IS MEDICAL CARE PALLIATIVE CARE?

The  definition of palliative care in Oxford dictionary.

“Relieving or soothing the symptoms of a disease or disorder without effecting a cure.”

This is essentially what modern medicine is: a misguided attempt to “relieve orsoothe the symptoms of a disease or disorder without affecting a cure”. Why misguided?   Misguided, as medical treatment doesn’t go to the cause of the problem: the food we eat.   Misguided, as it is obvious that erecting a fence at the top of the cliff, is better than having teams of ambulances and paramedics at the bottom to take away and treat the injured, who are repeatedly falling over the cliff.  Even better than the fence, of course, is promoting our sense of balance and care for our life, so that we don’t fall over the cliff.

For us to feel a sense of balance and care for our life, we have to feel that we have power to influence what is going to happen. Unfortunately, more and more of our life is being taken into, the realm of experts. I have seen this within my own field of social work, where like all fields there is the imperative to follow ‘best practice’.  Unfortunately best practice in my field, just means saying, ” I am practicing motivational interviewing and cognitive behaviour therapy.”   Putting aside the question as to whether there is any evidence, that these therapeutic models are any more effective than any others, there is no need within my field, to establish proficiency or training in these models, to make the claim that the practitioner is engaging in best practice.  I would contend, that there is no evidence that these models are any more effective than others, due to the problem of research bias. The more something is researched, the more it gets researched, in a self perpetuating cycle. The other thing that has been happening in social work and many fields, is the standardised, technological response. This is elevating the social worker to the position of expert, who diagnoses the problem and applies a dose related intervention. This sounds a lot like the medical model doesn’t it! This is because lower status professions attempt to gain ground by mimicking higher status professions, like medicine.

On the Health Report, on Radio National, I hear discussions about ‘shared care’. This is the way medicine should be done and I am sure many medical professionals are doing this, but unfortunately there are many barriers from the patient’s side and the Dr’s side. Shared care is about the Dr or health professional sharing power and information and having an open discussion about the costs and benefits of each course of action, taking into account the patients particular values and goals.

My experience of Drs is thankfully limited, as fortunately through genes, good management and probably good luck as well, I don’t get sick.  Unfortunately, even from my limited experience, I have examples of the opposite of shared care. Thirty odd years ago, after my wife died of a heart attack, I naturally had a heightened concern about heart attack!   I spoke to my Dr about the Pritikin Diet, a diet which has now been proven, that if followed, would reduce heart attack dramatically. His response? “That is too extreme, no-one will ever stick to it”. This attitude continues to be one of the reasons large numbers of people die unnecessarily.   When asked why they don’t talk to patients about eating less animal products and junk food and more beans and vegetables, they often say, “people won’t do it”.    Yet Drs will talk to people about giving up smoking and cutting back their alcohol.   Somehow food is a no go zone.  One of the “pleasures” of life that can’t be messed with.

In relation to my Dr thirty years ago, saying people won’t stick to it, I have been sticking to it for the last 12 years! The phrase “sticking to it” is actually unhelpful, as it implies it is something that has to be endured. To the contrary, I have found it highly enjoyable, for the same reasons many other people, also find it highly enjoyable.

That is, it not just that I don’t get sick, I feel well: high energy and feel alive. I am making the diet more ‘extreme’ all of the while. As mentioned in a previous blog, I have recently dropped oil of any kind from what I eat.

At first sight, what I eat would seem extreme to many people.   As Dr Caldwell Esseltyn says, “how extreme is it to have your chest sawn open?”, which is the other likely option. Heart disease can be prevented and reversed with a whole foods plant based diet. 

My recent experience on the periphery of my mother in laws journey with lung cancer, is that there were examples of shared care and there were examples of more traditional medical care: that is we know what’s best for you, you will be the passive recipient of our treatment and we won’t talk to you about the downsides of any treatment that we decide to give you.

This is the other reason that medical care as palliative care is misguided: there are always downsides to any treatment. There is also a general progression: treatment leads to more treatment, drugs lead to more drugs.   In an ideal world, we would be active consumers of medical care, like we are in relation to other products and services.

When we look at the majority of medical treatment it fits the palliative picture.

Almost any time we take a drug/medication we are in palliative territory, with the major exception that I can think of, being anti-biotics.   With anti-biotics, we take a drug, to attack the bacteria, which is causing the illness. Pretty straightforward, except for thinking about the health of our immune system (which can be greatly improved by eating plants, exercise and attitude) and why on this particular occasion, it was not able to ward off the bacteria causing the disease.   This is not even thinking about the rush we often have, to take anti-biotics, when we don’t actually need them, thereby weakening our immune system.   Factory farming is already a big enough threat in terms of infectious diseases, by the use of anti-biotics without ourselves also participating in increasing the risk. (taking anti-biotics unnecessarily-Health report, Radio National) weakens the immune system by wiping out the good bacteria in our gut. These bacteria produce chemicals which boost our immune system.

Standard medical treatments which fit the palliative model are:

Drugs for blood pressure/cholesterol

Drugs for diabetes

Anti-depressants and other mental health drugs

Drugs for rheumatoid and even osteo-arthritis

Drugs for digestive problems like acid reflux, constipation, irritable bowel syndrome, ulcerative diverticulits and so on

Drugs for auto-immune diseases such as Lupus and so on

We tend to think about palliative care as the care that we get at the end stage of life, the care that will ease our passing from this world. If we rely only on standard medical treatment and don’t address the causes of our illness, we are entering the end stage of our life. This may be at age 25, but it is still the end stage.   And just like when we think of palliative care now for those that are dying, as ever increasing medication, every increasing disability, with ever decreasing quality of life, so it will be for us, if we rely only on standard medical care. Of course there is a place for standard medical care, but expect true shared care, where we are in the driver’s seat of decisions about what treatments, we are going to have and we take responsibility for what steps we are going to take to prevent, reverse or manage our illness.

Many people have faith in the Dr, the drugs and the technology. It is good to look at the evidence and one way to do this, is to do what I have suggested before. Look around at the friends, family, workmates in your circle and see what is happening to them over time. Are they cured? Vital, energetic, alive?

The evidence from the research is clear, that the effectiveness of many of these drugs and even heart surgery is questionable, but the effectiveness of a whole foods plant based diet is unequivocal.   Add moderate exercise, even just daily walking for 30 – 60 minutes and we are in a good place.