It’s clear that America is in the process of reassessing, and probably revolutionizing, its public health policy.
That’s the expectation after the confirmation of Robert F. Kennedy Jr. as secretary of the Department of Health and Human Services. He brings a famously jaundiced eye to the government’s cozy relationship with pharmaceutical companies, to the politics of medical research, and — most notoriously — to vaccine schedules. A reexamination is coming of Americans’ health, and the way entrenched bureaucracies and long-held dogmas promote or negatively affect it.
Let’s face it: Our collective physical health is abysmal. Obesity is the most obvious and perhaps the most significant challenge we face, although diabetes, heart disease, and cancer are also exploding. We are definitely on the wrong track, or more likely, on several wrong tracks at once. I see it every day in my own medical practice, in a way that fills me with pity for my patients.
We’ll have to wait and see whether some of these trends will be reversed by fresh approaches. In the meantime, there is a deeper philosophical question that is bubbling under the surface: the concept of “health” itself.
The classic, biomedical notion of health — the one that I was trained in and have practiced for 25 years — quite simply means the absence of disease. In this setting, health care is the treatment of illnesses and the prolongation of life. No infection, cancer, or chronic illness? All systems working as expected for age and sex? The patient is healthy and needs nothing more, except screening tests like mammograms and colonoscopies to detect diseases at their earliest manifestations.
The biomedical model has largely been abandoned, for both good and ill. We have moved on to a holistic approach embracing much more than the simply physical. The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
That is certainly a holistic — or all-embracing — approach, which at first sight seems ridiculous. Anyone who has lived any length of time knows that days in which we feel “complete” well-being are few and far between. Even our most joyful seasons are marred by some negative wrinkle in some aspect of our lives. We Christians, in fact, hope to experience complete well-being in heaven and not before.
And yet, for all the hyperbole, there is something important in the WHO’s definition.
There is a deep connection between our physical state and the state of our souls and minds. No matter how strong our bodies, a dysfunctional home, a soul-crushing job, or a deep depression have the ability to steal physical contentment from us.
And it works the other way. For instance, studies have shown that married people live longer, and have lower rates of chronic illness like heart disease, diabetes, and hypertension. Similar benefits come from regular church attendance. It is thought that companionship and connectedness, and the sense of purpose and meaning that marriage and faith bring, somehow improve our immune function and lower our cortisol levels. I can just see the note on the prescription pad: “A strong marriage once per day and Mass once per week.”
There is a dark side to the holistic health perspective, however. It sets up impossible expectations of complete contentment, breeding unhappiness with the inevitable difficulties of life. There is no such thing, anymore, as “normal for age.” Whether wrinkles, age-related infertility, or some thickening around the waist, there is a demand for medical fixes to normal human experiences. This has effectively turned patients into consumers, and doctors into vending machines.
The crisis is seen in the topic of infertility. The term has long referred to the inability of a couple in their childbearing years to achieve and maintain a pregnancy. But a redefinition is underway. Now it has been expanded to something called “social infertility,” which can include a post-menopausal or single woman, or two men who have no natural way to conceive a child.
Because the definition of health itself has changed to include social well-being, and for many people this includes becoming a parent, ethically disturbing practices like surrogacy and IVF have become widespread. Many feel they should be accessible to anyone, and free of cost to the consumer.
Abortion, assisted suicide, and transgender “care” are related to the redefinition of health, and have in turn poisoned medicine itself. Elective abortion is justified as necessary for the mother’s social and emotional health, inflicting incalculable damage on the ethical practice of medicine, the doctor-patient relationship, and our collective understanding of the dignity of life.
Just as horrifying, suicide is now prescribed in many states to “treat” a lack of well-being, through the simple expedient of killing the sufferer. And the hormonal alterations and cosmetic surgeries of transgender “care” assault the physical health of children and adults and do not appreciably improve mental health, all in the name of “well-being.”
These are, of course, some of the darker ways holistic medicine has changed our concept of health. Other ways, like the prolongation of youthful energy through hormonal replacement, on the surface seem to promise only good things.
Looking ahead, we can be certain that a reexamination of America’s models of well-being — the dogmas and bureaucracies that promote those models — and our progress toward a better state of health, is long overdue.
Let’s hope we get it right.
