I’m looking at something I never expected to see, no-one ever expected to see. Take a photo of a black hole 54 million light years (318,000,000,000,000 miles) from earth? Never! Well, a 28-year old computer science graduate student believed it could be done and she was so bold as to tell the astronomers how to do it. Simple, she explained. Construct a camera the size of the earth by linking 8 radio-telescopes to work in tandem, then write some algorithms to blend their images. Voila! The impossible becomes possible.
And what is a black hole anyway? Just a collapsed star whose gravity is so strong that it sucks everything, including light, into itself, and gives nothing back. I’ve known people like that. We all have. You do everything for them, and nothing seems to make a difference. In a way, patients have been doing this to doctors for generations. Think about it. Today we know that the majority of our patients are getting sick and dying, not from some out-of-the-blue infectious disease we can swoop in and cure with our great knowledge and skill; but from preventable diseases. Whether this is caused by lack of awareness (which it certainly often is) or simply a lack of motivation to change (also common), the result is the same, the patient’s health suffers, and there is no simple action doctors can take to turn this around. The actions must be taken by the patients themselves, and that has not been happening.
We doctors have done our very best to enlighten patients, to encourage them to adopt a healthful lifestyle…eat right, stop smoking, exercise. Our blood, sweat, tears; day in and day out, year after year, and it doesn’t work and they get fatter every year, and spend more time in front of the tube eating the wrong foods. Simply put, it is incredibly frustrating. The hours and hours of our lives spent attempting to prevent these slow-moving catastrophes is to no avail…might as well be speaking into a black hole, the good we’ve done. Mission impossible.
As they “go out to eat,” (sorely tempted by that ubiquitous fried food, all-you-can-eat ribs, or you-can-add-bacon-to-that) clogging up their arteries, which we will try to clear out with ever increasing dosages of cholesterol-lowering medicines and eventually by jamming them open with stents, or, if we can, by by-passing the worst areas, which we know in own our hearts (hopefully these are healthy) will eventually fail.
Or as they sit around watching “the game” (and who can avoid it when U. of M. or MSU are in the Final Four or Rose Bowl?), the expected snack is often a jumbo bag of salty chips, which we know will drive up blood pressure. This is relatively easy to correct in the short run with diuretics, which they are unlikely to receive because, let’s face it, the chances of that same individual going to the doctor the day after the big game are slim to none. Therefore, this leads, in the long run, to sustained high blood pressure, suffered by 80-million Americans for which less than half will get adequate treatment, leading to strokes, heart attacks and kidney failure.
Or as they celebrate that all-important family reunion; how can they not give their loved-ones those delicious sugary soft drinks and bite-sized candy snacks so relentlessly promoted by the advertising industry; we know that their blood sugars will start a continuous rise year over year from “normal” to “pre-diabetes” to “diabetes”. All the while, there is debate over when exactly we should prescribe pills or an ever-increasing variety of injections, there is no debate over the fact that these people face forever an increased risk of kidney disease and cardiovascular disease.
We know we badly need prevention, and we know we are failing at doing that, so we too often just give up on it. We fall back at treating people after they get sick, which is never as successful, and although we are certainly getting better at that, the irrefutable fact is that people are now getting sick faster than we can heal them. And, of course, there is the small problem that society cannot afford this approach.
Yet the pressure on doctors to “do something” about this national catastrophe is unyielding. Insurance companies and the government grade us on our “effectiveness” and now are starting to pay us according to their definition of that effectiveness. When you are held responsible for something over which you have absolutely NO control…it is no wonder so many doctors are burning out, retiring early or finding other lines of work.
Something needs to change. We need a new idea. We need a Katie Bouman-like big idea. Oh yes! That’s exactly what THRIVE is doing!
And THRIVE has no shortage of big ideas. Here are some of them: Instead of just relying on doctors to educate patients, you get everybody working on it; you get creative, since this problem originates in the way parents cook for and feed their children, in the way schools hand out food at lunchtime, restaurants serve food, supermarkets market foods, communities provide opportunities and encouragement for exercise, employers design workspaces, and on and on, and on. We are all responsible for this unhealthy environment we are in and we all need to come up with ideas – large and small – for turning this around. The solution is probably more complicated than photographing a black hole at a crazy distance, but, I believe, it is not “mission-impossible”.