A few months ago, in the middle of peak job applications, interviews, and exams season, I started having new skin issues. I believed it to be caused by stress, but nevertheless I scheduled a doctor's appointment to get an expert's opinion.
After sitting in a waiting room for an hour, I was called in. A rushed conversation, a brief glance, and about 3 minutes later, I was prescribed antibiotics and a topical cream. I left that office annoyed, disappointed, and dismayed.
I took the prescription topical for a few days, which seemed to do nothing. Instead, I used warm compresses and nature-based formulations and cut down on shaving, deodorant, dairy, and meat consumption. In a few days, the symptoms disappeared.
I recalled how prescription antibiotics to fight acne had made me violently nauseous in high school. My body flat out rejected them. Fighting acne was not worth vomiting over.
Although the original decision was personal, my college senior thesis reinforced it. After spending a year researching interactions between microbiota, the immune system, and the central nervous system, I knew ingesting broad-spectrum antibiotics was not a reasonable solution to my skin problems and could instead decimate my gut bacteria, leaving me more susceptible to illness. We have to stop treating our guts like our lawns, spraying pesticides and growing a monoculture. That is a recipe for disease for both our bodies and our Earth.
A mini self-science experiment
As a lifelong writer, I have a small collection of separate journals that I actively use. These include my regular journal, a pocket journal, a dream journal, and a food journal. Admittedly, it's more consistent and convenient to log your food electronically, but I found the paper-pen method useful in the short-term. Plus, it can be more detailed and informative.
Elements of a Food Journal
What, when, and how much I ate/drank
Mood, satiety, sensations
Cravings/thoughts on food
Activity levels (sleep, exercise, screen use)
Poop (you know... for science)
Keeping a food journal made me realize firsthand that my skin is a two-week delayed reflection of the quality of my diet. Two weeks after logging 3 consecutive days consuming lots of dairy (I quote you, "home fries with 7 different kinds of cheese"), I got a large zit on my chin. This knowledge gives me the option to make lifestyle choices in the right direction. (The lesson: everything in moderation, even and especially delicious food.)
It's been an ongoing process to keep my facts in check and meticulously keep records, but so far, I've been able to accomplish a whole lot more and achieve greater health with focused lifestyle interventions. I now attribute skin problems to stress, diet, hormones, and self-care practices. Treating bacterial infection is like addressing a symptom but not the root cause of skin problems.
Through advances in epigenetics and improvements in our understanding of how environmental factors alter gene expression, the antibiotic revolution is giving way to the probiotic revolution. It's time to treat our bodies like the ecosystems they are.
Main problems with modern healthcare
The current Western medical paradigm has been heavily shaped by industrialization. Some major problems with healthcare include:
reactive and episodic
over-reliance on pills
inefficient implementation of centralized data sharing
Reactive and episodic
Healthcare tends to be episodic, but health is a continuous pursuit. The way it usually goes is, you get a bothersome symptom, you go to the doctor, they prescribe antibiotics, creams, or refer you to some other specialist. Many people don't even acknowledge the problem until it presents as pain. Healthcare should be proactive, not reactive. To move towards prevention, lifestyle factors needs to be emphasized.
The U.S. has a recent (read: current) history of overprescribing opioids and antibiotics and being over-reliant on chronic disease medication to manage symptoms. 17% of Americans take 3 or more prescriptions, and many express desire to move away from pills. These are expensive, quick fixes that don't get at the larger root problem. We need medicines that provide functional results rather than managing symptoms and creating side effects that are more unpleasant than the condition itself. People's health needs to be prioritized over profit. Direct-to-consumer (DTC) marketing normalizes prescription drugs as the solution, even when a particular drug may be inappropriate for a given person's physiology.
Doctors and other HCPs often work over 8-hour shifts, with 12- or even 16-hour shifts being common practice among nurses. Fatigue and stress increase the likelihood of mistakes and decrease patient satisfaction (Stimpfel, 2012). Working shifts longer than 13 hours can triple the chance of medical error (Lockley, 2007).
According to some sources, medical error is the third leading cause of death in the U.S. (Makary, 2016). One study estimated that in the U.S., 210,000-440,000 deaths per year are due to medical error (James, 2013). Medical error can include errors in diagnosis, treatment strategy, or prevention. If this is true, we need to seriously rethink how healthcare is delivered and update our causal models to do a more effective job of treating and preventing illnesses.
Doctors often have busy schedules, leaving little time for patient interactions. This can cause them to not listen as attentively, ask the right questions, or take their patients' concerns seriously. This is problematic because the patient is more familiar with their body and has more information and investment in their health than a third-party observer. Of course doctors have more background knowledge and training than the average person, but effort should be taken to build the doctor-patient relationship, and doctors should be sure to convey biomedical evidence to the patient in layman's terms and be prepared to thoroughly answer any questions they may have. The reality is, when interaction is minimized to a mere 5-10 minutes, the relationship doesn't have much room to grow. This rift can increase patient non-compliance or cause patients to switch healthcare providers.
Inefficient implementation of centralized data sharing
Although there is a massive amount of data, we still lack implementation of reliable, user-friendly data centralization platforms. Electronic medical records (EMRs) often don't have enough of the "right kind" of data that matters to the patient. Doctors don't have access to lifestyle data, and patients sometimes have poor access to their own medical records. When lifestyle data from health trackers like FitBit is sent to medical professionals, that data becomes HIPAA-protected, which can create a gray area with regards to data integration and privacy.
In addition, even though you're entitled to access to your own medical records, some patients are charged for access to or copies of their own medical records. In New Jersey, it is legal for health care providers to charge up to $200 for hard copies of one's medical record, which can make it more difficult to switch doctors.
Now that I have identified some current limitations of the medical industry, let's talk about opportunities for growth in healthcare.
Future Directions of Medicine
Some promising avenues of medicine include:
AI and machine learning for diagnostics
-omics sequencing for personalized disease prevention
biologics and nutraceuticals
minimally-invasive surgical interventions
doctors trained in holistic and functional medicine
informative, user-friendly UI
Artificial intelligence and machine learning in diagnostics
AI could manage mountains of data, even unstructured ones like brain scans and voice recordings. If you can teach a computer pairings between charts and disease states, you can quickly pin down possible diagnoses based on imaging scans, bloodwork, and other health data.
Genome, proteome, and microbiome sequencing for personalized disease prevention
Information on mutations that affect absorption (e.g. in certain intestinal cell transporters) could inform doctors to advise patients on whether certain nutrients would be expedient to include in their diet. Sequencing could also identify genetic risk factors and help personalize lifestyle interventions. Even more challenging will be proteomic sequencing, which aims to determine protein expression over time in various cell types. Proteome and microbiome sequencing can provide revealing information about the role of environment, which can help us improve our causal models with respect to health. Sequencing methods are becoming increasingly cheaper and more efficient due to robotics and high-throughput technology, so we can expect to see this area grow.
Biologics, nanoparticles, and nutraceuticals for treatments
Earth-based solutions are at the forefront of the probiotic revolution. Plants and fungi have been used for medicinal purposes for thousands of years, and it's time to enhance these solutions with R&D in science and biotechnology. Biotechnology solutions require skill in manufacturing, packaging, processing, and delivery. Training in biology, biomedical engineering, physics, and chemistry are in great demand. Areas of growing interest include biomaterials, 3D printing, formulations, and synthesis of biodegradable polymers, micelles, and nanoparticles to enhance absorption and therapeutic value.
More advanced medical devices will make surgery less invasive
Surgical techniques are improving, and as a result, surgical scars are shrinking. Nanotechnology allows the ingestion of tiny monitoring devices that can assist in diagnostics and surgical interventions. Medical innovations and scientific findings are cutting down on unnecessary procedures, and the risks and benefits are being more thoroughly analyzed and conveyed. AI is also being used in robotic surgery to minimize potential complications and postoperative pain. This shift towards decreased invasiveness will continue as surgical techniques advance.
On a related note, new technologies like Dia-Vit, GlucoWise, and sugarBEAT will allow for diabetic patients to accurately track their blood glucose level without the painful finger prick. Some of these products are still undergoing testing, and the ones that are out on the market are still expensive.
Doctors trained in holistic and functional medicine
In compromised health, patients and their families want a trustworthy and dependable physician who has their best interest in mind across multiple dimensions. This is why high emotional intelligence, active listening, and attention to the patient's overall well-being (physical, mental, emotional, and spiritual) are increasingly in-demand skills. Patients want to know their doctor is dedicated to working with them to maximize their health, considering both short-term and long-term quality of life.
Doctors with robust critical-thinking and root cause analytical skills, who stay appraised on the literature, will be in great demand. Patients want someone who can explain the science and answer their questions honestly without using excessive technical jargon and without talking down to them.
Informative, user-friendly digital interface
Creativity and collaboration across disciplines are integral to innovation. Healthcare providers, researchers, and patients need to articulate their needs and identify what's missing from current technology. IT experts need to understand the needs of users and come up with and implement creative solutions.
Patients want something consistent that will allow them to quickly and conveniently log lifestyle factors such as diet, exercise, sleep, water intake, health conditions, and menstrual cycles. Wearable health devices, such as FitBit or Apple Watch, already offer this technology. The next step is more advanced monitoring, such as skin cortisol levels, and widespread integration. If wearable health devices are synced with electronic medical records, the data could be assembled into a more comprehensive picture of patient health. Data could also be used, with patient consent, to make new findings that could directly benefit the patient and other people.