Projections as to the future of medicine, psychology, health care, Alternative Mind/Body medicine, and the current state of affairs in health care in the USA
During the closing weeks of the 105th Congress, Norm Anderson, Director of the Office of Behavioral and Social Sciences Research at the National Institute of Health (NIH), testified before the Senate Appropriations Committee on the topic of Mind/Body Medicine.
At that time, the media and physician witnesses pointed out that spending on our nation's health care is likely to double to $2.1 trillion by the year 2007; that already proven mind-body therapies could eliminate 37 percent of visits to the doctor per year and save $54 billion annually; and that stress contributes to many of the medical conditions confronted by healthcare practitioners -- between 60 to 90 percent of visits to Physicians are related to stress and other psychosocial factors.
Senator Tom Harkin, the Ranking member of the Appropriations subcommittee, subsequently shared with his colleagues a report developed by the Institute for Alternative Futures. This document noted that today, complementary and alternative approaches to health and medicine are among the fastest growing aspects of health care. In 1990, one-third of the U.S. population used some form of alternative approach to health care, and by the year 2010 at least two-thirds will.
The Institute further projected that one shall soon experience the customizing or personalization of health care, integrating several approaches based on the unique needs of each individual. Genomics will identify what genes and what physical or behavioral characteristics (genotypes and phenotypes) are most relevant for determining how to treat a given condition with given modalities.
Interestingly, complementary and alternative approaches such as oriental medicine, homeopathy and ayurveda already have extensive knowledge of individual differences built into their diagnostic and therapeutic systems. We must expect these complementary modes of analysis becoming integrated into conventional care, along with parallel psychological tests -- conventional medicine and alternative approaches will both challenge and learn from each other.
The report noted the dramatic growth in numbers among the complementary and alternative health professions. For example, health care professionals (including physicians) trained in oriental medicine will swell to 24,000 by the year 2010; the number of chiropractors will nearly double by then from 55,000 to 103,000. This expansion of practitioners comes at a time when numerous other credible forecasts suggest significant surpluses of conventional health care providers by the year 2010 (e.g., surpluses of 100,000 physicians, 200,000 nurses, and 40,000 pharmacists). Accordingly, all professions and individual practitioners must expect tremendously increased competition from other disciplines and traditional health care systems. While the opportunities to function, as a "healer" will expand dramatically, the ability to be financially successful will become more and more challenging.
The 21st century will also undoubtedly be the era of the integration of exponential advances within technology fields with critical events in health care. Outcome measures will be applied to local health care Providers and appear in local report cards accessible to consumers and third party payers (those who ultimately "pay the bill") by the year 2010.
Our nation's health professional educational systems will undergo major, if not unprecedented, changes. These, of necessity, must incorporate significantly greater use of technology and "virtual learning environments".
Similarly, state professional licensing systems will undergo major modifications. One must expect professionals of all disciplines to attempt to maintain and "protect their turf", but ultimately the boundaries of the professions are likely to blur. The right to continue to practice with a license will be based upon one's demonstrated outcomes; as local marketplaces become "smarter", consumers will regulate the market by economically rewarding "better practitioners".
The Institute further projected that these trends will lead to Managed Care by the 2010 that is far more effective, prevention-oriented and customized. It will utilize health care professionals far more effectively. A projected major source of competition for managed care will become "self-managed care". The same information tools that will enable managed care to become more effective, prevention-oriented and customized will be available to individuals and families -- consumers will seek prevention and wellness services that go far beyond what today we contemplate as "medical" or even "health care".
Least one might think that the report forwarded to his colleagues by the Ranking member of the Appropriations subcommittee is a little too "futuristic", we would like to share some thoughts we recently received from the President of the Robert Wood Johnson Foundation, which over the past several decades has been extraordinarily active in fostering changes within our nation's health care system.
"Our assets have ballooned to over $7 billion dollars, almost tripling since I came here in 1990. In a landmark 1990 paper in JAMA, our senior consultant... found that fewer than 10% of premature deaths in the United States can be prevented by medical care. Nearly half of all deaths are associated with lifestyle and behavior choices. Yet this nation spends less than 5% of its total health care dollar on disease prevention and health promotion. This is not surprising given that Medicare providers and patients (and other players) are a political force in the health care arena, while health itself has no such natural constituency. Health is something of an orphan."
"Beginning in 1990-91, with our commitment to reducing the health consequences of substance abuse, we have been bolstering our prevention and behavior/lifestyle investments. But we can do more. The restructuring will facilitate our growth into other behaviors associated with significant morbidity and mortality in this country. We are exploring, for example, whether targeted grantmaking could help reverse Americans' increasingly sedentary lifestyle.
If you think Americans have turned into physical fitness freaks, consider these statistics:
The time Americans spend in the cars quadrupled between 1960 and 1990;
and between 1960 and 1992 the time watching television per household per day increased from 5.06 to 7.04 hours...."
Norm Anderson's testimony: "NIH has a long and revered tradition of funding research in the physiological realm, and more recently, there is tremendous excitement in the realm of genetics research. But equally important is the recognition of the role that behavioral, psychological, sociocultural and environmental factors play in health.
Our beliefs, our emotions, our behavior, our thoughts, our family and cultural systems, as well as the environmental context in which we live, all are as relevant to our health as our genetic inheritance and our physiology...."
"Health science has reached a point where it is no longer accurate to talk about psychology versus biology; the mind versus the body; or nature versus nurture. These processes are inextricably linked. When I talk about mind/body medicine, I am referring to these linkages. That is, the connections between psychological, behavioral, and sociocultural processes with all levels of biological functioning - from the organ systems, to the cellular, to the molecular.
PAT DE LEON
President Elect Div. 29, American Psychological Ass.