For as long as I remember medicine has taught me about disease: the characteristics of disease, the effects of disease, its signs and symptoms, how to diagnose it, and how to attack it.
Sadly, medicine rarely gets truly involved with the big picture of health, let alone the bigger picture of public health - a people’s need to have a roof over their head, feel safe, get good education, excellent nutrition, enjoy their wealth, and protect their health... I wonder why I never defected!
During my early school years, senior surgical residents said they could cure a patient by removing a sick appendix or a gangrenous limb while the rest of us in other specialties were destined to forever wallow in disease, never able to claim a cure except for an occasional infection. I felt bad because I thought they were right.
Today, I see people with diabetes and heart disease on significant amounts of drugs and relying on high-tech invasive procedures, who are living longer due to modern medical advancements that are mainly palliative. We are paying dearly for this intoxicating medicine, which makes us believe it is the best and only way. Clones of drugs hit the market with new claims and names every year. Joints are replaced. Heart surgery is routine.
During this same time, research into chronic illness is forcing us to recede the limits of what we accept as normal. We are diagnosing the disease process earlier and earlier in its continuum. We have revised the accepted levels of blood pressure, blood sugar, and cholesterol, yet because we insist on the disease model, we go on applying expert palliation.
Something is obvious to me now: we have walked in a circle for our own good. Research into chronic illness is bringing us closest to admitting that protection is the first cure. Something else is apparent. If we take healthful steps that are ever so small, it will take us forever to close the loop.
Diabetes, heart disease, and many cancers are linked to lifestyle. It is time we accept that we have institutionalized the promotion of disease and time to claim our personal responsibility.
The medical model insists on creating more disease categories - childhood obesity, syndrome X, metabolic syndrome, insulin resistance - but turns a blind eye to the culture that breeds them. We have a responsibility to ponder, identify, and correct, the systemic social constructs that drive the tide of these chronic diseases.
It is futile to exhort patients in neighborhoods rife with violence and unhealthy food joints to exercise and diet. A community sustained by civic centers, YMCA’s, sidewalks, playgrounds, vegetable gardens, farmers markets, parks, arts, and other forms of recreation, stands in contrast with. We must expand the limits of our vision and not just fight disease, but protect health every way we can.
As a family physician practicing in the 21st century, I take joy in cooking with my patients, in teaching food literacy, in promoting competence and life sustaining routines, in using all of our senses to support of healing and wellness. I recognize the body, mind, and spirit as allies in healing.
Ana M. Negrón MD