Health Care

Adapted from a manuscript draft of Creative Systems Theory:

“Wherever the art of medicine is loved, there also is love of humanity.”

Defining Questions

What will be the long-term effects of the biotechnology revolution for medicine and health care more broadly?

How do we create equitable and affordable health care systems?

How do we best think about the relationship of mind and body, personal health and cultural health, physical health and psychological or spiritual health?

The future

Health care issues span the far extremes of the creative spectrum—from the far right-hand world of laboratory science, to the sociological concerns of public health, to more emotional and even spiritual issues (for example, in psychiatry and work with the dying). Issues on each part of the spectrum will be important to health care’s future.

The last century has been a time of great advancement in medicine, with major increases in longevity, the taming of many formerly intractable scourges, and a remarkable array of technical innovations—new diagnostic technologies and surgical approaches, increasingly effective medicines. It has also presented dilemmas of great potential consequence that so far have escaped solution—most notably skyrocketing health-care costs and newly complex ethical quandaries. And the world of health care is not without its Transitional Absurdities. I think most immediately of modern society’s “pill for every ill” mind-set and the role of medicine and the pharmaceutical industry in promoting it.

Technical Advances and Ethical Quandaries

What will medicine’s technological future bring?—certainly a growing role for genetics in medicine, further advances in transplant technology, ever more sophisticated drugs, and increasingly individualized treatment. The coming biotechnology revolution will surely amaze us and change our worlds. Cultural Maturity doesn’t help with predicting specific advances. But it has a role in providing conceptual context—as with emerging science more generally. Many advances will likely draw on the dynamically systemic understandings it makes possible.

Cultural Maturity will also have pertinence because of the ethical quandaries many of these advances will inevitably present. New moral challenges will follow inescapably from increasingly available and complex reproductive technologies (we already confront the specter of cloning to harvest organs), genetic mapping and manipulation (present concerns over genetic privacy are the tip of the iceberg), and new potential for life extension (at the least, the question of who gets life prolonged). And those are just a few of the most obvious examples. In times past it was appropriate to claim that we “can’t change human nature.” Less and less will this be the case. Future ethical quandaries should make current front-page issues such as abortion or assisted suicide seem mere training exercises. Culturally mature perspective will be needed if we are to address them at all effectively.

The Health Care Delivery Crisis

However dramatic the advances of the biotechnology revolution and the wrenching questions it may present, the health care delivery crisis and the changes it will makes necessary could very well overshadow them in significance. Certain technical advances may save money, particularly those that impact the on-going costs of treating chronic disease. But most will only further inflate health-care expenditures. In the end we will effectively address spiraling costs only through a mature acknowledgment of real limits (and the challenging of both medicine’s heroic mythology and society’s denial of death such acknowledgment requires).

Needed changes will present potentially even more wrenching moral/ethical quandaries, but the consequences should be positive on multiple levels. Better acknowledging limits will lead toward wiser allocation of health care resources. It should also help promote more cost effective health care approaches and technologies. And it should play a major role in encouraging us to measure health care success more systemically (in terms other than just the absence of disease) and in ways that better recognize the multiplicity of factors that affect that success. I’ve described how Cultural Maturity challenges us to rethink the health care endeavor fundamentally. It is the health care delivery crisis that will at least first bring the needed more mature lens to the task.

Further Changes

The need to confront limits to health care resources intersects with other maturity-related, health care changes. Certainly there is the importance of greater patient awareness and increasing patient responsibility. Greater patient involvement in care derives growing importance as chronic disease processes such as diabetes, hypertension, and arthritis eclipse infectious disease as medicine’s primary concern (and an increasing number of once-terminal conditions such as cancer and AIDS become better thought of as chronic illnesses). Patients taking responsibility for their health produces not just more efficient care, but better care. We are only beginning to appreciate how much only patient’s can know about their bodies and the importance of factors—such as diet, exercise, and the living of a vital and purposeful life—that must reside ultimately in the patient’s hands.

There is also the growing effort in medicine to reconcile and integrate diverse approaches to health care. This is an area in which patients are often taking the lead as an increasing number of people use “alternative” treatments as adjuncts to or even substitutes for modern medicine. While much in such efforts proves ultimately not helpful, at the same time such efforts sometimes contribute powerfully to innovation and often invite approaches that can serve as less costly options to more invasive approaches.

Some of the most interesting of such alternative approaches that have their origins in different cultural times and places—acupuncture provides the most familiar example.

One of the most important implications of addressing health care limits is the way it invites a fresh look at what health in ultimately about. Step beyond defeating death and disease as the primary health care referent and our picture of what we should include in the health care equation expands considerably. Certainly this shift highlights the importance of prevention and the roles of diet, exercise, and the more psychological aspects of physical health. In the end, every aspect of human well-being becomes a legitimate consideration in the health care equation, not just our personal physical health, but also the health of the environment, the quality of our schools, access to good jobs, and our personal and collective spiritual health.

Rethinking the Body

Many of the most important maturity-related future health care advances will involve not just new approaches, but quite new ways of thinking. Most will in some way draw on newly systemic understandings of how mind and body relate.

Better appreciating the mind/body relationships should play a key role in future scientific advances, in finding approaches more consistent with the containment of costs, and furthering patient responsibility.

If I could know in advance the future’s answer to one health care question, my choice would be immediate: “What is a body?”  On the surface, this might seem an odd question. It makes perfect sense to inquire about how neurons work, about the biochemistry of digestion, or the role of genes in disease. But what is a body? We need only look down; there it is. In fact, it is not a simple question. It the end it brings us to the same conundrum we encounter with trying to define life. Certainly the mind/body question is perplexing philosophically The body is at once something we have and something we are—not an easy fact to reconcile. In the end, it is just a perplexing scientifically. We are only beginning to understand the body’s immense complexity—particularly its deep systemic complexity.

In part this is a product of research not yet done. But Cultural Maturity suggests it is as much a product of the mechanistic assumptions of modern thought. And Transitional culture, with its near absence of lower pole sensibility, would be expected to distance us even further from anything more than the most rudimentary action-reaction notions of bodily functioning. I’ve commented on the trickiness of talking about “body intelligence” given how little connection with the body as experience our times make available. Understanding the body as more than just anatomy and physiology requires a stretch that we are only just beginning to make.

Increasingly we confront the necessity of understanding the body as a system—and a system in more than just the connect-the-dots sense. If health and healing are about anything they are about life. And, as we’ve seen, machine models can’t explain living processes (much less the particular mind/bodies we are by virtue of being human).   We’ve always known at some level that healing was more complex than fixing broken anatomy. I am reminded of Benjamin Franklin’s quip “God heals and the doctor takes the fees.” But the full implications have before been more than we could handle.

We are making a start toward a more sophisticated picture. Discoveries in immunology and neurology are revealing the once unnavigable moat separating brain and body to be in fact a waterway bustling with intricately interplaying neurotransmitters, hormones, and other communications molecules. Imaging techniques that let us watch the brain as we engage in various activities make it inescapable that no thought or mood is “just psychological.” A growing number of studies document the role of stress, attitude, personality style, and even religious belief in health and disease. And increasing interest in the health care practices from different cultural times and places is stretching our thinking about how the body works in fascinating ways. The surgeon who conceives of the body in terms of anatomy and an acupuncturist who sees it in terms of flows of energy can seem to be looking at different bodies—and in important ways they are.

It is important to appreciate that we’ve never really just studied the body—objectively stood back from it—even the modern scientific body. We’ve always studied mind/bodies, just of different sorts (and being mind/bodies ourselves, never from a purely objective perspective). We are learning to better understand and engage the body as life. The implications are pertinent not just to the practice of medicine. Of particular relevance to today’s crisis of purpose, the body we are coming to study is increasingly the body as somebody.

A Thumbnail Summary: Cultural Maturity predicts …

—that the biotechnology revolution will radically alter the health-care landscape with regard both to what it possible and the ethical challenges what is possible presents.

—that health care will come to more effectively deal with limits, both to availability of health-care resources and to our heroic orientation toward death and disease.

—that the health-care world will increasingly question the traditional parent/child health care relationship and embrace models that affirm and support patient responsibility.

—and that we will come to understand the body and what it means to heal and be healthy in much more complex and deeply systemic ways. The resulting picture of health care will include not just the treatment of disease, but also all aspects of prevention, from personal self-care to larger societal well-being.

Thought experiments

You are a member of an advisory committee given the task of addressing where “health care” dollars will be spent. You can choose any geographic scale—your community, your country, or the planet as a whole. You can spend the money in any way you think would ultimately be most promoting of health (treatment of disease, prevention, social services, whatever). How would you approach this task? What might your priority list look like?

Reflect on the role of the body in being human. List some of the ways our thinking about the body and bodily process might change in the future. What are some of the implication of what you have included in your list for the future of health and healing?

Describe how you would solve the health care delivery crisis.