantial majority of disregulated systems, undoubtedly, the trajectory will be toward increased disregulation over time. Due to effects of aging, poor nutrition, poor lifestyle factors, toxic influences, and whatever else, the system gradually diminishes in its capacity for self-recovery. The largest factor biasing us toward further disregulation is the intimate mutual dependency among regulatory systems. When things are working, they mutually support each other in homeodynamic status. When things are not working well, they affect each other adversely.
Poor sleep quality affects brain function directly, thus limiting self-recovery. Mood regulation suffers; and attentional function is disrupted. Our attentional mechanisms are likely fairly universal, which bears even on the aspects of attention of which we are not aware, namely the brain's self-monitoring of its various internal regulatory functions. Endocrine and immune regulation end up compromised, as is interoception, our sense of the state of the body, and the regulation of our autonomic nervous system. Our digestive regulation suffers, and then in turn our nutritional status. One disregulation begets another in a downward, mutually reinforcing spiral.
With this hypothesis in mind, how much of our population may be involved in this gradual but pernicious disregulation cascade? We may assume that this population lines up roughly with those who depend on any of the above-mentioned categories of medication for extended periods of time. That's perhaps one-third of our population, tending ever higher as we move toward the upper age categories. The average number of medications consumed by people over 65 is about six. No doubt a vast majority of the elderly are caught up in the disregulation cascade. But disregulation is already a big issue in childhood as well. Dick Gevirtz has reported that some one-third of children complain of chronic abdominal pain, which can be seen as indexing a disorder of disregulation. (This can be confidently asserted because in his study 100% remediation was achieved with a dual strategy of nutritional support and biofeedback.)
We therefore have a situation in which certain medications, even at their best, may worsen our status over the longer term and set us up for premature functional deterioration. It is unlikely that this hypothesis is getting any serious attention simply because the exercise would be futile. We have no choice, after all, but to deploy the remedies at our disposal to provide relief whenever we can. Surely even adverse long-term outcomes would not justify withholding remedies in the near term. Ironically, this picture mirrors what is going on with illicit drugs. They are typically taken in relief of a near-term felt need, and invariably involve long-term costs. The distinction is further blurred by drugs such as marijuana, which often fill a clear medical need, but also exact long-term costs. On the other side of the divide we have the anxiolytics, the pain and sleep medications, which can be as addictive as any illicit drug. The story is the same for both the licit and illicit drugs: We derive short-term benefit only at the price of long-term dysfunction.
The Self-Regulation Remedy
We do, however, have remedies at hand for disorders of disregulation that lie outside of the domain of medicine as it currently views itself. These are the self-regulation technologies. If we simply took the cue that the first observation of a head pain or stomach pain pattern emerging was an indicator for a self-regulation remedy, then we could at each turn bias the system back toward wholesome, well-regulated functioning. Right now this remains a fond hope with regard to universal implementation, but we already have evidence that the strategy is workable.
At the present time we commonly see clients who come to us after years of having gone from one doctor to another and from one ostensible remedy to another. They are the very picture of disregulation. They may be environmentally or chemically sensitive. They may see fibromyalgia as their primary complaint, or migraines. They may be in extreme chronic pain. But their disregulation status is pervasive. Many are still quite productive in life despite their handicaps, a testimony to their extraordinary determination. But they are fighting up-hill all the way.