Two Reasons Conventional Medicine Will Never Solve Chronic Disease

on June 14, 2017 by Chris Kresser

Chronic disease is shortening our lifespan, destroying our quality of life, bankrupting governments, and threatening the health of future generations. Unfortunately, conventional medicine has failed to adequately address this challenge, and the prevalence of most chronic health problems continues to rise. In this article I explore why that is and outline a new approach to healthcare that would much more effectively tackle the chronic disease challenge.

Chronic disease is the biggest healthcare challenge we face today—by a long shot.

Consider the following (scary) statistics:

  • One in two Americans now suffers from chronic disease, and one in four has multiple chronic conditions.
  • Chronic disease is responsible for seven of ten deaths each year.
  • The rate of chronic disease in kids more than doubled between 1994 and 2006.
  • 84 percent of the $3.8 trillion we spend on healthcare in the United States each year goes toward treating chronic disease.

We’ve reached the point where chronic disease has become so common that we think it’s normal. But there’s a big difference between common and normal.

Even in the United States, at the turn of the last century, the three major causes of death were all acute, infectious diseases: tuberculosis, typhoid, and pneumonia.

You might argue that this is simply because our recent ancestors didn’t live long enough to acquire chronic diseases. But although it’s true that our average life expectancy has increased significantly over the past century, it’s also true that chronic diseases like heart disease, diabetes, and Alzheimer’s—which are now among the top causes of death in the United States—are rare in contemporary hunter–gatherers that have maintained their traditional diet and lifestyle.

How would you rate conventional medicine’s approach to chronic disease?

As a case in point, consider the Tsimané, a subsistence farmer and hunter–gatherer population in Bolivia. They eat meat, fish, fruit, vegetables, nuts and seeds, and some starchy plants. They walk an average of 17,000 steps (~8 miles) a day. They spend a lot of time outdoors, get plenty of sleep, and aren’t exposed to a lot of artificial light at night.

In a recent study, researchers found that the prevalence of atherosclerosis was 80 percent lower in the Tsimané than in the United States. Nearly nine in ten Tsimané adults between the ages of 40 and 94 had clean arteries and faced virtually no risk of cardiovascular disease. What’s more, this study included elderly people—it was estimated that the average 80-year-old in the Tsimané group had the same vascular age as an American in his mid-50s. (1)

The consequences of chronic disease are profound

Chronic disease is not a small problem. It’s an insidious, slow-motion plague that is exploding through Western populations, shortening our lifespan, destroying our quality of life, bankrupting our country, and threatening the very survival of our species.

The consequences for patients are painfully obvious. Consider the following:

  • Two-thirds of Americans are overweight, and one in three is obese. According to a recent report, half of Americans will be obese by 2030. (2)
  • The prevalence of autism spectrum disorder (ASD) more than doubled from 2000 to 2010—and not just because of increased rates of detection. (3)
  • Rates of autoimmune disease have doubled or tripled over the past 50 years (depending on which estimate you look at) and are expected to continue to rise sharply.
  • Over half of adults take prescription drugs, and 40 percent of the elderly take more than five medications. (4)

But it’s not just patients that are affected; doctors and healthcare professionals are also victims. For example:

  • 90 percent of doctors feel medicine is on the wrong track.
  • 83 percent of doctors have thought of quitting medicine.
  • Half of doctors describe themselves as either often or always feeling “burned out.”
  • In inflation-adjusted dollars, the average physician earns the same wage as she did in 1970 but sees twice the number of patients. (5, 6)

Above and beyond the effects of chronic disease on individual patients and healthcare professionals, the costs to society at large are enormous and potentially catastrophic:

  • Annual healthcare expenditures in the United States hit $3.8 trillion in 2013—more than $10,000 for every man, woman, and child and about 24 percent of our GDP.
  • If healthcare spending continues to rise at its current pace, the United States will be insolvent (bankrupt) by 2035.
  • Globally, spending on chronic disease is expected to reach $47 trillion by 2030, an amount greater than the GDP of the six largest economies in the world.

I think it’s pretty safe to say that chronic disease is literally bringing the world to its knees, and what we’ve been doing to address it isn’t working.

But why?

Two reasons conventional medicine has failed to address chronic disease

There are many reasons conventional medicine has failed to address the chronic disease epidemic, but I’d like to focus on what I believe are the two most fundamental issues.

#1: The wrong medical paradigm

Conventional medicine evolved during a time when acute, infectious diseases were the leading causes of death. Most other problems that brought people to the doctor were also acute, like appendicitis or gall bladder attack.

Treatment in these cases was relatively simple: the patient developed pneumonia, went to see the doctor, received an antibiotic (once they were invented), and either got well or died. One problem, one doctor, one treatment.

Today things aren’t quite so simple. The average patient sees the doctor not for an acute problem, but for a chronic one (or in many cases, more than one chronic issue). Chronic diseases are difficult to manage, expensive to treat, require more than one doctor, and typically last a lifetime. They don’t lend themselves to the “one problem, one doctor, one treatment” approach of the past.

Unfortunately, the application of the conventional medical paradigm to the modern problem of chronic disease has led to a system that emphasizes suppressing symptoms with drugs (and sometimes surgery), rather than addressing the underlying cause of the problem.

For example, if you go to the doctor and find out you have high cholesterol and/or high blood pressure, you’ll be given a drug to lower them—and expected to take that drug for the rest of your life. There is rarely any serious investigation into why your cholesterol or blood pressure is high in the first place.

If we consider health and disease on a spectrum, where perfect health is on the left and death is on the right, conventional medicine is focused on intervening at the far right of the spectrum.

If I get hit by a bus, I definitely want to go to the hospital! Conventional medicine is also embracing new technologies to do some amazing things, like restoring sight to the blind, re-attaching limbs, and potentially fighting cancer with nanorobots.

However, these approaches are not the best way to prevent and reverse chronic disease. Recent statistics suggest that more than 85 percent of chronic disease is caused by environmental factors like diet, behavior, environmental toxins, and lifestyle. (7)

More specifically, chronic disease is the direct result of a mismatch between our genes and biology on the one hand and the modern environment on the other. I summarized the research supporting this argument in my first book, The Paleo Cure, and there are numerous examples everywhere we look.

For instance, in 1980 only 1 percent of the Chinese population had diabetes. In just one generation, the incidence of diabetes rose by an astounding 1,160 percent! (8) What happened? Was there some kind of massive gene mutation in Chinese people over the past 30 years that caused an outbreak of diabetes?

Of course not. Genetic changes take a lot longer than that to occur. Instead, during this period the Chinese shifted from a more traditional diet to a more industrialized, processed diet.

The takeaway is clear: if we want to prevent and reverse chronic disease, we need a medical paradigm that:

  1. Recognizes the mismatch between our genes and our behavior and environment as the primary driver of chronic disease; and
  2. Focuses on preventing and reversing the underlying causes of disease, rather than just suppressing symptoms

#2 The wrong delivery model

It’s not just our approach to chronic disease that is inadequate; our model for how care is delivered is also a huge problem.

Why? For several reasons.

First, it’s not structured to support the most important interventions. As I mentioned above, the primary causes of the chronic disease epidemic are not genetic, but behavioral. It boils down to people making the wrong choices about diet, physical activity, sleep, stress management, etc.—over and over again, throughout a lifetime.

This makes it clear that one of the most important roles healthcare providers should play is supporting our patients in making positive behavior changes.

Unfortunately, the conventional medical system makes this extremely difficult. The average patient visit with a primary care provider (PCP) lasts about 10 to 12 minutes, and the average PCP has about 2,500 patients on his roster. If a patient has multiple chronic conditions, is taking several medications, and presents with new symptoms, it is nearly impossible to provide quality care during that 10-minute visit.

Once the initial intake and review of medications has taken place, there’s just barely enough time to prescribe a new drug for the new symptoms—and no time at all for a detailed discussion of diet and lifestyle factors that might be contributing. And since the PCP has 2,499 other patients and is already overworked, there’s no other time or place for that kind of discussion.

Even if the provider does happen to make a diet or lifestyle suggestion as the patient is on her way out, will it be successful? It’s now widely accepted that knowledge is not enough to change behavior; we’ve all encountered crazy shrinks and divorced marriage counselors, right? The expectation is that if the PCP tells the patient to change her diet, she’ll just do it. But in reality, we know that rarely happens. Patients need a lot of additional support in order to make those changes successful and long-lasting.

What’s more, if 95 percent of the appointment is spent talking about symptoms and medications and only the last 5 percent on potential diet and lifestyle causes and solutions—what do you think the patient will take more seriously?

To truly address chronic disease, we need a different model of delivering care. Among other things, this model should:

  1. Make possible and encourage longer visits with with patients, with more detailed intake and history and time for discussion and support. Ten- to 12-minute visits may be fine for prescribing drugs for symptoms, but they fall hopelessly short for actually addressing the cause of those symptoms.
  2. Emphasize collaborative care, where the doctor works with the patient as a partner, rather than in the “expert” model that characterizes our current system. The patient also has access to a care team that includes nurse practitioners/physician assistants, nutritionists, health coaches, and other allied providers to provide another layer of care and more support between appointments.
  3. Be both high-tech and high-touch, utilizing current technology and practices to streamline and automate cumbersome administrative processes and reduce overhead, both of which free up more time for practitioners to provide quality care to patients.

The future is already here

The good news—both for patients and practitioners—is that this future has already arrived. The new model I’ve described above is one that hundreds of clinics across the country (including my own clinic, CCFM) have begun to implement.

But as you might expect, there’s a lot more to this story. And that’s exactly why it’s the subject of my upcoming book, Unconventional Medicine: Join the Revolution to Reinvent Healthcare, Reverse Chronic Disease, and Create a Practice You Love.

The book will go into more depth on why conventional medicine has failed to address the chronic disease epidemic. But more importantly, it outlines a solution that has the potential not only to prevent and reverse chronic disease, but also to reinvent the healthcare system in a way that satisfies the needs of both clinicians/practitioners and patients.

Although the book is primarily written for those currently working or considering working in healthcare, it’s also intended for people in the general population who are interested in functional medicine, ancestral health (i.e., “genetically aligned, species-appropriate diet and lifestyle”), innovation, and even revolution in healthcare and playing some role—however small—in helping to co-create the future of medicine.

We don’t have a firm release date yet, but the current plan is for a late-August or early-September launch. I’m really excited about it and I hope you are too!

Now I’d like to hear from you. How would you rate conventional medicine’s approach to chronic disease? Have you had trouble finding the support you need for a chronic illness within the conventional paradigm? If you’re a practitioner working within this model, how has it served and not served you and your patients? Let me know in the comments section!

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  1. Looking forward to your book. You are right on the mark! Perhaps send your book to the right congressmen or make appointment to share it in person. You might be able to spearhead a revolutionary change to our current Disease model & patriarchal system of ‘sick’ care. I think that a mindset shift needs to happen in the whole population where people understand the basics of health and wellness and how taking personal responsibility is an exciting adventure.

  2. I’ve suffered a whole host of supposedly untreatable symptoms since I suffered a cycling collision with a vehicle and sustained, most significantly, a temporal bone fracture.

  3. I am a 90 year old vegan (25 years) and ski, windsurf, bike ride, and am generally very active. My #1 question is:
    Young people say to me “What do I do to be so fit when I’m 90?” There is no answer that I have found that works on more than 10 % of the people. Of course it is nutrition, exercise, sleep, and stress control. I have found that the fundamental basic of life: “Performance rewarded is repeated” does not work in moving a person from omnivore to herbavore because the reward and the performance are so separated in time. Find my answer and a mass amount of human suffering cane avoided.
    Don Guild, Pharmacist

  4. Occupational Therapists are best trained to work with patients on behavior modifications and should be part of physicians offices.

  5. Excellent article and wish more people across the board understood the challenges involved in healthcare!!! Some believe throwing money at it will make everything better which clearly hasn’t worked. Others believe insurance carriers are the cure, but may not understand they are a business and are there to make $…..not to care for patients. A complete overall of how medicine is practiced is very much needed for both the benefit of patients and physicians (who still want to help in this current crazy system).

    My personal believe is to get rid of health insurance (GASP!!), but if you really sit back and see what you get for your $ it doesn’t hold water. Too many loop holes, prices are through the roof, you have to play “Where’s Waldo” to figure out if your provider is still in “network”, and even if your insurance is accepted that doesn’t mean they will pay anything in the end.

    Now…..with concern for convential medicine’s way of practice I believe it is horrible. When one develops a condition there is no time to really figure it out, so by the time you can get another appointment your condition has bloomed even further. So now your condition is snowballing without any direction and have been turned over to specialists…….which you now have to wait 9 months to get in to see just one. By one I mean just the endocrinologist……..though your symptoms are now so broad due to the wait time you are now being sent to the gastro, nuero, OBGYN, and etc. Since everyone works in their own “box” nobody is working together and your GP who is suppost to be doing that is swamped since they can only talk for 10mins……so you are left to slowly wilt and hope someone will help. Though I hate to say it…….I believe this is part of the reason why GPs are the highest prescribers of SSRI!!! They don’t know what to do and since nobody has put the puzzle pieces together you must just be stressed…..so have a pill that will make you even worse at best.

    Thank you so much for bringing to this light. As you can tell I personally have been involved and am amazed at how messed up the system is currently. The US may spent the most $ on healthcare, but from what I have seen it’s been spent poorly and not on the root cause. Convential medicine isn’t good at finding the root cause of issues. Great at trauma, but not “quality of life” issues.

  6. Totally agree. We need to get back to live how we were supposed to. Your medical practitioner is a GP – which means general practice. They are also busy and with appointments lasting 10 to 15 minutes how can you get a true diagnosis? I think doctors are pushed for time and give out short fixes to move patients on to see the next. Also pharmaceutical companies are quick to send out the latest products and quite often a doctor will give you some drug that is new on the market to try. I fail to see how in a 10 minute short interview with a patient you can get an overall feel of that person. Questions should be ask such as what is your lifestyle What exercise do you do. Are you getting enough sleep. And if the answer to these questions are not enough then the medical practitioners should be exploring options. I’m not sure about other countries but I think doctors don’t do a great deal of study in nutrition and a ill-advised to be able to treat their patients.

  7. I work at a university. My employer contributes a lot to my healthcare, but only traditional healthcare. I have to pay out-of-pocket for my GAPS/WAPF naturopath, periodic breast thermography, and less often a chiropractor. My conventional PCP has told me that whatever I am doing, to keep doing it. Most women she sees get less healthy as the age but I have gotten more healthy. I take zero pharmaceuticals. I told her I have been trying to tell her what I am doing but she is not able to hear this because it is outside the “standard of care.” And she is one of the better traditional physicians out there. I see her once a year for about a half an hour. I absolutely agree with everything you are saying. When I changed my diet about eight years ago to one that eliminates sugar (except a little fruit, not much) and includes many inflammation reducing foods, the change has been dramatic. I eat according to GAPS — probiotic foods, organ meats, healthy fats, bone broth and meat stock, and lots of “wet” vegetables. I have an exercise practice and a meditation practice. But these are all new to me in the last eight years so even change later in life can have a dramatic effect. I am 68. You are absolutely on the right track. You are a beacon of truth. I am looking forward to your new book and I am glad you chose that cover.

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