Your relationship with your doctor is perhaps the most intimate human relationship beyond that of your family and those you love. It is one we hope that we can trust with our lives. We need to have and to trust that intimacy but does the system encourage that? Might the honestly held goals of your physician to protect you be overwhelmed by the bargains that society makes? I wonder what we should think if it is the official policy of the patient care system to avoid telling you of an advancing disease before you actually get sick?
Imagine for a moment that the man of the link below, is your physician, who may well be singing your life with his words.
That was a change of pace but expresses rather well the message in this article.
We live in a world where technology has sped past our ability to incorporate it in our society. Since the focus of the Foundation is liver disease I'll talk about that specifically but this is happening in multiple areas. Those of us who have been diagnosed with disease are engaged with the management of our problems and coping with our symptoms. But imagine if it was possible to know that your liver was being damaged before it made you sick. Suppose it was possible to avoid spending years in pain if you could get an early warning and avoid having a fatal disease. Would that be a good thing? Would a warning cause you to actually do something about it?
When I think about that I'm reminded of other early warning strategies like mammography and colonoscopy that are just routine, with the goal of keeping us healthy. These are evidence that we believe in wellness, except perhaps in the case of liver disease. You might be surprised to learn that 100 million of us have liver disease. Of course, "Only" 20 million have progressed to a point of some concern and only one million are in serious danger but don't yet have symptoms so why worry.
THE PROBLEM: We now have non-invasive tests that can identify people with fibrosis, but who have no symptoms, before they become ill. Good idea? Yes indeed. Is that what we do? Not so much. It is the official guideline not to screen for liver disease, even though we can. Instead, your physician is supposed to tell you to lose weight and send you on your way. That is killing you softly while waiting until you get sick so there will be symptoms to treat. Is this the kind of support you want to get?
This is a classical moral hazard. The people who you trust to keep you alive do not benefit from you staying well. Our system rewards others for your suffering so providing funding for wellness isn't really in the interest of the established organizations. As a business model, we pay for procedures not success which ultimately works to the disadvantage of society.
The central problem is that the issue is obesity. Our society has become fundamentally unhealthy and efforts to educate have had little success. We have a torrent of advertising about weight loss and experts of all kinds pushing products but it is largely a failure as we continue to get fatter as a society.
OK, a policy not to screen makes some sense, since people don't solve their obesity problem, even though their docs suggest it. Why spend money to screen people if nothing changes? That is valid, but is there a group that would benefit from early screening? The Foundation supports a screening program for diabetic and pre-diabetic patients as they are already engaged in dealing with health questions. The reason to start there is that recent studies have shown that up to 70% of type 2 diabetic patients have undiagnosed liver fibrosis. By starting a screening program with motivated people it can be built out and eventually support the entire at risk community.
The obvious question is, since a diabetic diet is similar to a liver friendly diet, what difference does it make? Most diabetic patients fail to lose the weight they need to in part because they rely on insulin to manage their blood sugar. This provides an easier path than relying on diet and exercise alone. A nice discussion of the diabetic problem is in this review from Harvard.
So what is different about a liver friendly diet and the standard diabetic diet? When you make things easy for the liver you automatically have made life easier for the pancreas. The difference between the two diets is that for the liver the Foundation concentrates on omega 9 as the primary dietary fat and seeks to manage the omega fatty acid ratio by lowering omega 6 and increasing omega 3. Beyond that the advice of being mostly plant based is very similar.
The message to avoid the co-morbidity associated with liver disease, when presented to a health conscious diabetic, has a better opportunity to take root than discussing just another diet plan. The report produced by the Fibroscan system that we propose to deploy is more motivating than a blood test and can catalyze needed behavioral changes.