Mar 112013


But we’ll get to that in a sec.

Last night, CNN aired Escape Fire, a documentary that uncovers what’s wrong with America’s health care. Actually, it reveals that we don’t have health care—we have disease care. Ours is really only a system of disease management.

This very issue was the impetus for Fit minus Fiction (PhD Fitness, whatever we’re calling it these days). Five years ago when I met the PhD, he told me so many unbelievable things it made my head explode. Like how most things you hear or read regarding exercise are false. Even in the places where you expect expertise, there is none, because physicians and hospitals aren’t trained in how to keep you healthy. And what’s more, the system doesn’t want you to be healthy. Remember, hospitals aren’t run by doctors. They are businesses, run by business people. Doctors are simply operating within a system that has become warped. They are not in much of a position to change it.

Everything is incentivized backwards. To promote profitable procedures, rather than good outcomes. It’s no surprise, when the health industry lobby is the biggest lobby there is. Bigger than oil & gas. Bigger than the teachers’ union. On their own, Pharmaceutical / Health Product companies have the biggest lobby in the country. But that’s only one-quarter of the truth—there are three other health industry categories on the top 20 lobby list (Hospitals / Nursing Homes, Health Professionals and Health Services / HMO’s). When you add them up, the health industry eclipses everything else.

Lobby for the entire health care industry = $5,270,522,190
The next largest lobby (insurance industry, go figure) = $1,812,199,377
Oil & Gas lobby is 6th on the list = $1,364,045,081

Bam. Eclipsed.

There was just one topic I wish Escape Fire would have given more attention to. (And they did so well with this documentary, I feel like a jerk bringing it up.) This country already has an army of advance-degreed prevention experts. The film kept talking about retraining physicians in preventive medicine. It showed physicians in workshops learning, basically, the elementary version of what the PhD and his kind have already mastered. And can apply.

But until insurance companies agree to reimburse for the services of real exercise physiologists or alternative medicine professionals (they are finally starting to reimburse for dietitians), this Prevention Army remains sidelined, impotent. All dressed up with no place to work.

Escape Fire does acknowledge this point, saying that nothing will change until reimbursement changes. But they don’t follow through too much on what that means. At one point, Dr. Dean Ornish (god love ‘im) mentions very briefly that the insurance companies need to reimburse for services from health and wellness experts. And after 16 years, he finally convinced Medicare to do so. But only for people who go through his program. Not for anyone else. Not anyplace else.

In other words, the first step toward real prevention had to come through an MD. And quite frankly, that’s kind of the reason we’re in this chronic disease cycle. Physicians didn’t understand the impact that preventive medicine could have. Nor do they get paid for discussing preventive measures. So they were never able to offer much beyond a pill or a procedure. Which, the film argues, doesn’t really cure anyone.

While very gratifying for us, as prevention geeks, to watch, the information in Escape Fire is not new. There have always been professionals out there who realized the impact of preventive medicine. It’s just that no one listened. Partly because prevention doesn’t make as much money as a bypass surgery. Partly because we sort of deify physicians. It’s such a surprise to us that they don’t know everything about the human body. In reality, the human body is so complex, there’s no way any one person can understand everything. That’s why specialties exist. (Go ahead, ask an immunologist about a pinched nerve in your neck. See what kind of answer you get.)

It’s funny, when I tell people what the PhD does for a living, the first reaction is confusion. He works in healthcare, but he’s not a physician. He knows about fitness, yet he’s not a personal trainer. So I just dumb it down and say, “He works in prevention.” The immediate response is, “Oh, that’s a good area to get into, good for him!”

But the fact is, it’s not. It’s super-hard for him to find a job. Because the current solution for most places pedaling “wellness” or “prevention” is to hire nurses and nurse practitioners. In other words, Physician, Jr.

Only the most progressive places are really interested in doing prevention right. And if the PhD were writing this post, he could go on explaining how past lobbying efforts pushed exercise physiologists and athletic trainers out of health care. But he’s not, and I can’t. Story for another day, I suppose. In the meantime, check out the film. It’ll rewire your brain, and it’s applicable to everyone. Because we all have a body. And we’re not really being taught how to maintain it.

Then come back and read PhD Fitness some more.  :)

» You can catch Escape Fire again on Sunday, March 16th at 8pm & 11pm Eastern on CNN.

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