By Rob Verkerk PhD, founder, executive and scientific director

It’s hard to apply the adjective ‘visionary’ to many world leaders these days. Some may argue that’s because it’s getting harder to predict what may happen in months, let alone years, ahead. But – maybe more important – we seem to be immersed in a world in which there appears a dearth of quality leadership. Gandhi, Churchill and Roosevelt are widely regarded as great leaders because of what they managed to do during very troubled times. Creating cohesiveness and self-reliance among their respective populations during very trying circumstances were among their greatest accomplishments.

I’m not convinced that we will look back at the May and Trump era in a similar way. If you can’t get Westminster or Congress onside – it’s a tough ask getting citizens at large to play to your song sheet – that’s assuming you even have the vision to have created one and don’t keep changing your mind!

What is widely accepted now is that ‘healthcare’ is entering a crisis born out of its inability to cope with the burden of diet and lifestyle related diseases. The pills in the drug armoury don’t work well, or at all, for these diseases, there are insufficient staff or facilities to look after the sick – and the whole kit and caboodle simply costs too much money. This crisis could be of such magnitude that most key decision-makers have difficulty imagining what the face of healthcare will look like in the coming decades.

“We hear, but we’ll ignore”

Victor Dzau MD from Duke University is one of the most senior doctors and medical academics in the United States. Among his credentials is his presidency of the US National Academy of Medicine (formerly the Institute of Medicine), in turn a part of the US National Academy of Sciences. Dr Dzau who heads up the Vital Directions discussion paper series has theorised about some of the major changes that need to happen if healthcare is to become more sustainable. He and his colleagues conclude a number of things are required to help improve health at lower cost – with which so many of us are in broad agreement:

1. The US spends on average 2.5 times more money on healthcare than other OECD nations, but the population is on average less healthy. This suggests that throwing money at healthcare doesn’t necessarily make the quality of healthcare better.
2. Diet and lifestyle-related impacts on health affect the poorest in society most, leading to ever greater health disparities between the rich and the poor.
3. In one of the Vital Directions discussion papers (2016), Lynn Goldman and colleagues stated, “There is direct and undeniable evidence that there are major opportunities to improve population health that lie outside this system or require fundamental changes in how the system operates.” This focus on ‘health systems’ that are outside of mainstream health care delivery through primary care clinics and hospitals is a central focus of our blueprint for health system sustainability.

In essence, we need to shift our focus from being disease-centric, to being health-centric. We need to have a clearer and shared understanding of how the body works so that we are less susceptible to following often conflicting advice from experts that have been deeply influenced by one vested interest or another. That’s our reason for proposing in our blueprint a common language that we can use to interpret health, via the multiple systems on which we depend. To do this we use an ecological lens – because it’s hard to deny we are biological entities that function within complex, varied and dynamic ecological systems. This way of looking at health is many miles away from the fragmented, biomedical, siloed model that most of us have grown up with, that remains the basis of all mainstream medical education.

Why shift fields when the pastures are so rich…

However, it’s human nature to not look to doing something differently if there is no need. We are economical by nature; being this way enhances our survival. When a natural system becomes unstable, a new dynamic order develops in an attempt to generate feedback that improves the survival chance of the organism, species or community (ecosystem).

Applying this analogy to healthcare – if you deny there’s anything fundamentally wrong with the present system – why change it? Sadly, despite very high level medics like Dr Dzau doing his thing, calling for a kind of revolution that includes the type of approach we propose in our blueprint, the vast monolith of mainstream healthcare has no desire to change. Doing business with disease is just too profitable. So Big Pharma works overtime with paid-up PR ‘spin machines’ to justify the drug model for ‘healthcare’ (that’s actually about disease, not health, care). Journals pay lip service to improvements in their declarations of interest and transparency. Regular publicity in the national press to ‘breakthrough’ cancer, blood lipid-controlling, anti-obesity or anti-diabetic drugs maintain the illusion that a ‘pill for an ill’ will always be found.

Clear evidence of biomedical failure

It’s therefore of great interest when we have solid evidence of something being very wrong with the mainstream biomedical model. The wave of support given to Dr Peter Gøtzche’s protestations against Cochrane, exemplified by the Council for Evidence-based Psychiatry, is an important example of mainstream medics coming together to say all is not well in the mainstream medicine camp. This followed Dr Gotzche’s powerful exposé in his 2013 book “Deadly Medicines and Organized Crime”.

The latest cry over major defects in the mainstream medical model comes from a senior Irish gastroenterologist, Dr Seamus O’Mahony in his just-published book, “Can Medicine Be Cured? The Corruption of a Profession” (Zeus, 2019). Dr O’Mahony is no alternative medicine guru – in fact, he couldn’t be more conventional if he tried. He makes a mockery, for example, of ‘non-coeliac gluten sensitivity’ that he believes to be a made-up, psychosomatic disease. We think he’s wrong on this point, but it’s his dead-centre conventional position that makes his other criticisms even more powerful.

Some of the most poignant points made in the book are:

• The ‘golden age of medicine’ that saw genuine advances in healthcare with a swathe of effective antibiotics and other drugs, better anaesthetics and surgical innovations ended in the 1970s
• This ‘golden age’ spawned a system that has allowed the pharmaceutical industry to become the dominant player in medical research, despite, nearly half a century on, us being firmly entrenched in “the age of unmet and unrealistic expectations, the age of disappointment”
• There is an increasing gulf between researchers and clinicians. Bad science and misinformation have become the norm among researchers whose value is now judged more by the size of their grants or number of postdocs, not the quality of their work. This means the public doesn’t benefit proportionately from the huge investment in medicine made predominantly by Big Pharma.
• O’Mahony hits out at polypharmacy (exposure to multiple drugs), a subject to which his brother has devoted his life as an academic geriatrician. He refers to it as a “direct cause of major side effects and increased mortality, and a huge waste of money”.
• A new force in medical research is ‘philanthrocapitalism’. Here, the likes of Facebook’s Mark Zuckererg, Microsoft’s Bill Gates and entrepreneur Eli Broad, are piling money into medical research and have become a “new force in global health”. The vast majority of the money feeds the status quo, not the new, more sustainable health systems that Dzau and others, including ourselves, talk about.

For a more detailed review of the book, check out ex-BMJ editor Peter Smith’s review in the BMJ.

Going on trial

What I’ve written above is a slightly long-winded way of saying “the system is badly broken, but there’ll be little appetite for change because too many people are making too much money out of the broken system”.

Leading US internist and psychiatrist, Dr George Engel showed, in a Science paper published over 40 years ago (1977) that the ‘biomedicine model’ wasn’t fit for dealing with the growing burden of mental health illness and even diabetes. He called on the creation of a new model – a ‘biopsychosocial’ one – that he argued may even need to exist completely separately from the mainstream biomedicine one. That’s because the way we interact with our environments is so much more complex than the mechanistic and molecular biology approach favoured by biomedicine.

But it wasn’t to be. The status quo didn’t change. The same vested interests that Drs Gøtzsche, O’Mahony, Marcia Angell and others have crowed about so loudly love it too much the way it is. Why muck with a system that benefits you so well, especially when you largely control it.

Plan B

So telling the world the system is broken doesn’t appear to be enough on its own.

Plan B, we believe, means going out there and evaluating it. This is fast becoming our major mission in relation to our work on our health system blueprint – working with communities, bottom-up not top-down, to evaluate if health systems based around a deep and consistent understanding of natural processes, can indeed be sustainable.

We are convinced that without positive demonstration of effect, it will just be another good idea that was never put to test. Like Dr Engels found, over 40 years ago. Governments, Big Science and Big Pharma will never fund such work. They have too much to lose and by and large they’re not interested in good health. Roosevelt and Churchill discovered that war triggered the development of industry and the economy, and current governments know that widespread disease – and hunting for unachievable moonshots – is also good for business, at least businesses based on pharmaceuticals.

Not only does a new way of doing healthcare need to be demonstrated, it also needs to be carried forward with good leadership. Our view is that we need to initially address the first part of this challenge. Leadership will emerge once there’s a plan that’s a whole lot clearer than the ones presently being used by the UK and US governments.

We’d like to hear from you if you can help

If you think you have skills, contacts or funds that could help roll out the next steps of our blueprint project in the UK or beyond, we’d love to hear from you.

Please email [email protected] and include the word ‘Blueprint’ in the subject line or call +44 (0)1306 646 600 during UK business hours. We greatly look forward to hearing from you.