How do we define health?

There is an awful lot of discussion about health care reform these days. It might be a good idea to have a national discussion about what health is before we talk about reforming health care.

The National Institutes of Health (NIH), which coordinates the vast majority of government-funded medical research, defines its mission (in part) this way:

“NIH provides leadership and direction to programs designed to improve the health of the Nation by conducting and supporting research [into] the causes, diagnosis, prevention, and cure of human diseases.”

So, we have the health of the nation being supported by conducting research into all aspects of disease. That should be a warning sign. Our national medical research institution has no active definition of health that defines its mission. There is no understanding of the state of health that is other than the absence of disease.

The problem is that we go on to define diseases as some collection of symptoms. For example, osteoarthritis (OA) is the disease defined predominantly by pain in the joints (typically the larger joints of the body, such as hips, knees and shoulders).

Conventional medical treatment is focused on relieving the pain experienced by the person diagnosed with OA. Thus, anti-inflammatory medications such as ibuprofen or steroids are given to lower inflammation and thus relieve pain. If these medications “work” to relieve the pain, then the OA is said to be “managed” or “under control.” A patient with a diagnosis of OA who takes prednisone and thus experiences no pain in their joints would likely consider their health served, as would the prescribing physician.

With this sleight of hand, the masking of symptoms gets equated with the care of health. But what are we to do with the enormous list of unhealthy effects of both ibuprofen (and here and here) and especially prednisone (and here).?

The problem is that relief of a symptom (or symptoms) has been equated with care for health, when in fact all that has been accomplished is the suppression of symptoms. While the joint pain is relieved by prednisone, the patient’s bones are losing calcium, their blood sugar may be rising, their connective tissue is becoming weaker, and a whole range of other unhealthy processes are going on.

Any therapy that claims to care for health should meet a few basic criteria:

• Someone receiving that therapy should have a decreased risk of any disease in the future
• Someone receiving that therapy should experience an overall enhancement of their sense of vitality and well-being as their health improves in response to the therapy
• The therapy should not be needed indefinitely. In other words, if the therapy is truly improving health, then at some point the health should be improved to the point that the therapy is no longer needed

By equating the masking of symptoms with the care for health, the medical world evades the need to actually improve an individual’s health. If one were to exclude from use all medications and procedures that in some way compromise the body’s ability to function harmoniously in its totality, then virtually nothing would be left of conventional medicine.

True health care reform would begin with a discussion about what health really is. It would then focus on those therapies and those lines of research that serve health in its entirety. So long as the goal is simply the suppression of symptoms, the best we will ever do is manage our miseries in ways that are very, very profitable.