I understand we’re in an age where technology allows people to monitor dozens of variables instantaneously, and many believe more data points can only help to individualize decisions about health. But there is a threshold where less is more, when the noise drowns out evidence-based, appropriate clinical care.
Hey Terminalxylem, you know I'm generally in agreement with what you say, but "appropriate" is doing a lot of heavy lifting here. Nowhere is there an acknowledgement that "appropriate care" is done with cost constraints in mind (wherever that happens along the conveyor belt, from public corporation or closely-held corporation or unincorporated insurer to provider to insured). What you're allowing yourself to say (and I'm not saying you are) is that how we determine what is "appropriate" under our current system is the best care. And you've written nearly exhaustively about how our system actually isn't good.
How do you reconcile the two?
Good point. You are absolutely correct that our system is broken, but it isn’t primarily due to undertesting. If anything, we test way too much. Even with financial constraints, our medical care is the most costly, and wasteful in the world. Outcomes are mediocre, at best.
At the same time, there are instances where insurance lags behind the science, refusing to pay for appropriate testing, procedures, and therapeutics. Usually clinicians can petition to change their minds, and that may entail reviewing contemporary best practice. Or patients hop through hoops for financial assistance. But frank denial of care is pretty uncommon, in my experience (mostly in the hospital setting). Still, it definitely happens, as the cost of care is an inescapable reality.
I’m not sure how any of that justifies paying hundreds-thousands of dollars out of pocket for a bunch of dubious tests. And the people pursuing functional medicine aren't usually the same as those being denied care, typically un- or underinsured people in marginalized communities. I'd bet Function's clients are mostly affluent, college educated, and well insured. They're probably healthier than average, too.
I mean, I get it. People aren't satisfied with Big Medicine, Big Pharma, or any entity that treats healthcare like a business. They want to feel in control of individualized care, and not be a cog in the medical assembly line. I just don't think gratuitous phlebotomy and whole body scans are the answer. Alternative Medicine seems every bit as profit-driven as the other Bigs, even predatory from my vantage point, and much more poorly regulated.
I also think there need to be limits on unnecessary care. Rather than basing it on ability to pay, or recommendations from quasi-medical podcasters, wed to their sponsors, shouldn't doctors do the doctoring?
Clearly, we're failing at preventative care, and that failure is multifactorial, with providers shouldering some of the blame. At the minimum, nutrition, exercise, and functional longevity need to be incorporated to medical curricula, and practitioners prioritize prescribing it. Not sure how that happens, unfortunately. So I guess we're left letting the market decide what patients want, even if it may not be what they need.
ETA I see you edited your post. I agree there's a swath of patients who have growth to distrust doctors, and the institution of medicine. I don't know how we reverse that trend, though an emphasis on informed, shared decision making is a good start. I also think we should learn from what works in other countries, which treads too far into political territory for this forum.
