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Health Care in the Last 100 Years:
Lessons for the New Millenium

By Bob Fies, M.D.

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What are the lessons of the last 100 years? And can we apply them in our daily lives to make the next millenium happier, healthier, and sustainable for us and our children?

The first half of this century began with childbirth, influenza, and everyday trauma inflicting high casualties. Medical education improved such that in 1911 "for the first time in history the average patient seeing an average doctor for an average problem had better than a fifty-fifty chance of benefiting from the transaction." By the mid 1950's progress in sanitation, immunizations, and antibiotics led to the eradication of polio and smallpox, the expectation of living to old age, and new wonder drugs. Spirits were high. There seemed to be little that science couldn't eventually conquer.

The last fifty years have seen dramatic shifts. Knowledge, technologies, and entrepreneurism accelerate ever-faster. Acute diseases have been replaced by new illnesses of body and psyche such as coronary heart disease, chronic fatigue syndrome, pain syndromes, arthritis, cancers, teen age suicide, and addictions of all varieties. And for all of these chronic maladies, medicine typically fails to effectively address the root causes.

We are now said to be entering "the post-antibiotic era" as use of progressively stronger antibiotics turns our hospitals into training grounds for super-pathogens. Science has brought us immense material benefits but threatens to bury us in its increasingly complex and expensive products: organ transplantation, genetically engineered drugs at a cost of several thousand dollars a dose, the human genome project including ability to detect hereditary diseases. We are beginning to reach real limits.


1. What we eat really does count.
Coronary heart disease, our leading killer, has shown gradually decreasing incidence and mortality in the last forty years. Lowering fat calories from 45% of our diet in 1957 to 34% now has been of real benefit. Limiting saturated and unsaturated fats to below10% each and raising monounsaturates such as olive and canola oils should further help. Attention to quality is perhaps of greater importance. Virtually all commercially refined oils are loaded with harmful trans fatty acids. Use of natural unrefined fats and oils such as olive and fish has been shown to lower heart attacks and is strongly recommended.

Adverse blood lipids contribute to hardening of the arteries. But heart attacks often occur in minimally narrowed arteries as placque ruptures and blood clots. The use of clotting inhibitors such as 400iu of vitamin E or one aspirin taken daily lowers actual heart attacks by about 40%. The same type of benefit might be expected from use of omega-3,6,&9 oils, Ginkgo biloba, and certain other natural substances. For the 20% of people who carry high blood levels of the amino acid homocysteine, taking extra folic acid, B6, and B12 prevents heart damage. These are matters to discuss with your medical doctor.

The enormous range of health benefits from appropriate use of natural food substances (and avoidance of man-made toxins) is only beginning to be widely explored and employed. Particularly promising is the use of essential fatty acids, amino acids, and newly discovered glycoproteins in preventing and treating specific diseases. The risks as well as benefits of burgeoning food supplements need to be more clearly delineated. We now know that folic acid in small amounts early in pregnancy prevents neural tube defects such as spina bifida (a serious disease of newborns). At the same time, overdosage of selenium, copper, and most other trace minerals and synthetic vitamins can be highly hazardous.

2. Our emotional lives play a profound role in our health.
People who hold in feelings (suppressives) and hostilities (type A's) have higher cortisol and adrenalin levels and substantially more heart attacks, as do those who feel isolated. Depressed people who have a heart attack have an immensely higher death rate. The new science of behavioral medicine is demonstrating that our beliefs and thoughts help form our feelings, attitudes and actions and that they can indeed be changed for the better. Self-help books, counseling, Twelve-Step and self-help groups have proven useful in refractory chronic conditions. What seems essential is to use new insights to practice appropriate new behaviors so that they become established into our daily life. Innovative medical care in this area is in its infancy, tends to utilize group learning, and is best demonstrated by the work of Dean Ornish, David Sobel, and Kate Lorig.*

3. Vigorous use begets vigor--passivity kills.
Inactivity of body, mind, or spirit predictably produces atrophy. The new disease of "affluenza" centers about self-gratification and seems to intensify chronic illnesses and addicitions. Material consumption is not enough. Harnessing the energy of one's passion and using it to achieve dreams or to live a daily life of focused simplicity both produce health. The amount of physical or mental activity appears less important than its regularity, focus and quality. Activities that connect us with nature and with those we enjoy are particularly helpful. People with an active spiritual life have demonstrably more resilience to life's adversities.

4. Attention is our most powerful tool.
Our attention has become a commodity manipulated and sold by the communications industry. Reclaiming and focusing it are vital to maintaining health in this confusing fast-paced world. This requires conscious choice, prioritizing, and training, as all of us have habits that lead us astray. Focusing attention on areas of pain and contraction paradoxically leads to relaxation and relief. Attending to activities and relationships we enjoy produces happiness. Fortunately, centering practices such as martial arts, meditation, and prayer are readily available. Small oases of stillness carefully built into our daily lives pay large dividends.

5. Prevention requires healthy community.
We live in a competitive culture. Yet for every kill-or-be-killed moment in nature, there are countless interactions of interdependent support. Churches, softball teams, car pools, lunches for the poor, restoration projects, neighborhood watches-- the web goes on and on. It is the vitality of this web on which our health truly depends. As we enter the next millenium, our ability to support one another sharing our lay and professional skills in nutrition, bodywork, counseling, yoga, and other disciplines will be far more effective in promoting health than further advances in medical technology.

In the 20th century we have tried to conquer diseases. We have had some successes and we've made messes we have to clean up-- both human and environmental. We've mistaken science as salvation, not as a provider of tools to be used wisely. In the 21st century we will advance and apply our growing understanding of natural healing while retaining useful tools from the past. We have to come back into balance and we can. The decisions required are not complex. We can choose to eat fresh locally produced fruits and vegetables and whole grains. We can spend more time with family and friends and community groups. We can cooperate as well as compete. Together, we can create and enjoy healthy lives.

*Dean Ornish, Dr. Dean Ornish's Complete Guide to the Reversal of Heart Disease, Ballantine, 1992., IVY, 1997. Kate Lorig et al, Living a Healthy Life with Chronic Conditions, Bull Publishing, 1994. David Sobel and Robert Ornstein, The Healthy Mind , Healthy Body Handbook, Time/Life, 1996.

Bob Fies, M.D. is a board-certified internist who works with the collaborative Santa Rosa Medical Group in Santa Rosa, California. He integrates behavioral and mind-body practices with preventive medicine and particularly enjoys teaching self-management skills to individuals and groups. For more information about Dr. Fies or the Santa Rosa Medical Group, call (707) 539-3511.


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