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Limitations of Medical Practice
Each person has some control over their life course and some ability to prevent injury and disease. Often, diseases emerge because of ignorance or careless disregard for risky behaviors. On the other hand, some people become overly concerned about unseen health risks and focus on small issues, using casually gathered misinformation. Although their intentions are admirable, their methods fail to achieve the right results.
Medical practice overall treats emerging diseases with drugs and is less concerned with self-responsible actions that could prevent disease and mitigate the consequences of diseases. Affluent countries tend to create dependent citizens who may fail to act responsibly and instead, dependent people expect that MDs and hospitals will rescue them from all misadventures.
Denial of Food Allergy
I continue to champion the idea of delayed pattern food allergy as the cause of common dysfunction and disease. I join an illustrious group of physicians who have recognized this possibility for over 2500 years, starting with Hippocrates in ancient Greece. The problem for patients is that most MDs remain ignorant of this possibility and do not guide patients toward a solution. Medical care insurers should notice that this oversight leads to expensive prolonged investigations and futile treatments. No-one knows the cost of the oversight, but it must in the hundreds of millions of dollar per year in the USA and Canada alone.
Another problem is that medicine promotes a passive, dependent attitude and patients are discouraged from seeking their own solutions for dysfunction and disease. I promote self-managed health care and believe that intelligent, well motivated people can solve the most prevalent health problems without medical resources.
I have abandoned the idea of neatly packaged diseases. Health problems tend to cluster in groups and evolve over time. Many factors contribute to the final end-stage disease, listed as diagnoses in medical records. Non-specific illnesses may be misunderstood by physicians who have been taught to make diagnoses of specific disorders. Often patients with mild symptoms are proceeding toward a major illness, but they may suffer in an ill-defined state for months or years.
As illnesses progress, more specific features tend to emerge-dysfunction and tissue changes become more obvious, and medical diagnoses become more useful. A heart attack or stroke, both calamitous events with obvious features, fit the medical model well and tend to be diagnosed reliably and treated in a standard fashion. These are end-point events - the underlying pathology takes years to develop and increasing dysfunction is often ignored as the pathology progresses toward a dramatic conclusion. Other processes may remain ill defined; chronic fatigue, muscle pains, headaches and cognitive dysfunction may make life miserable for many years before a more definable disease such as arthritis becomes apparent.
One missing ingredient is self-responsibility. Since everyone is blameless, any and all misadventures and environmental degradations are tolerated . The supply of medical problems increases. Some injuries and some diseases are indeed blameless and any good person will want to help the victims. But more than half of all diseases and injury are self-inflicted and are preventable by well-informed self-responsibility.
Even if prevention fails, diseases such as diabetes require well-informed self-management. The American Diabetes Association published revised Standards of Care for diabetes emphasizing that high-quality diabetes care must be individualized to reflect the needs, interests, and abilities of each patient. Patient education and motivation must be a central component of quality diabetes care because the patient must provide daily self-care such eating properly, monitoring blood sugar levels and fulfilling exercise requirements.
A steady flow of molecules from the environment enters the body of each individual through the air breathed and the food and liquids ingested. This body-input determines health and disease in whole populations over the long-term and the moment to moment functional capacity of the individual. A person's performance can change dramatically with changes in this molecular stream. The quality and composition of air, food, and water changes continuously. The illusion of food continuity in the supermarket conceals changes in the growth, contamination, storage, spoiling, transportation, and merchandising of food products. To understand environmental reactivity we must deal with changes, variability and inconsistencies, and we must seek adaptive, flexible responses to changing circumstances.
The improvement in the diversity and availability of foods has been a mixed blessing with major problems emerging to negate the potential benefits. Food is the most intimate part of the environment because we ingest it. When something goes wrong, it makes good sense to look at the flow of substances through the mouth for the source of the problem. We look not only at the composition of the food but also, and more importantly, at the interaction of the ingested molecules with body. Adverse reactions to food are common and produce many disturbances by a variety of mechanisms. Diagnosing adverse reactions to food is an important task of clinical medicine, despite the fact that it is not currently taught in medical schools.
Stephen Gislason MD
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