Majid Ali, M.D.
America’s extreme health problems cannot be addressed without a radically new way of thinking about health and the absence of health. A serious consideration of this statement creates a new vision with strong innovative possibilities. I offer my proposal with a thought experiment, for which I safely assume: (1) There is no end in sight for the deepening health care crisis with the prevailing medical model; (2) We Americans are a compassionate and resourceful people who resolved grave problems in our history with massive citizens’ efforts; and (3) The country has a sufficient number of civic leaders, teachers, and integrative clinicians willing and able to develop and implement an all voluntary national “Health Corps”—drawing on the experience of the Peace Corps—but robustly protected from the corporate influences of the American “medical-industrial complex.”
As for the first assumption, in RDA: Rats, Drugs, and Assumptions (1994)1 , I included a letter to the U.S. Congress that began with the following words:
Two elements characterize medicine in the U.S. today: The cost of health care continues to escalate, and the health of Americans continues to deteriorate. If the two trends were to hold, a time can be foreseen when the nation’s total resources will have to be committed to health care, and everyone will be unwell.
The U.S. clearly continues on the disturbing trajectory which I foresaw fifteen years ago. The country spent $2.4 trillion in 2008 on healthcare, and Americans, as I show later, continue to get sicker. The incidence rates of most inflammatory and degenerative disorders in the U.S. are steadily rising.
My second assumption—compassion and resourcefulness of the people—has become more compelling in recent months. As for the third assumption of my thought experiment, I observed a most impressive display of medical altruism at Capital University of Integrative Medicine, Washington, D.C. during a decade when I served as its president, and again in the summer of 2008 with an all voluntary “Diabetes/Hypertension Initiative” organized and implemented by non-commercial, listener-supported WBAI radio based in New York (both described later).
Now to my thought experiment relating to a National Health Corps: Concerned citizens led by President Barak Obama and the Congress pass a “Health Corps Law” with the following three provisions:
1. Creation of a Health Corps (the “Corps”) for a national program of education, motivation, mentoring, and monitoring of all school children and college students in the country (the “Plan”) to be developed and implemented by an all voluntary board of trustees (the “Board”) and practitioners experienced in clinical nutrition, environmental medicine, and chronic stress (the “Practitioners”).
2. Funding of the Corps by the U.S. Congress with legislative allocation of two dollars per $1,000 spent on healthcare by any and all healthcare entities in 2008. The Corps will receive $4.8 billion annually (0.2% of $2.4 trillion spent in 2008).
3. Implementation of the Corps program of motivation, education, and meals (breakfast, lunch, and afternoon snacks) for all students in nation’s schools and colleges. The curriculum will be established by the Practitioners and taught in weekly classes by a cadre of teachers paid for training and teaching age-appropriate educational materials (booklets, on-line materials, field programs, etc.).
Some elaboration of the three provisions of the Health Corps Law are necessary. First, the members of the all voluntary Board will not have any commercial interests in any businesses dealing with the Corps. Specifically, the Corps will operate free of any interference from insurance and pharmaceutical corporations. Second, the all voluntary practitioners will have a minimum of ten years experience in non-drug therapies and a documented professional income of more than 50% from such activity. Specifically, clinicians not well-versed with clinical nutrition and environmental medicine or otherwise opposed to these disciplines will not be invited to advise the Corps. Third, the Corps will have a strong and enduring focus on the teaching and training aspects of the Corps’s Plan. Specifically, it includes training of teachers to instruct weekly classes on nutrition, environment, and stress to all school children with age-appropriate materials (booklets, on-line materials, field programs). Teachers will be compensated fairly, both for training and teaching.
Our Nation’s hospitals, by and large, have outreach programs for community health. Such programs can be harnessed to advance the Corps’s goals and objectives. It is noteworthy that hospitals do not generate revenues by preventing disease. So, the hospital staff doctors will not be invited to develop any aspects of the Corps’s academic curriculum nor food choices of foods unless they meet the above criteria.
Finally, the Corps will closely monitor the efficacy of the program with comprehensive clinical outcome sheets designed by the practitioners and completed by teachers during weekly classes. The Congress and the President will receive quarterly reports of the progress of the Corps, and complete transparency will be assured with regular on-line postings.
I return to my first assumption and ask: How dire is America’s health crisis? Consider the following:
1. “Diabetes has already stricken an estimated one of every eight adult New Yorkers, a rate nearly one-third higher than in the nation as a whole. If unchecked, it is expected to ensnare coming generations on an unheard-of scale: One in every three Americans born five years ago; one in two Latinos.” (The New York Times. January 9, 2006)
2. Antidepressant and stimulant prevalence were three or more times greater in the United States than in the Netherlands and Germany, while antipsychotic prevalence was 1.5 to 2.2 times greater.2
3. The records of 14,187 children between the ages of three and eighteen were reviewed. Of those children, 3.6 percent were found to have hypertension. Regrettably, 376 (74 percent) were not diagnosed.3
4. “Ninety percent [of Americans over sixty] is a staggering statistic and cause for concern,” Health and Human Services Secretary, Tommy G. Thompson, said in a statement from the National Heart Lung and Blood Institute (NHLBI) that supports the Framingham Heart Study. “This finding should energize Americans to take steps to protect themselves against high blood pressure.”4
5. The incidence rates of diabetes and cancer are nearly twice as high among white 50-59-year-old American men as in British white males of same age.5
Absence of Health
In Rats (1994)1, I diagnosed the fundamental nature of America’s health crisis with the following words:
The two corps problems of American medicine — in my view — are these: 1) We address the 21st-century problems of environment, nutrition and stress with the 19th-century notions of disease and drugs, and 2) We have raised generations of physicians who believe all nondrug, nonscalpel therapies are quackery. Nutrients—not drugs—heal injured tissues. Drug medicine is a medicine of blockage. Drugs—essential as they are for acute, life-threatening diseases—work by blocking essential physiologic processes, i.e., calcium channel blockers block cell membrane channels, ACE enzyme inhibitors block enzymes that are necessary for the production of certain essential hormones, beta blockers block beta receptors on cell membranes, antidepressants block the uptake of some neurotransmitters.
In chronic degenerative disorders, healthy cells do not become sick overnight. I began Oxygen and Aging (2000)6 with the following words:
Oxygen is the organizing influence of human biology and governs the aging process. From that idea, I develop two other dominant themes in this book. First, dysfunctional oxygen metabolism (dysoxygenosis) is the primary mechanism of cellular aging and will be the single most important threat to the human life span in the coming decades. Second, a growing understanding of relationships among man’s internal and external environments will govern all our plans for preserving health and reversing disease.
Inflammation plays crucial roles in the etiology of nearly all degenerative disorders. I address this subject in Darwin, Dysox, and Disease (2002)7 with the following words:
Life is an unending injury-healing-injury cycle. Injury is inevitable in an organism’s struggle for survival. Healing is the intrinsic capacity of the organism to repair damage inflicted by that injury. Inflammation—in my view—is one aspect of the energetic-molecular mosaic of that intrinsic capacity. This view of inflammation—that it is a physiologic component of the essential injury-healing-injury nature of life—extends far beyond the classical and wholly inadequate notion of it being a process characterized by edema, erythema, tenderness, pain, and infiltrate of inflammatory cells.
I devote Darwin and Dysox Trilogy (2009), the tenth, eleventh, and twelfth volumes of The Principles and Practice of Integrative Medicine7-9 to an in-depth treatment of the subjects of oxygen homeostasis, inflammation, clinical nutrition, environmentally-induced illness, and the consequences of chronic anger and stress. The Trilogy includes a large number of long-term clinical outcome studies documenting the efficacy of integrative protocols for diverse clinical disorders.
Altruism in the United States
I developed a clear sense of the scope of clinical altruism among practitioners of integrative medicine in the United States during my ten-year period of voluntary service as the President of Capital University of Integrative Medicine, Washington, D.C. All 58 members of the university faculty also accepted full academic obligations pro bono for that period as well. Most faculty members were busy practitioners who travelled from various states to Washington, D.C. one weekend per month to teach. Additionally, they devoted considerable time between those weekends to do curriculum work, evaluate academic work of the students, and offer student-advisory functions.
In the summer of 2008, I observed an inspiring display of voluntarism among the general public. Bon-commercial, listener-supported WBAI radio based in New York (heard on-line at http://www.wbai.org) developed and implemented the first phase of its all voluntary Diabetes/Hypertension Initiative, with the following five goals: (1) A well-structured and ongoing radio program of education for the general WBAI community; (2) Development and implementation of a Study Protocol with well-defined goals; (3) Close monitoring of the Study Protocol and assessment of the program outcome by a WBAI team composed of WBAI producers, staff, and volunteers; (4) Collation, organization, and presentation of the study data to the WBAI community and general academic community; and (5) Enhancement of the program for future community service and formal extended studies. My colleagues at WBAI and I presented the data collected during the first phase on the air (now posted at http://www.majidali.com). The second expanded phase of the program was launched in January 2009.
Diseases Do Not Descend from Mountains
Nor do diseases emerge from the depth of oceans. So, we are left with the matters of nutrition, environment, and stress. The diagnostic rubrics in the existing classifications of diseases do not take into account the issues of contaminated foods, polluted environment, and chronic anger and frustration. As for genetics, no gene therapies are available at this time for common disorders. The central tragedy of the
prevailing dogma of medicine is that it has convinced the public that diseases can only be treated with drugs and surgery and that disease prevention and reversal with non-drug natural measures is not scientific.
The notion of organizing a Health Corps patterned after the Peace Corps, of course, is not new. However, there is a world of difference between a Health Corps of integrative physicians—total committment to clinical nutrition, environmental toxicities, and spiritual work is their passion—and a Health Corps propounded by doctors who earn their livelihood using drugs and scalpels. There is a wide gulf between the ideologies and ethics of practitioners of natural therapies and those practicing “preventive medicine” with drugs, such as statins, proton pump inhibitors, and drugs that block bone remodelling. This must be accepted as the core issue in all deliberations of a national Health Corps.
Reaching Parents and Grandparents
What might be the results if the thought experiment presented here were to be executed? I expect the following:
1. The health of children and college students will improve dramatically when the issues of dehydration, sugar-insulin-adrenaline roller coasters are prevented with school meals designed specifically to prevent these problems;
2. The health of parents and grandparents will improve dramatically when they learn the principles and practice of sound health in the Corps classes, and then act on that knowledge to varying degrees for themselves;
3. The focus on environment and spiritual aspects of health will usher in a new era of enlightenment, ethics, and compassion for students, parents, and grandparents; and
4. There will be a national movement to counter the rising tide of unethical and deceptive practices to market drugs with limited short-term benefits and serious long-term consequences.
Rhythm of Compassion, Ethics With Passion
It is my sense that the currency of compassion and ethics among the peoples of the world is greater than at any other time in history. Compassion—it seems to me—is seeing one’s own self in others. It is the ability to observe suffering of others and a capacity to experience their anguish. Compassion is the faculty of obliterating the distinction between peoples of different regions and ethnicities, as well as between peoples and animals and animals and plants. Compassion is generosity of the spirit—the courage to act to alleviate suffering. Ethics, simply stated, is the study of the consequences of one’s actions on others. Ethics is also the study of the consequences of one’s failure to take the needed action on others.
I consider the matters of compassion and ethics crucial in discussions of national health, the roles of organized medicine, and the medical-industrial complex in our age of spreading pandemics of developmental disorders of childhood, asthma, obesity, diabetes, and hypertension. How ethical is the use of drugs for such disorders before diligently considering the issues of unhealthy foods, environmental toxins, and chronic frustration and anger? In insulin disorders—obesity, insulin resistance, and Type 2 diabetes—the fundamental problem is functional defect of insulin receptors embedded in the cell membranes—the crank of insulin cannot turn the crankshaft of insulin receptor, so to speak—and the proper treatment is to restore the functionality of those receptors by addressing the relevant issues of nutrition, ecology, and stress. Is it ethical for a doctor to prescribe drugs to further increase insulin activity—hyperinsulism subtantially increases the risk of most metabolic and degenerative disorders—without addressing the underlying causes of insulin resistance? Can compassion find a new rhythm in the world today? Can passion for ethics become clinical in our time? Can such a rhythm of compassion and a passion for ethics be harnessed for global health? Can the U.S. be a beacon of hope in such a possibility? These are the questions that seem important to me.
From a practical standpoint, the Health Corps model proposed in the form of a thought experiement has other strengths. It can be pursued parallel with other innovative ideas for the nation’s health crisis. It does not require dismantling of any existing health care structures. It can be a major component of voluntary citizens’ efforts to move our national agenda forward. For further reading on the philosophy and practice of authentic integrative medicine relevant to the Corps thought experiment, I refer the readers to http://www.healthcorps.us. I close this column by reiterating that the success of any Peace Corps initiative will essentialy depend upon the society’s committment to protect the program from the nefarious influences of the medical-industrial complex.
1. Ali M: RDA:Rats, Drugs, and Assumptions. Denville, New Jersey, Life Span Books 1995.
2. Zito JM, Safer DJ, de Jong-van den Berg LTW. A three-country comparison of psychotropic medication prevalence in youth.. The Journal Child and Adolescent Psychiatry and Mental Health, 2008; 2:25-30.
3 Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of Hypertension in Children and Adolescents. JAMA. 2007;298(8):874-879.
4. Vasan, RS, Beiser, A, Seshadri, S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA 2002; 287:1003. And: http://www.scienceblog.com/community/older/2002/E/20023767.html-10k
5. Banks J, Marmot M, Oldfield Z Disease and Disadvantage in the United States and in England. JAMA. 2006;295:2037-2045.
6. Ali M. Oxygen and Aging. (Ist ed.) New York, Canary 21 Press. Aging Healthfully Book 2000. .
7. Ali M. The Principles and Practice of Integrative Medicine Volume XI: Darwin, Dysox, and Disease.2000. 3rd. Edi. 2008. New York. Insitute of Integrative Medicine Press.
8. Ali M. The Principles and Practice of Integrative Medicine Volume III: Darwin, Oxygen Homeostasis, and Oxystatic Therapies. 3rd. Edi. New York. Insitute of Integrative Medicine Press.
9. Ali M. The Principles and Practice of Integrative Medicine Volume XI: Darwin, Dysox, and Integrative Protocols. 2008. New York. Insitute of Integrative Medicine Press.