Dr. Lee Hieb is an orthopaedic surgeon specializing in spinal surgery. She is past president of the Association of American Physicians and Surgeons, a free market medical organization.More ↓Less ↑
The crazy, upside-down world of medical regulation virtually guarantees that American doctors practice out-of-date medicine. The details are in my article, “Why Your Doctor is Out of Date,” available online.
Once upon a time, I had thought medicine was medicine … until I attended a national meeting of the American Academy of Anti-Aging Medicine, or A4M, and discovered that I had been metaphorically a member of the flat-earth society. Unlike much of organized medicine, which is shrinking, the A4M has ballooned from a few members 15 years ago to over 30,000 members, spearheading the largest growth in specialty learning.
Of course, the American Board of Medical Subspecialties refuses to even acknowledge its existence.
What makes this branch of medicine – the one Dr. Oz touts every day to millions – so appealing? It is all the things we want medicine to be: It is up to date and applies the latest science to the treatment of humans, it doesn’t wait till you are half dead to do something, it is truly preventative, it is personalized and it is cost effective.
Standard medicine, on the other hand, has become rigid in its thinking. Now, unless you have 30 years of paperwork to back up your idea, you cannot apply any new treatment idea to humans. This is known as “evidence-based medicine,” or EBM. The problem with EBM is that it sounds good, but turns the principles of scientific progress on their head.
We used to practice “Primum Non Nocere,” or “first do no harm” – meaning, if a treatment was safe it could be tried if it might help. This is the principle we generally use in everyday life. It is the way we built Apple iPads and much of our body of medical knowledge.
But now we are told to stand on our hands like the skeptic who did not try to get the man out of the ditch because he had no proof he could do so. In a great spoof of EBM, two British physicians demonstrated that the use of parachutes does not meet the criteria for belief in their use. We all know they work, but there is no 30 year body of knowledge to support their use.
Anti-aging specialists, instead of demanding this ridiculous standard of proof, look at basic science and experience to guide them, as well as the body of current and past literature in medicine. This is what we have done for hundreds of years. And these specialists believe in intervening in a truly preventative way.
Engineers model failure rates for any given product as a curve showing how many of a product fail at what point in their lifespan. A Russian mathematician plotted this for the human body, and the graph looks rather like a saucepan, with a steep, downward slope at birth until about age 20, then a flattening out of the death rate at a low level (the bottom of the pan) from age 20-55, then a sharp upswing to 90. Interestingly, after about 95 (although any individual is more apt to die any year at that advanced age) the rate of death levels out.
Armed with this failure curve of the human body, he then looked around in engineering to find some mechanical object whose failure curve was similar to the human body, and found the best fit to be old Soviet computers. Many of these computers failed right off the production line (perinatal mortality). But, those that made it into use ran for years without breaking down because of much redundancy in their construction (in a human: two kidneys, excess oxygen capacity, etc.) Then at the end of their usual life span, they began to fail rapidly.
Years ago I used to build desktop PCs and made a beautiful unit for my husband. It ran well for a number of years, then unbeknownst to me developed a problem in the main CPR cooling fan. My husband started hearing a small noise but didn’t let me know. When the $5 fan quit, the CPU overheated and the whole computer stopped working, necessetating a complete rebuild. Had I detected the fan problem and electively replaced that cheap component, all would have been well for years more.
There is an implication in all this for the practice of medicine. In standard medicine, we wait till the body begins to fail in order to repair it – but then it is too late. If, during the years when things are running well, we look under the case at the guts of the computer or body, and see what components are starting to go bad, we can avoid or at least lessen later catastrophic failure.
So too with the human body. We now have the ability to test very subtle changes in basic metabolism. For less than $500 you can take a test that checks for subtle deficiencies in enzymes and cofactors that process nutrition into energy. It has been shown that up to 30 percent of men with dementia have a subtle form of B12 deficiency. By the time one has dementia the effects of this deficiency on the brain may be irreversible. But if at age 30 or 50 we had done these “non-standard” tests, noted and corrected this deficiency, it would have avoided all these men becoming demented. Talk about cost efficiency. What is the cost of a bottle of sublingual B12? About $5 a month. What is the cost of caring for a nation of demented people? A lot more than $5 a month.
We have the ability to do personalized, one-on-one medicine using the latest science, and the opportunity to really make a difference. Why don’t we? Because we cannot without risking legal hassles.
Organized medicine and all its enforcement arms from the American Board of Medical Subspecialties to the state medical licensing boards tell doctors to practice “standard” (i.e. out-of-date) medicine. By their definition, “standard medicine” is what 90 percent of your colleagues are practicing. Of course, that is far from state of the art. And if you step out of line, you are by definition “wrong.”
Individualized, preventive medicine also requires the patient to pay directly for the care. Since it is not one-size-fits-all, it cannot be charged under some insurance scheme. And it cannot be codified for Medicare. But unlike prices for standard medicine, this type of medicine responds to free market forces. Cash payments keep costs down, because the patient determines value per dollar – not some government bureaucrat.
I practice this type of medicine for my family and myself. I have friends that come to me to optimize health, and I test them and advise them. But unless you are willing and able to step out of the standard mode of medical care, this great medical opportunity will be unavailable.
For those interested in being healthier longer, I recommend a couple of resources: WorldHealth.net (the A4M website), and Life Extensions at LEF.org, ( if you use my initials, LDH, you can access their wonderful journal for free for 6 months.) You can use the A4M website to seek out physicians in your area who practice anti-aging and complementary medicine.
The tragedy of Obamacare, Medicare and every other government “care” is not just that it is expensive and a bureaucratic nightmare, but that it is out of date and mediocre.