The Unnecessary Overuse of Biomedical Interventions
A few years ago, I was at a routine annual checkup. I mentioned to the doctor that I’d been feeling lethargic and had low energy, yet when it was time for bed, I was having trouble sleeping. He ordered a blood test and when I followed up a few weeks later, it was revealed that low testosterone was the culprit. This was not surprising to me since, at the time, I was ferociously busy with work and grad school. High stress meant inadequate sleep, lack of exercise, and poor nutrition choices; all of which are a recipe for low testosterone. What I did find surprising was the doctor’s response. I was expecting a recommendation on how to adjust my lifestyle to regulate my hormones and recalibrate my adrenal system. Instead, the first thing he mentioned was seeing an endocrinologist to be put on biosynthetic hormone replacement therapy. Knowing the little that I do about wellness, I was amazed that a doctor would prescribe this treatment for a 31 year-old man in otherwise good health! I politely declined, went home and did some research on how to increase testosterone naturally, and made the appropriate interventions regarding sleep, nutrition, exercise, stress management, and herbal alternatives. Just six weeks later, a second blood test showed that my free and total testosterone had increased to the high end of the healthy range.
While my health issues seemed to have been resolved, I couldn’t stop thinking about the doctor’s irresponsible and unnecessary prescription. Health care professionals these days are far too quick to resort to biomedical intervention. Can’t concentrate? Here’s some Adderall. Having trouble sleeping? Take Ambien. Feeling depressed? Zoloft will help with that. These drugs are doing nothing to address the root cause of the problem. They work by masking the symptoms, and in doing so change the natural chemistry of the body or brain. To be clear, there are certainly instances when these drugs are both necessary and beneficial. The problem lies in their overprescription and overuse.
The Overuse of Biomedical Intervention
In a 1998 report, the Institute of Medicine defined overuse as “the provision of medical services that are more likely to cause harm than good.” This is critical. Overuse means not only providing unnecessary medical treatment, but treatment that can actually be detrimental to a patient’s physical or mental health. It’s important to differentiate. For example, the overuse of blood tests or CT scans might be a waste of time and money, but they are largely beneficial with little to no possible harm to the patient. Conversely, the overuse of biomedical interventions such as surgical procedures or the prescription of pharmaceuticals can have severely detrimental effects on the patient’s short and long-term health. One 2014 study determined that 34% of total knee replacement surgeries in the U.S. were “inappropriate” or unnecessary. Another 2011 study from St. Luke's Mid America Heart and Vascular Institute found that approximately 12% of (non-acute) open heart surgeries were inappropriate. These are major surgical procedures that, if not performed successfully, could cause severe adverse health effects or even death.
Even more disconcerting is the overuse of biomedical intervention pertaining to mental health. It seems that these days there’s a drug out there for everything. Doctor’s are quick to pick up the pen and pad and write a script for whatever psychotropic pill matches your symptoms. According to the American Psychological Association, “The use of psychotropic drugs by adult Americans increased 22 percent from 2001 to 2010, with one in five adults now taking at least one psychotropic medication... In 2010, Americans spent more than $16 billion on antipsychotics, $11 billion on antidepressants and $7 billion for drugs to treat attention-deficit hyperactivity disorder (ADHD).” And the epidemic has grown since that data was collected nearly ten years ago.
Who’s To Blame For The Overuse Of Biomedical Interventions?
Everyone has an opinion and it’s easy to point fingers, but the reasoning for rampant inappropriate and unnecessary biomedical interventions is complex. As mentioned, when it comes to pharmaceuticals, there’s a lot of money involved. This provides incentive for big pharma to produce and sell more drugs. Sales reps convince health care professionals that each new drug is a magic pill, while lobbyists persuade politicians that these drugs are healthy and benign. And while many people do benefit, too much of any medicine makes it a poison, especially if no prior holistic interventions were attempted in the first place.
To add, the modern western medical system is largely dysfunctional and for a number of reasons. One major issue is that doctors don’t take the time to fully assess their patients and solve health issues at the root level. Not because they don’t want to, but because they don’t have time. A 2012 survey by the Physicians Foundation reported that 39.8% of general practitioners see between 11 and 20 patients per day, and 26.8% see 21 to 30 patients a day. That means the average time for each patient meeting is 13 minutes on the low end. How much can a doctor really dive into a proper medical assessment with each patient if they are under such time constraints? Often, they are left with two choices: pass the patient on to a specialist, or write a script for a quick fix. When you combine the financial incentive to push drugs with this broken healthcare model, you have a recipe for the current state of biomedical intervention overuse.
How Do We Prevent The Overuse Of Biomedical Interventions?
While addressing the role of big pharma and the structure of modern healthcare as a whole are both important issues, the key to preventing overuse of such interventions is a cultural shift, not a political one. Stop treating the symptoms and start treating the underlying problems. Medical professionals need to take a more holistic approach and look at each patient physically, mentally, and emotionally. Patient assessments should consist of in-depth conversation, as well as clinical examinations, lab tests, and a deep dive into their personal medical history. In doing so, doctors will be able to identify and treat the true source of illness without overusing unnecessary procedures or prescriptions. While this approach may seem extensive and improbable based on the current amount of time doctors spend with patients, over the long run it will save time and money because people will actually be getting better.
The Pillars Of Health: Food, Sleep, Exercise, and Stress Management
The answer isn’t just addressing that overuse exists and identifying what we shouldn’t do, but in recognizing what we should do. One major factor is taking responsibility for personal wellness. This means educating people as to how to live a healthy life, and on a personal level, it means harnessing a sense of discipline. By dialing in to lifestyle factors like sleep, nutrition, exercise, and stress management many physical and mental ailments can be prevented altogether. If already sick, these pillars of health should be addressed before any biomedical intervention takes place.
Community: The Forgotten Pillar Of Health
One pillar of health that was not mentioned before--but that is of equal importance--has to do with the relationships in our lives. When it comes to health and wellness, relationships aren't what most people think of. Yet, they are incredibly crucial for our wellbeing. Whether you identify as an introvert or extrovert, humans are social animals. We thrive when life is full of family and friends and positive relationships.
Mental health is especially dependent on the connections we have with others, yet we’ve become an individualist society in many ways. The modern world has made cultivation of authentic human connection more and more difficult. People think that happiness is an accomplishment; a big house, a promotion, a six-figure salary. But it’s not. Happiness is all about the present. It’s not about working your way to a place where you feel you’ve reached contentment, but instead about being content and fulfilled with what each and every day brings. A big part of that is having people around you that you love and support and encourage, and that do the same for you. The term “social networks” is now used to describe the array of online platforms with which we are connected to others. But likes, comments, and scrolling through curated moments of other people’s lives is not connection at all. Authentic communication, real-life contact, and meaningful emotional exchange is what creates a connection. When we build a community of meaningful relationships, this missing pillar of health returns strong and sturdy. We can trade depression for happiness, and anxiousness for peace. It is connection that’s the true antidepressant.
In this day and age, it’s more apparent than ever that we can’t wait for the system to fix itself. Such a shift in the paradigm has to start with the people. There are many things we can do to take action. On a political level, vote and write letters to congress. A more direct approach, might involve demanding holistic considerations from healthcare providers and general practitioners. But the most impact will come from demanding change within ourselves. When it comes to diet, exercise, and sleep, make the right choices. Put down the smartphone and go hang out with your friends. It may be simple, but it sure isn’t easy. Rebuilding community and committing to self-care are the first steps in freeing ourselves from inappropriate biomedical interventions.