Health Care or Disease Care?

News flash: the health care system needs to be changed. The system is broken. It is set up right now to encourage illness. Doctors have no incentive to make you well (other than ethics an d integrity). You as a patient are the source of income. If you get better and stop coming in, doctors don't get paid. That's how it is set up right now. You would think that the insurance companies would want you to be well because they only pay when you are sick. Occassionally they will pay for prevention visits. But not all do. Why not? Two words: money and risk. Insurance companies are willing to gamble and bet that they won't pay out more than you put in. Over the course of a year, how many times do you go to the doctor? If we are generous in our estimate (and for ease of math) let's say 10 times per year. Lets say the average doctor visit costs $90. That equals $900 assuming the insurance company pays 100% of the charges billed (which they never do). If the average monthly premium for an individual in their mid 30s is $300, over the course of 12 months they are paying $3600 (not counting copays or deductibles). The difference is $2700. From a business standpoint, who wins? INSURANCE COMPANY!! Who loses?? We all do - patients and doctors!! Insurance costs continue to rise. Reimbursement for physicians continues to go down. Offering insurance coverage for everyone is not the answer. It will only make the problem worse.

In order to change the system, we have to change our focus. We must focus on wellness rather than illness. Insurance companies should consider paying to keep people well. Doctors should be paid when their patients are well rather when they are sick. What if you paid the doctor to keep you well and never paid when you were sick? What if insurance paid for medical procedures that were unexpected or emergent only? What if doctors were compensated for how few times their patients came in rather than the opposite? What if people were responsible for their own health and forced to make changes rather than rely on drugs?

Take Diabetes, high cholesterol, and high blood pressure for example...Our system lacks personal responsibility. If you want to overeat and live a sedantary lifestyle, go for it! When you develop Type II diabetes, high cholesterol, and high blood pressure, your doctor will just give you some "prescription medications." And when those don't work (because you didn't change behavior), he or she will give you more. And when that doesn't work, and you have a heart attack, the doctor will do surgery. And guess what, insurance will pay for it all!! Hooray!! Thanks big insurance company. Thanks for the "health care." Gimme a break. What if insurance companies told people, "Stop eating crap, get off the couch and exercise, quit smoking cigarettes and drinking excessive amounts of alcohol and energy boosting drinks, and make some changes or else we aren't going to pay for your health care?" WOW. Sounds radical . Instead they just increaese the premiums across the board. We are all so brain washed into thinking that some chronic diseases are not our fault. And we are told they cannot be changed. "Once you have diabetes or high blood pressure you will be on medication forever." Bull. I have seen patients reverse high cholesterol in 3 months. Many cases of diabetes can be reversed - without drugs! IF the patient wants to change. In my experience, most patients don't want to change. It's too hard. Too much work. So by those patients choosing to not change, MY insurance cost goes up. Hey insurance company, stop paying for chronic diseases that can be reversed with diet and lifestyle changes. Or maybe pay for prescriptions ONLY AFTER aggressive lifestyle changes have been made...not just attempted but implemented. It's not rocket science. But not all doctors are trained to treat the cause. Many don't know how to sit down and talk to their patients about diet and lifestyle changes. They are in a hurry (and have to hurry to meet costs - an unfortunate "side effect" of the system). And besides, there are drugs that can alter the lab results for a short time which looks great on paper. Unfortunately drugs are often the only option a conventional doctor has to offer. It's sad really. Especially since the drugs are often nothing more than expensive band aids. Don't get me wrong, there is a time and a place for pharmaceuticals. I am not opposed to pharmaceuticals. If I have a bacterial infection, I want antibiotics. Nothing works like prednisone or albuterol. And when needed, they can be lifesaving treatments. But to prescribe a cholesterol lowering medication (Lipitor is the number one selling drug in the world), and NOT LOWER MY RISK OF HAVING A HEART ATTACK OR A STROKE...no thank you. What is the point in taking a drug that lowers numbers on a piece of paper but doesn't lower risk? For the patient, no point at all. For the drug company, big time money - billions of dollars. Does anyone else out there see the problem?

The problem isn't the poor people and the children that don't have health care. The problem is the system. The problem is big money in pharmaceuticals. If high cholesterol can be reversed or better yet prevented, there is no need for cholesterol lowering medications. No cholesterol lowering medications = no money. No money = no happy for big pharma. If I owned a pharmaceutical company, I wouldn't want you to get better either. Because then you wouldn't need my product. Lower the cost of medications, decrease incentive, and maybe things will change. But there is too much money right now in pharmaceuticals and no chance of that changing anytime soon. If the door is opened for everyone to have "health care" guess who wins? Big pharma!! The pharmaceutical industry wants socialized medicine. More demand = more $$$$$.

What can you do? Keep yourself healthy. Eat right. Exercise. Get a good night sleep. If demand for the medications is reduced (hopefully as a result of being healthy and not needing the drugs), production and costs have to go down. Then maybe the system will start to change.

No UN-D's

Many of you are familiar with complementary and alternative medicine. In 1997, it was estimated that consumers spent over 27 billion dollars on complementary and alternative medicine. Many of you are also familiar with Naturopathic Medicine and Naturopathic Doctors (NDs). For those of you who are not, I encourage you to read my blog What the Health is a Naturopath. However, what many of you may not realize is that Naturopathic Doctors are not licensed in all states. Thousands of "professionals" have taken advantage of this huge demand and lack of regulation by calling themselves Naturopaths even though they have not received the necessary training. They are "UN-Ds" not NDs. They are not doctors. This misrepresentation is not only unfortunate, it is deceptive, dangerous, and in some cases illegal.


Currently, Naturopathic Doctors are licensed in 15 states (see below) as well as the District of Columbia, Puerto Rico, and the US Virgin Islands. In order to receive a license to practice medicine, these states require that Naturopathic Doctors graduate from a four year, accredited naturopathic medical school, pass extensive post doctoral board examinations, and complete state mandated continuing education requirements annually. When selecting a Naturopathic Doctor, it is essential that he/she meets the above criteria.

There are Naturopathic Doctors in each and every state. In unlicensed states, many of these doctors practice in integrative medicine clinics under the direction of conventional medical doctors. The American Association of Naturopathic Physicians (AANP) is a national organization whose members must meet the above listed criteria. Although not all licensed naturopathic doctors are members, this is a good place to start when looking for a new doctor. On the AANP website, click on the "Find a Doctor" tab, type in your zip code, and a list of local doctors will be presented.

If your state currently does not license Naturopathic Doctors, contact your local legislators. Let them know you believe licensure is necessary to ensure the safety of the public and to provide you with the freedom and confidence to choose a Naturopathic Doctor as your primary care provider.



States with licensing laws for Naturopathic Doctors:



Alaska
Arizona
California
Connecticut
District of Columbia
Hawaii
Idaho
Kansas
Maine
Minnesota*
Montana
New Hampshire
Oregon
Utah
Vermont
Washington
United States Territories: Puerto Rico and Virgin Islands





*Effective July 2, 2009.

What the Health is a Naturopath?

Finally...A blog designed with the health of the patient as a priority.

My name is Dr. John Nowicki, and I am a Naturopathic Doctor. For those of you who do not know what that is, let me explain...

In Washington State (where my practice is located), I am a Primary Care Provider. I am licensed to do the most of the things that a conventional Medical Doctor specializing in Family Medicine can do. I perform general physical exams (sports physicals, well adult/well child exams), condition specific treatments, conventional laboratory tests, referrals, imaging, etc. My office visits include detailed history taking, physical exam, and laboratory testing as needed. There are several differences, but three that I will mention here.

1) I look to treat the cause, not just the symptoms of disease. Let's take headaches for example. My goal is to figure out where the headaches are coming from rather than just saying take ibuprofen or acetominophen or magnesium. These may relieve the pain, and I am not opposed to symptom relief. If ibuprofen helps get rid of the headache, great! However, these treatments do not correct the ultimate problem; they just relieve the symptoms. My goal is to figure out where the headaches are coming from and then to treat that cause. If we can figure out the cause of the headaches, the symptom relieving medicines are no longer necessary, and the headaches are gone. This applies to all symptoms, headaches, fatigue, digestive complaints, etc. The goal is always to determine the cause.

2) The treatment options I use include diet and lifestyle changes, natural medicines (like vitamins, minerals, and botanical medicines), and pharmaceutical medications when needed, not always in that order. It depends on the presentation of the patient. If someone comes in with a bacterial infection, I would prescribe antibiotics rather than just telling the individual to cut out milk from their diet. Antibiotics would be the appropriate treatment in that case. But in the majority of chronic conditions, the protocol is diet and lifestyle changes, followed by natural medicines, and then pharmaceutical prescriptions if required.

3) I spend more time with my patients. Most first office visits are between 60 and 90 minutes and are primarily focused on information gathering. In order to determine the cause, I need to get to know my patients and that requires more time.

I view my relationship with patients as a team, where the patient is the "captain" of the team. I will provide my opinion, talk about treatment options, pros and cons/risks and benefits of those options, and together come up with a treatment plan that works to accomplish your goals. I expect open communcation between me and my patients. If there is something I feel strongly about, I will always let you know. But I expect the same in return. My goal is to help you achieve your goals, and we need to be on the same page to do so. I do not want to give my patients 20 things to do and then have them leave saying, " I am not going to do this." That would be a waste of your time and a waste of my time. I do not think my role is to be a dictator...It is not my job to tell you what to do or not to do. I look at my role as an educator...to provide options, talk about pros and cons, risks and benefits of treatment, and then together determine the path we are to travel down. I will guide and direct my patients along that path, reevaluating as necessary, ultimately achieving the goals you desire.

I look forward to sharing more information with you as we venture down the path towards health.

You can read more about our clinic here: http://www.issaquahnaturalmedicine.com/
and more about Naturopathic Medicine here: http://www.naturopathic.org/ and here: http://www.wanp.org/