We are in the midst of a long-term shift in paradigms related to the essence of how we take care of ourselves as we live until we die. The shift is from the predominant current model which we call healthcare to a new model which I call wellness-longevity. I contrast these models and discuss specific examples of the multiple ways in which the new model is slowly emerging.
“Health care is the diagnosis, treatment and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers.” Healthcare in advanced countries is mainly based on a medical model, a repair-shop model primarily focused on trying to cure people or allow them to be functional after they obviously get sick or become debilitated. This is often an inefficient process and for many situations like age-related dementia and several cancers works poorly or not at all.
Healthcare is an extremely large and diverse industry. According to an overview of the healthcare industry: “The United States of America has one of the largest medical and in the world, followed by Switzerland and Germany. The USA’s medical industry comprises of more than 750,000 physicians and 5,200 hospitals. USA witnesses approximately 3.8 million inpatient visits and 20 million outpatients visit on a daily basis. Furthermore, the United States of America has the largest workforce i.e. one in every 11 US residents employed in the health care business.” Important additional components of the healthcare industry includes the pharmaceutical industry, many biotech companies, medical equipment manufacturers, government agencies like the National Institutes of Health and the FDA, multiple State health and regulatory agencies, health insurance companies, the armed services medical corps, and university schools of medicine, dentistry and public health.
The economics of healthcare are staggering. “The Global prescription drug market was $550 billion in the year 2006. Also, the total health care expenditures across the world were $4.5 trillion last year. Of which, US solely account for $ 2.2 trillion, $ 2 trillion in OECD countries and remaining $ 0.3 in other countries of the world. Learn about the challenges for the medical industry in the article ‘2009 Financial Crisis: Top 9 Issues for Health Industries(ref).” “Dramatic figures in the CMS report show that health care accounted for 17.3% of the U.S. economy in 2009(ref).” (I would not be surprised if the number is now up to 20%) “The increase in health spending, from $2.34 trillion in 2008 to $2.47 trillion in 2009, was the largest one-year jump since 1960. CMS predicts total U.S. health spending in 2019 will be $4.5 trillion.” Breakdown of US national health care expenditures can be found here.
Besides becoming ever-more and more expensive and possibly unworkable, the health care model often produces poor results. If a car is poorly maintained, by the time blue smoke is coming out of the exhaust and oil is being burned, the rings and valves in the engine could already be ruined and the car not economically repairable. Simple maintenance and regular oil and oil filter changes can largely avert the problem. If the body of an obese elderly person is poorly taken care of with insufficient exercise and poor diet, by the time active signs of diabetes show up the body’s metabolic systems could have so remodeled themselves that cure is impossible. Simple preventative maintenance including a program of exercise and good diet can also frequently prevent diabetes from manifesting itself.
Wellness-longevity is a new paradigm that subsumes health care but goes far beyond it. It is a paradigm that has been discussed for a long time but that is only now starting to become manifest. Wellness-longevity is not focused on sickness but rather on maintenance of health and longevity. It is comparable to preventive maintenance where steps are taken to prevent debility or sickness sufficiently in advance so that debility or sickness becomes relatively scarce. While important aspects of wellness-longevity are captured in the traditional idea of preventative medicine, wellness-longevity goes much further in expectations for ever-enhanced longevity, personal productivity and transformed lifestyles.
Airliner safety maintenance – a working model of wellness and longevity
Prodded by governments, long ago commercial airlines industry decided to adopt a wellness-longevity model for their airplanes. When air crashes occur it is usually because that model has not been followed diligently. The decision to make this model universal was based on safety and economics. If the airlines industry were to follow a model like our healthcare systems where most problems are addressed only after they became manifest, we would probably be hearing about dozens of crashed airplanes every week.
It is useful to look at the airlines wellness-longevity model and see how it works and how effective it is. As it turns out, many aspects of the model can be applied to human wellness-longevity. The objective of the airliner safety program is to assure that every working airliner is a safe to fly in as a new one. Even if the aircraft is 50 years old. So different aircraft can compete in terms of efficiency, range, comfort, etc., but are basically the same in terms of passenger safety.
Details of the wellness-longevity program for aircraft are contained in this Maintenance: Airplane and Airline FAQ. Aspects of the program include limitations on the numbers of flights and flight hours between inspection, multiple levels of preventative maintenance including before every flight, maintenance of detailed computer records on the history of every component in the aircraft, a schedule of frequent inspections of multiple kinds, computerized logs of multiple kinds, definitions of when parts must be overhauled or replaced, documentation of every problem observed no matter how slight, multiple monitoring systems built into the aircraft, centralized reporting of problems with information shared across airlines, government-mandated upgrades and constant manufacturer improvement of components. If and when accidents occur there is careful analysis of what happened and identification of possible corrective actions.
Clearly there are some things in this program like stripping out all the parts and maintaining or replacing them individually can’t be done with humans. But many other aspects of the program may well be worth emulating. For example: “AIRWORTHINESS DIRECTIVES (A.D.’s) As a further double-check that the commercial airline fleet is meticulously maintained, the FAA has set up an information system where maintenance reliability data can be shared by the airlines. If certain important components of an aircraft such as the engines, flight controls, hydraulic system, brakes, etc. should fail during flight, the individual airline must notify the FAA, which forwards the data to all airlines. This serves as an alert to the airlines so their inspection schedule can be altered as necessary. If another failure should occur with that same component, the FAA can order a mandatory change in the inspection timetable by issuing an Airworthiness Directive. Regardless of how soon the next preventive maintenance or overhaul is scheduled, an A.D. requires immediate action in the time allowed by the FAA, even if it requires removing an airplane from service. If an unsafe condition exists, an A.D. will be issued that will ground an entire fleet of airplanes, until a safe fix can be found(ref).”
Despite these rules, adherence to them by different airlines vary. Five-year safety records for different airlines can be found here. The main point is that even for the worst airlines, air travel is by far the safest form of travel on a per-mile basis. Accidents are very rare and not the norm. This chart shows how the vast majority of important airlines in the world have not had a fatal accident in the last 10 years. Why can’t we do something like this for people? I am convinced we can and will and are already started on the way to getting there.
The benefits of going beyond healthcare to wellness-longevity paradigm
The healthcare paradigm by itself is broken, obsolete, and produces poor results. Despite the fact that the US spends more per capita on healthcare than leading European countries that put somewhat more emphasis on wellness, we trail those countries miserably in multiple measures of health and trail them in longevity. See the blog US falling behind in longevity increases – why? Curing diseases after they occur is vastly more difficult than preventing disease occurrences in the first place. Further, many diseases themselves create multiple forms of collateral damage, particularly in elderly patients. So a serious disease late in life often leads to a down-hill cascade of events leading soon to disability and death. And many diseases of old age like Alzheimer’s disease have proven themselves to be resistant to the possibility of “cure” despite tens of billions of dollars spent researching them.
For individuals, benefits of moving to the new paradigm are a longer healthier life. For health plans and health insurance companies, immediate benefits include drastically lowered health care costs. The same is true for state and federal governments and for corporations that provide health care coverage for employees. And along with lowered health care costs go increased productivity of healthier longer-lived people.
Examples of the emerging wellness-longevity paradigm
Expressions of the new wellness-longevity paradigm are showing up in multiple forms. I mention only a few of the many things happening.
“The SilverSneakers® Fitness Program is an innovative health, exercise and wellness program helping older adults live healthy, active lifestyles.” The program is offered through health plans. “The Silver Sneakers Fitness Program brings yoga, Pilates, aquatic and cardio circuit classes to older Americans at 10,000 locations in 50 states. “We have done a lot to educate,” said Stephanie Wong, spokesperson for Silver Sneakers. “Particularly among 70- and 80-year olds who have not been members of a gym, it’s a whole new ball game.” Brain booster exercises are also on the menu for the Silver Sneaker participant, whose average age is 72. “The longer you can be independent, the more successfully you’re going to age,” Wong said. “If you prevent falling you avoid being transitioned into a senior centre. Physical activity promotes brain health. Recent studies support that(ref).”
· access to conditioning classes, exercise equipment, pool, sauna and other available amenities
· customized SilverSneakers classes designed exclusively for older adults who want to improve their strength, flexibility, balance and endurance
· health education seminars and other events that promote the benefits of a healthy lifestyle
· a specially trained Senior AdvisorSM at the fitness center to introduce you to SilverSneakers and help you get started
· member-only access to online support that can help you lose weight, quit smoking or reduce your stress
· SilverSneakers Steps for members without convenient access to a location(ref)”
Lest it be thought that the emerging wellness-longevity paradigm is concerned only with seniors Let’s Move is a fitness thrust oriented to children. Let’s Move is a campaign designed to reduce the incidence of childhood obesity being promoted by Michelle Obama. As such it is oriented to people at the opposite end of age demographics. It is concerned with promotion of healthy food and nutrition as well as regular exercise as tools for preventing obesity and creating a healthier generation of younger Americans at all economic levels.
RWJF has engaged with Netcentric Campaigns to create and implement networking strategies that support the Foundation, the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity, other RWJF-funded national programs and others working in the field. Netcentric has supported other health-related online campaigns such as the Health Care for America Now (HCAN) campaign.
Because of institutional rigidities, the new wellness-longevity paradigm may be moved along swiftly by entrepreneurial ventures. Here are a few examples:
23andme is a $207 personal genotyping service oriented toward ordinary people and the wellness rather than the healthcare market. Using a DNA chip, the service scans the saliva of a customer to look for the presence of about a million SNPs that are spread across the entire genome. “A single-nucleotide polymorphism (SNP, pronounced snip) is a DNA sequence variation occurring when a single nucleotide — A, T, C, or G — in the genome (or other shared sequence) differs between members of a biological species or paired chromosomes in an individual(ref)” The SNPs looked for are ones known to be “tag” SNPs correlated with ones that have important disease, hereditary and other associations. “23andMe is a retail DNA testing service providing information and tools for consumers to learn about and explore their DNA. We utilize the Illumina OmniExpress Plus Research Use Only Chip which has been customized for use in all of our products and services by 23andMe. All of the laboratory testing for 23andMe is done in a CLIA-certified laboratory.” Among things scanned for are carrier status for 24 inherited conditions, 19 kinds of drug responses, 50 traits and disease risk for 100 conditions. Output is a personalized profile with much interpretative and educational material.
The 23andMe service includes a one-year Personal Genome Service subscription which includes updates about yourself, browsable raw data, discounts on future platforms, secure storage, and alerts when relatives are discovered.
The 23andMe service is careful to point out that the genotyping does not constitute a diagnostic test: a) because the 23andme service it is not FDA approved, b) because the gene chips involved are less reliable than much more expensive ones, c) because the number of SNPs scanned for is a small fraction of those known to show up in the whole human genome, d) because many of the disease and other associations indicated by the presence of SNPs are weak indicating only a probabilistic propensity, and perhaps most critically, e) because interpretations of SNPs are only as good as the association studies that provide such interpretations. Rather, 23andMe is a direct-to-consumer wellness-longevity service that is in the genotyping area where the medical profession has been slow to respond.
MDVIP is a network of primary care doctors who deliver both personalized wellness services as well as conventional medical services in a service model defined by MDVIP. Current membership includes 450 doctors in 33 states. While an average family practitioner may have 2,400 patients, MDVIP limits the load to 600 patients per doctor and requires all participating doctors to follow its model. Focus is on personalized care, detection and early prevention. “When it comes to your health, you deserve an equal partner. — With the right support, you have the power to transform your life. That’s why at MDVIP, we’ve created a unique approach to healthcare that puts you, your health and your needs first. You’ll have the chance to create a strong, compassionate partnership with your personal doctor – a relationship that will help you reach your wellness goals and become an advocate for healthy living in your community. — Our approach departs from traditional healthcare systems that reward doctors for seeing as many patients as possible. Instead, we give your doctor the time and freedom to get to know you, your lifestyle and your current health. He or she can then offer you carefully thought out, comprehensive health plans with long-term health benefits. Your doctor can follow up with you on a regular basis to help prevent any new medical issues from going undetected.” Patients pay from $1,500 to $1,800 per year to their MDVIP doctor for wellness services not covered by insurance. This makes joining MDVIP attractive to primary care doctors who tend to be overworked and underpaid when compared to their medical-specialty peers.
Apparently the MDVIP model is successful in both providing wellness and reducing medical costs, reducing hospital utilization by 75% in the case of medicare patients, reducing hospital utilization by 65% in the case of privately-insured patients. This is according to information provided me by MDVIP. I plan to do a separate blog entry on MDVIP.
Shape up the nation
The web service shapeupthenation.com seeks to utilize social networking for personal achievement of health objectives. The concept is connecting with people you trust to help you fulfill your health goals. “Shapeupthenation offers a web platform that can be used by health plans to achieve a number of objectives including “Embrace Social Networking: Health plans across the nation are trying to figure out their social networking strategy. Our platform harnesses the power of trusted social networks to help you achieve your business objectives using the latest and most innovative technology. Don’t keep putting it off — it’s time to get started. — Engage Members: Healthy, engaged members are every health plan’s dream. Let us help you build positive relationships with your members and bring them together with your company as the central partner in their health. Build Value for Employers: Your employer groups are desperately seeking ways to control rising health care costs and boost morale, productivity, and retention. Help them by offering a proven way to change employee behavior and transform company culture. Reduce Costs: Our evidence–based program is proven to help members increase exercise and lose weight. In fact, a recent study shows that the average participant loses one Body Mass Index point, which translates to a $202.30 reduction in claims annually. Help Community: Some health plans are looking beyond their current membership and wondering how they can play a role in helping to promote healthy lifestyles on a community–wide basis. We have experience in running large–scale community wellness programs and can do the same for you.”
Perhaps nowhere can small-scale entrepreneurial initiatives for wellness-longevity be seen more dramatically than in the swelling list of health-fitness apps for iPhones and Android phones. There are hundreds of such apps out there, mainly supported by small entrepreneurial companies.
Smartphones have orientation and motion sensors that can help determine your kinds and levels of movement. They have GPS and cell-tower location sensing that allows you, for example, to track an exercise path in the woods. They have cameras that can be used to read bar codes on food packages and monitor heart rates. And they have Bluetooth capability that enables them to link to Bluetooth-enabled body sensors. They can listen to and interpret what you say and talk back to you. They are usually with you. They can keep you in constant connection with multiple health databases. And the data related to the apps are available both wirelessly and online via computers and tablet devices.
I find these apps fascinating and plan to do a blog entry on them in the near future. For now, Android health and fitness marketplace apps are here. You can check out the “8 best android apps for health and fitness,” the “50 Coolest Fitness and Health Apps for the iPhone,” and “100 Fabulous iPhone Apps for Your Health and Fitness.” Yesterday, I started using a couple of apps on my Google Android phone, both of which were downloaded for free. One is called Myfitnesspal, an application allows the user to set and track weight goals by detailed monitoring of daily diet and exercise. It knows calorie contents of many foods. Online access is available either via computer or Android phone. Another amazing app I have started using measures heart rate using your my phone’s camera. It is called Instant Heart Rate and has been downloaded 250,000 times.
We are in interesting times! I invite my blog readers to comment on these and other wellness-longevity initiatives you may find to be particularly interesting.