The Healthcare Delusion

Stedman's Medical Dictionary defines delusion as "a false belief or judgment held with conviction despite incontrovertible evidence to the contrary." With all the current discussion about healthcare reform it's time for some straight talk on health and disease and the "healthcare system."

First of all, we don't have a healthcare system. We have an illness care system which, if it must be labeled, I would call the medical care system. The task of the medical care system is mostly to ameliorate and help people cope with the diseases that beset them. Some diseases can be cured but hardly any can be prevented. Prevention has only been documented for certain infectious diseases and this has been accomplished mainly through public health measures such as provision of clean water, chemical eradication of disease-carrying insects, etc.

The idea that "life style" habits such as diet and exercise can affect the incidence of disease is especially pernicious as it provides a rationale for totalitarian regulation of individual choice by the government and the hordes of busybodies who yearn to control the behavior of others. This should be clear to all libertarians. It distresses me to see some of my fellow libertarians buy into the phony arguments for "lifestyle" causation of disease which is based on pseudoscientific gibberish that they would never accept on another subject such as, say, global warming.

Much of the confusion may be due to a lack of appreciation for the difference between health and disease. Health is our natural condition. Disease is a physical or biochemical alteration that causes one or more of the body's organs or organ systems to malfunction. Once the infectious diseases are excluded, there is virtually nothing known for certain about the causation of disease. This is especially true for the ubiquitous degenerative diseases that afflict all of us as we age – predominantly cancer and atherosclerosis with the latter being the underlying cause of heart attacks and strokes.

Natural Health Remedie... Maccaro PhD CNC, Janet Best Price: $1.25 Buy New $8.14 (as of 04:05 UTC - Details)

Most people confuse health with the way they feel. Although almost all diseases will eventually affect the way one feels, it is possible to feel well for quite some time despite the presence of disease in the early stages. Conversely, people may feel poorly for a variety of reasons even though they enjoy good health (i.e. the absence of disease). How one feels is subjective while the presence of absence of disease is quite objective.

For example, exercising and maintaining physical fitness certainly provide a sense of well-being for most people. There is no question that physical fitness provides one with a feeling of more energy and the ability to get around with less fatigue, sluggishness, etc. But there is not a scintilla of scientific evidence that exercise or fitness prevents disease or prolongs life despite the never-ending exhortations to the contrary.

Diet is an even greater source of misunderstanding and misinformation. The attempt to link diet to health and disease has a long and rich history. The only thing lacking is any scientifically credible evidence that the two are related. Most of the so-called "evidence" that is cited comes out of a pseudoscience known as epidemiology.*

Epidemiology was once somewhat useful in pinpointing the causes of infectious diseases. But it has been counterproductive in elucidating the causes of chronic and degenerative diseases. It has steered research down a blind alley seeking "risk factors" and "lifestyle choices" as causes of disease. This is done through that manipulation of statistics using data that are highly suspect to begin with. Much of what passes for medical research these days is nothing more than "numbers crunching" to show correlations between risk factors and disease. These "studies" give us our health scare of the week where the media announces with great solemnity that "investigators at X university have discovered that people who drink y cups of coffee per day exhibit a higher incidence of (name the disease)." These bulletins are popular with the media because they provide an endless source of stories. They are favored by researchers because they can crank out dozens of papers without ever leaving their easy chairs.

An example with which I am intimately familiar because it is in my specialty field (cardiology) is the purported link between cholesterol and coronary heart disease. I have written a book on this subject titled The Cholesterol Delusion which I am hoping will be published in the near future. The book attacks the cholesterol theory root and branch and shows how the theory was built up on a few studies which used correlations between unreliable statistics and conflated tiny differences into significance through statistical legerdemain and outright fraud.

The biggest lie is that connecting diet to heart disease. There has never been any scientifically credible evidence for this association. The best-designed and conducted studies uniformly show that diet has no significant effect on heart disease or cancer. Even if cholesterol was a factor in the causation of atherosclerosis and heart disease, diet would not be the answer. There are literally hundreds of studies dating back many years showing that diet has a negligible effect on one's cholesterol levels. The reason for this is that cholesterol levels, like many other biological phenomena, are under the control of a feedback mechanism. Most people are not aware of the fact that we humans manufacture 80–90% of our cholesterol. This occurs mostly in the liver, but many other cells within the body can participate in this process as well. The reason for this is that cholesterol is a vitally important biochemical and life would be extremely fragile if we had to depend upon an external supply.

  Discount Canadian Prescription, OTC and Pet Meds   Thank you for supporting LRC with your online orders

Each individual has a range of blood cholesterol levels that are set by the genes. This range may vary quite a bit from person to person. If all the cholesterol is removed from the diet, the body will simply step up the rate of manufacture in order to restore the level to the preset range. Conversely, huge amounts of cholesterol may be added to the diet, but the body will only absorb so much and will reduce the rate of manufacture so as to bring the level back into the normal range. Biology is replete with these sorts of feedback control mechanisms which operate as self-correcting means to maintain biochemical and hormonal levels within the ranges compatible with life. Libertarians can probably appreciate the similarity with market self-correcting mechanisms.

Another source of health misinformation is the currently hot topic of obesity which was discussed in the recent excellent article by Karen DeCoster. There seems to be a lot of hysteria about an "obesity epidemic" which is ruining our national health (whatever that is). But the critics have yet to confront the fact that life expectancy continues to rise despite this horrible affliction. Actuarial statistics show that moderate obesity (as currently defined) has no significant effect on life expectancy. It is true that the morbidly obese have significant health problems but these are most often due to mechanical factors such as extreme obesity that limits the ability to breathe normally.

There have been many attempts to link obesity with diabetes but this association is tenuous at best. There are literally millions of people who are obese but show no evidence of diabetes. Conversely, there are lots of thin and physically fit individuals who are severe diabetics. It is true that some people may show a diabetic-like pattern of glucose intolerance when they gain weight and revert to normal when they shed some pounds. These individuals may have a marginal genetic tendency towards diabetes where the anti-insulin effects of excess body fat may reveal a pattern of glucose intolerance. But they rarely suffer the severity or the secondary problems seen in the truly diabetic.

The idea that one can eat his way to diabetes is sheer nonsense. Some of the confusion arises because of fundamental misunderstanding about the disease process in diabetes. Because diabetics have either a relative or absolute lack of insulin, their blood sugar (glucose) level may rise quite high if they ingest a glucose load. In order to avoid the secondary metabolic effects of a high blood sugar (or, more accurately, a relative deficiency of intracellular sugar), diabetics need to pay close attention to the amount of carbohydrate in their diet. But the glucose level in the blood is really only a marker for the disease. The sugar itself does no harm other than dehydrating the individual due to the osmotic effect. There are many other effects which produce the typical diabetic syndrome (accelerated atherosclerosis, kidney failure, blindness, etc.). It has been shown that even near perfect control of the blood glucose level does little to prevent these complications in the truly diabetic. The underlying cause seems to be genetic and affects the insulin production and perhaps other factors as well. But one can eat all the sugar one wishes and never develop diabetes if the underlying genetic cause is not present.

So what is one to do in order to maintain health and well-being? It would be nice if we could do so by following a "healthy" lifestyle or diet. But, unfortunately, that is not consistent with biological reality. Most likely good health is a combination of genetics and pure dumb luck. This is not intended to be a statement of medical nihilism, but rather to provide a realistic frame of reference for rational individuals who are constantly bombarded by nonsensical notions about health and disease.

Dangerous Legal Drugs:... Douglass II, MD, Willi... Best Price: $4.93 Buy New $1.99 (as of 02:35 UTC - Details)

It is certainly normal human nature to want to believe that we can promote our own health through clean living and healthy lifestyles. If only wishing could make it so. No one wants to feel like they are subject to the winds of chance when it comes to their health but a realistic perspective should aid one in his or her own decision making when it comes to matters of health and disease.

I see many articles on this website and others touting this or that diet and/or regimen of supplements that will prevent cancer and other diseases, prolong life, etc. These programs are often listed under the title of "alternative medicine." As a radical individualist myself, I can relate to the impulse to question the accepted wisdom and go against the grain. But to believe in such promises betrays a form of magical thinking and unscientific irrationality that is unbecoming to libertarians. Most of these are harmless and I certainly wouldn't advocate their suppression. However, I find these attempts to tinker with our biology analogous to Hayek's description of constructivism as applied to society. Like a free market economy, the human body has marvelous mechanisms for self-correction and will function best under a regimen of benign neglect. This doesn't mean one shouldn't consult a physician when something is wrong. Just don't waste time, money, and resources on useless "health maintenance" measures which have no biologic plausibility or scientific evidence behind them.

What does all this mean for 1) the "healthcare system," and 2) the individual?

1) There is nothing wrong with the system that couldn't be fixed with a healthy dose of free market principles.

A) A good start would be a free market in drugs. Any adult should be able to buy any drug they wish without a prescription. They may choose to consult a physician or not.

B) Obviously, all government intervention into the medical field should be ended. Medicare and Medicaid should be abolished. All licensing laws should be repealed. Any person should be able to select or consult with whatever type practitioner he chooses.

C) End all regulation that hampers a free market in medical insurance. The unpredictable nature of disease outlined above makes this area ideal for insurance coverage just like that which is available for disasters or other unforeseen calamities.

2) For the individual:

A) Eat what you enjoy. If you are moderately obese, don't worry about it. Food doesn't cause disease. You may feel a little more sluggish, but that is your choice. You can only make intelligent choices when you know the true costs and benefits of any course of action.

B) Exercise as much or as little as you like. It will only affect the way you feel. It has nothing to do with health or disease.

C) If you feel well, avoid contact with the medical system. If something is wrong, consult a doctor to obtain a diagnosis and proper treatment. Get second opinions – no one is infallible

D) Avoid medications as much as possible – all are two-edged swords.

E) Carry high-deductible "disaster" medical insurance. This will be relatively cheap and protect you against the "big hit." I have done this for years and my premiums have not increased significantly over the past several years even though my wife and I have had three surgeries during this time.

The best advice I have ever read is to live a life of moderate hedonism and enjoy the limited time one has on earth.

*For further discussion of epidemiology see The Epidemiologists: Have They Got Scares for You by John Brignell. There was also a very informative article several years ago in Science magazine titled "The Limits of Epidemiology." I haven't been able to locate my copy to give the precise reference but perhaps it can be found on the internet.

August 12, 2009