Wellness care is sometimes described as complementary to traditional medical care. But what if it was raised to the level of primary care, meaning wellness providers would see patients as family doctors?
Actually, this has already been done, and the results were pretty astounding.
In 1996, a large Chicago-based HMO broke the mold and began offering primary wellness care to their clients. Rather than just managing medical care differently, they offered true wellness care, delivered by chiropractors. (Medical and osteopathic providers were offered to join as well, but none signed up initially.) Clients were allowed to choose chiropractors as their “primary care providers” or family doctors.
The chiropractors ordered all the necessary tests, monitored their patients’ health, and referred to specialists as necessary. They also stayed true to their wellness philosophy, and treated their patients with only natural means — manipulation, acupuncture, lifestyle changes and herbal remedies. Any patients who needed drugs or surgery were sent to a medical provider.
After five years, the average costs per patient for the wellness providers were compared to the costs for the traditional medical providers. The results were nothing short of amazing. The overall expenses for the wellness family doctors were 60 percent less than their medical counterparts. Their patients reduced prescription drug use by a whopping 85 percent and hospital admissions by 60 percent. An article published in the 2007 Journal of Manipulative and Physiological Therapeutics gives the details of this effort.
It is telling that the chiropractors were able to handle — or perhaps, even better, prevent — a large majority of their patients’ health problems without drugs or surgery. When the patterns of doctor visits were examined, an interesting trend showed up. Most patients see their medical providers about once every 16 months. But the chiropractic patients were seen much more often, perhaps a few times a month, especially initially. This is because they were actually getting treatment from their providers, not just a prescription. These wellness treatments seem to have replaced the need for many prescriptions, tests, surgeries, and even hospitalizations.
There are other benefits besides the immediate savings. In a disturbing trend in medicine today called “the prescribing cascade,” a second drug is given to treat the side effects of a previously prescribed drug. The doctor does not recognize that the new symptom is a side effect of the first drug, and if there are side effects with the second drug, yet another one is added. The patient ends up on several medications, many of them unnecessary. The end result is called polypharmacy, and statistics show that the number of people taking five or more medications has made a big jump in recent years.
Many of my patients have been caught up in this prescribing cascade. A common example is a prescription for a heartburn drug such as Prevacid, which is given help with the stomach irritation caused by arthritis drugs. Prevacid does ease stomach pain by stopping the production of acid, but stomach acid is important to digestion, and if it is no longer produced, digestive problems often result in the lower bowel. This sets the patient up for even more drugs, more possible side effects, and a decline in their overall health. A common complaint of patients on several prescription drugs is a lack of energy and overall not feeling well.
Often, with wellness care, we can interrupt and even reverse this trend. With manipulation or acupuncture for pain relief, the patient may no longer need the arthritis drug. Because the arthritis drug caused the heartburn, after a while the patient is able to stop using the heartburn drug. This in turn improves the patient’s overall health; maybe they can start exercising again, which is one of the most important lifestyle changes one can make. Rather than the patient’s health spiraling downward, it improves with time.
Wellness care is very safe. Injuries from manipulation or acupuncture are rare, especially when compared to medical treatments. If it also can reduce prescription drug use by 85 percent, as shown in the Chicago HMO project, that might well lead to a big reduction in drug-related injuries and deaths. Interrupting the prescribing cascade might be one of the biggest benefits of wellness.
The lead author of the study, himself a medical doctor, tried to have his article published in several medical journals, but all of them rejected it. One editor was quite honest, saying the author could never publish research that showed his profession in such a bad light, writing in his rejection letter, “We cannot publish an article whose conclusions are so hostile to conventional medicine.”
We need to overcome this turf war mentality if we are to make serious changes in health care. Wellness care must be taken seriously and wellness providers need to be included in future health care reforms. Otherwise, we will never see the dramatic reductions in medication and surgery that are necessary to control health care costs.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.