Treating the root cause rather than the symptoms
The healthcare system works very well for acute and emergency care. In addition, the healthcare system has made tremendous progress in eliminating or drastically reducing contagious diseases like Tuberculosis, Malaria, Smallpox, HIV/AIDS, Measles, etc. Better treatments and public health interventions have significantly decreased these diseases’ instances and fatality rates.
However, given the latest advancements in medical science, data science, and technologies, the healthcare system is not optimal for managing and preventing chronic disease.
While advancements in acute and emergency care are allowing people to live longer, the quality of that longer life is impacted by chronic disease.
And unfortunately, chronic disease is commonplace. According to Rand Corporation, 60% of adults in the US live with one or more chronic conditions. 42% of adults live with multiple chronic conditions, and this jumps to 81% in adults 65 years and older.
So many people are affected by chronic disease and are not living their best lives. In my previous article, I walked through my personal and professional healthcare journey and explained five changes that could potentially improve chronic disease care. I will dive deeper into one of those five ideas in this article.
Chronic Disease Treatment vs. Symptom Management
The focus of medical care is typically on short-term symptom management rather than finding and treating the root cause. Chronic diseases are complex, difficult to correct, and involve multiple systems within the body.
Research has shown that chronic diseases develop for many different reasons. They can originate from genetics, physiological disorders, psychological issues, environmental exposure, and/or lifestyle choices.
For example, not all epilepsy, diabetes, hypertension, or cardiovascular diseases are the same. Chronic diseases can originate from physiological issues in the gut microbiome, digestive system, or endocrine systems or from metabolic syndrome, mitochondrial dysfunction, hormonal imbalance, inflammation, etc. They can originate from stress or other psychological issues. They can also stem from environmental exposure (e.g., mold/metals/pollution, etc.).
In many ways, chronic diseases are the manifestation of underlying physiological, mental, or environmental issues — and these issues are closely connected. Psychological problems can lead to physiological disorders. Physiological disorders can result in chronic disease.
Take, for example, stress and anxiety. Stress leads the brain to initiate a cascade of events involving the hypothalamic-pituitary-adrenal (HPA) axis. The adrenal glands receive signals to increase the production of the stress hormone cortisol. For most people, it’s fine for the HPA axis to function occasionally in this mode. But chronic stress can impair communication between the immune system and the HPA axis. This impaired communication has been linked to hormonal imbalances and numerous conditions, including chronic fatigue, metabolic disorders (e.g., Type 2 diabetes, obesity), hypertension, and immune disorders.
Treating the symptoms of chronic disease, without understanding its trigger, is not ideal in the long run.
Problems with our Current Treatment Philosophy
- Symptom management doesn’t work for everybody.
Take epilepsy as an example. Neurologists are the specialists who typically manage this disorder. And at this level, diagnostics and technology are highly advanced. The doctor can detect the disorder by viewing the brain’s structure through MRI (Magnetic Resonance Imaging), or by analyzing the brain’s electrical activity through EEG (Electroencephalogram).
Epilepsy medication is prescribed based on these diagnostic results, but it’s only effective for 70% of patients. 30% of patients still get seizures. For that 30%, a ketogenic diet is prescribed. And in two-thirds of these patients, the ketogenic diet either cures or drastically reduces seizure frequency. If epilepsy is entirely a neurological disorder, why does the ketogenic diet help?
Similarly, when I was experiencing sleep issues, treatment focused on managing my symptoms. I went through a highly advanced and extensive sleep test and was diagnosed with mild sleep apnea. When the sleep apnea treatment didn’t help, I was prescribed sleeping pills. I started sleeping more but still had low energy. Sleeping pills also stopped working after some time. Through my research and monitoring of sleep data, I found that the root cause of my poor sleep was a combination of behavioral, psychological, and environmental issues. I could improve my sleep by changing my eating habits, managing my stress, and making my bedroom environment more conducive to sleep.
In both scenarios above, treatment is not focused on finding and treating the root cause. And while a medical specialist may have vast knowledge in their field, the condition may have originated from the areas of other specialties. As a result, a “one-size-fits-all” treatment doesn’t work for everybody.
2. If the root cause is not addressed, it worsens over time.
It manifests in the form of other chronic diseases (i.e., comorbidity), compromising the wellness and happiness of the patient in the long run. For example, a person with diabetes and hypertension is much more likely to develop Alzheimer’s/dementia. Given the same cholesterol level, a person with diabetes, poor sleep, and hypertension have a higher probability of stroke and heart attack. This probably explains why 81% of patients over 65 years old have multiple chronic diseases.
Solutions Approach
I am amazed by the progress of medical diagnostics in identifying the root cause of chronic diseases. I believe that a combination of diagnostics, medicine, proactive monitoring, and lifestyle management has the potential to reduce chronic disease significantly.
With the advancements in medical science and technology, we can enhance our approach to chronic disease management in these four ways:
- Our approach to chronic illness should be holistic:
As I discussed above, chronic diseases happen for many reasons. They develop due to genetics, physiological disorders, psychological issues, environmental exposure, and lifestyle choices. Driven by the latest medical science and technology, we may benefit by changing our approach from treating the symptom to treating the root cause.
The root cause of a disease may vary from person to person. So rather than a one-size-fits-all approach, the treatment should be personalized and vary from person to person. The focus should be on eliminating the disease rather than managing the symptoms.
I am not saying that this approach will work for everybody. Along with medication, a holistic approach will require lifestyle changes. People may not be in a situation to make lifestyle changes, or they may prefer symptom management. However, I firmly believe that if all options and data are presented, most people will pick the options that are best for them in the long run.
Even if this works 30 to 50% of the time, it will go a long way to help improve quality of life and reduce healthcare costs. Chronic conditions worsen over time and manifest into other chronic diseases. If we catch and treat diseases when they first develop, we will improve overall health and reduce the instance of comorbidity. We will also lower healthcare costs. Take, for example, type-2 Diabetes patients on insulin. These patients typically spend $300 to $500 per month on insulin. If we reverse the disease in 30% of the patients, it will result in substantial cost savings. And in the case of type-2 diabetes, studies have already shown that it’s feasible.
2. Patient-centric care rather than specialty-centric care:
Rather than seeing multiple specialists in isolation, it may be more appropriate to have an integrated, multi-specialty therapy targeting the root cause. I am not saying we need to disrupt the current functioning of specialties. Medical specialties save lives, and as a result, life expectancy has gone up. Driven by the most current medical science, data science, and technology, I propose augmenting how the specialties function now to focus on the root cause before starting symptom treatment.
3. Make the latest diagnostics and monitoring mainstream:
Medical science and technology have allowed for innovations in the following areas -
- Advanced diagnostics to understand metabolic health: Many chronic diseases originate from physiological disorders in the gut microbiome or endocrine systems, as well as from metabolic problems, hormonal imbalances, inflammation, etc. Medical science has made huge progress in diagnosing such disorders in the past decade. Many functional and integrative medicine practitioners diagnose these causes regularly, but these diagnoses are not mainstream yet.
- Monitoring of physiologic data: Many of us monitor our physiologic health data through wearable devices. Some physiologic data (e.g., sleep, heart rate, and heart rate variability) could help healthcare providers (HCPs) understand the patient’s physiologic and psychological health to prevent chronic disease.
- Advanced understanding of interrelationships among body systems: Medical science and technologies have made incredible progress in understanding the connections across multiple body systems. For example, we know much more about the hypothalamic-pituitary-adrenal (HPA) axis, gut & brain connection, autonomic nervous system & metabolic health connection, etc. Applying this science to diagnose chronic diseases may help HCPs determine the root cause more quickly.
These approaches show promise in driving root-cause-driven testing, but various challenges exist. For example, these approaches have not gone through all the evidence-based testing required to make them standard practice. Technology and Data Science, in conjunction with regulations like “the 21st-century cures act”, has the potential to expedite the reach of these to patients sooner.
4. Promote the economic model that focuses on root-cause treatment over symptom management:
Our current healthcare model is a “break-fix” service-driven model. Patients seek medical care when they have symptoms, pain, or an injury. The more patients seek care; the better it is economically for healthcare providers. This service-based model is suitable for accidents and injuries, but not for root-cause treatment of chronic disease. Service encounters and prescription requirements will decrease if the healthcare system moves to a root-cause treatment model. A holistic approach will require many lifestyle adjustments; there is no economic benefit to proposing lifestyle changes in the current service-based model.
What if we change to a “Health as a Product” model for chronic disease management? The goal of the healthcare system becomes delivering a product — better health — by lowering the instance of chronic disease. The healthier our society gets, the more healthcare providers are rewarded. Economic compensation is independent of the number of service-driven encounters. Of course, this will require commitment and compliance from patients. There is a lot of detail to be sorted out, but I believe this is the best economic model to allow for holistic root-cause treatment.
The good news is that many healthcare companies are already considering this model. Many SAAS-based high-tech companies deliver subscription-based products in this fashion. The company gets penalized if the product quality is subpar or if there is a service disruption. We should take a similar approach to healthcare companies.
In Conclusion
Many HCPs and healthcare companies are already advocating for this approach.
There is early evidence of success with reversing or reducing chronic diseases like diabetes, early-stage dementia/Alzheimers, cardiovascular disease, and autoimmune conditions. Root-cause treatment has also shown promise with chronic migraines, sleep, and GI issues.
But as Geoffrey Moore describes in his book “Crossing the Chasm,” we are still in the early “Innovators” phase of adoption. Implementing these ideas into the mainstream healthcare system will require a lot of work. In conjunction with advancements in medical science, data science and technology will play a significant role in expediting the process.
And if we can do this successfully, we will live longer, healthier, and happier lives.
References -
- Dr. Christopher M. Palmer MD (Assistant Professor of Psychiatry at Harvard Medical School) -
- Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health — and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More (Book)
- Podcast — https://open.spotify.com/episode/6GEZVm18mwx76rWJueFHGj
2. Dr. Emeran Mayer, MD (Distinguished Research Professor in the Departments of Medicine, Physiology and Psychiatry, UCLA)
- The Mind-Gut Connection: How the Hidden Conversation Within Our Bodies Impacts Our Mood, Our Choices, and Our Overall Health (Book)
- The Gut-Immune Connection: How Understanding the Connection Between Food and Immunity Can Help Us Regain Our Health (Book)
- The Mind-Gut Connection podcast — https://emeranmayer.com/podcasts/
3. Dr. Dale Bredesen, chief resident in neurology at the University of California, San Francisco (UCSF) & Chief Science officer (Apollo Health)
- The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline (Book)
- The First Survivors of Alzheimer’s: How Patients Recovered Life and Hope in Their Own Words (Book)
- Dhru Purohit Podcast with Dr. Dale Bredesen: https://open.spotify.com/episode/1BtN7gw0CVQjlCMZ1PFke3
- Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project: https://www.apollohealthco.com/alzheimers-reversal/
4. Dr. Robin Berzin, MD (Founder and CEO of Parsley Health)
- State Change: End Anxiety, Beat Burnout, and Ignite a New Baseline of Energy and Flow (Book)
5. Dr. Mark L Hyman MD (The Head of Strategy and Innovation of the Cleveland Clinic Center for Functional Medicine, Board President for Clinical Affairs for The Institute for Functional Medicine — https://drhyman.com/)
- The Doctor’s Farmacy podcast — https://drhyman.com/blog/category/podcasts/
6. Dr. Justin L Sonnenburg (Professor, Microbiology & Immunology, Stanford — https://sonnenburglab.stanford.edu/)
- The Good Gut: Taking control of your long-term health (Book)
- Podcast: https://hubermanlab.com/dr-justin-sonnenburg-how-to-build-maintain-and-repair-gut-health/
7. Dr. Ayesha and Dean Sherzai, MD (Neurologists and co-director of the Alzheimer’s Prevention Program at Loma Linda University — https://thebraindocs.com/)
- The Brain Health revolution podcast — https://thebraindocs.com/podcasts/
8. Dr. Saray Stancic MD (board-certified physician — https://drstancic.com/)
- What’s missing from Medicine (Book)
- Documentary Codeblue — https://drstancic.com/codeblue/
9. Dr. David A. Sinclair, A.O., Ph.D. (Professor at Harvard Medical School)
- Lifespan Podcast — https://www.lifespanpodcast.com/
10. Dr. Andrew Huberman, Ph.D. (Neuroscientist, professor of Neurobiology at Stanford School of Medicine)
- Huberman Lab Podcast — https://hubermanlab.com/category/podcast-episodes/
11. Dr. Robert H. Lustig, M.D., M.S.L. (Professor emeritus of Pediatrics, neuroendocrinology, UCSF)
- Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (Book)
12. Dr. Atul Gawande (General & Endocrine Surgery, Brigham and Women’s Hospital & professor at Harvard Medical School)
- Being Mortal (Book)
13. Dr. Brittany Henderson, MD, ECNU (board-certified in internal medicine and endocrinology — https://www.drhendersonmd.com/)
- What You Must Know About Hashimoto’s Disease (Book)
14. Dr. Steven E. Phillips, MD (Yale-trained, world-renowned expert on zoonotic infections)
- Chronic: The Hidden Cause of the Autoimmune Pandemic and How to Get Healthy Again (Book)
15. Dr. Dean Ornish (Professor of medicine UCSD & Physician Consultant of Bill Clinton)
- Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (Book)
16. Dr. Kristen Willeumier, Ph.D (Neuroscientist with research expertise in neurobiology and neuroimaging — https://www.drwilleumier.com/)
- Biohack Your Brain: How to Boost Cognitive Health, Performance & Power (Book)
17. Dr. Aseem Malhothra (British Cardiologist)
- A Statin-Free Life: A Revolutionary Life Plan for Tackling Heart Disease (Book)
18. DUTCH (Dried Urine Test for Comprehensive Hormones) podcasts —
19. American Psychological Association —
20. Rand Corporation —
21. Centers for Disease Control and Prevention (CDC)
22. Sleep, Recovery, and Activity through several consumer devices
