What Does Sustainable Health Care Look Like?

Such a system must include a diverse mix of affordable options

Editor’s note: First in a seven-part series about creating a sustainable health-care system for Rhode Island.

By KARINA LUTZ/ecoRI News contributor

With all of the hubbub about the Affordable Health Care Act rollout, some have been quietly asking: What would a sustainable health-care system look like? To explore this question, and profile some of Rhode Island’s unsung sustainable health-care advocates and practitioners, ecoRI News takes an in-depth look at the topic in a seven-part series.

Environmentalists often look at health-care issues through the lens of the Hippocratic precept: “First, do no harm.” We focus environmental health efforts on avoiding pollution that will cause disease, such as lead poisoning or the climate change-greased spread of pathogens. And we love to promote double-lever direct actions, such as eating organic food, which protects wildlife and humans from toxins at farm and table, or riding a bicycle, which avoids generating car exhaust while exercising the body.

On a deeper level, it’s clear human health ultimately depends on a healthy environment. As the Hospitals for a Healthy Environment in Rhode Island (H2ERI) website reads: “It is hard to support healthy life in a sick planet. The healthcare community is beginning to realize that healing our bodies also requires healing our environment and our communities."

H2ERI join groups like Health Care without Harm in efforts to reduce medical waste and other causes of environmental harm within the health-care system.

The current globalized medical system’s treatments cause harm to patients, too, either unintentionally or by way of broken systems that reward bad science — the FDA relying on pharmaceutical companies’ own clinical trials for drug safety data, for instance — or reinforce fixes more than prevention (when someone makes more money off the fix).

Properly prescribed prescription medications apparently cause over 100,000 deaths a year, according to reports, to say nothing of improper prescriptions, over-the-counter medications and intentional abuse.

Pharmaceuticals can pollute our waters even after moving through our bodies. In spite of their obsession with killing pathogens — in fact, partially due to this hyper-hygiene — hospitals have become breeding grounds for antibiotic-resistant superbugs. Preventable deaths in U.S. hospitals have reached an alarming 210,000-400,000 a year, according to a recent study. Even veterinary care is causing pathology: factory farms are breeding antibiotic-resistant pathogens, such as E. coli, staph, campylobacter and salmonella.

Clearly, insurance and delivery aren’t the only systems broken in health care. But they are a part of the problem, and one people in Rhode Island are working to improve. We will highlight one of Rhode Island's pioneers in health-care affordability, Dr. Michael Fine. Using the classic Brundtland Commission definition of sustainability — “Meet the needs of current generations without compromising the ability of future generations to meet their own needs.” — health care can't be sustainable without better meeting the needs of the present as well.

All the practitioners interviewed for this series insisted they aren’t against Western medicine, and are in fact interested in collaboration. But ...

The buts were many: but it’s too reductionist, never holistic; but there is too much profit motive; but the FDA is corrupt or structurally flawed; but the American Medical Association (AMA) jealously hoards control over medicine and has never really stopped witch-hunting.

Meanwhile, all agreed that Western medicine is remarkably good at some things, particularly life extension and acute care. (Whether life extension is always good, as in the case of heart medicine given to Alzheimer’s patients, is rarely addressed.)

Many are working to advance integrative health care — holistic and allopathic modes working together. To choose the best of each, in a sustainable mix, is unclear. One conundrum is that always choosing the lowest-footprint modality first, to see if it works, may lose valuable time in cases where time is critical. So while a toxic medicine may do more harm than good for the same disease that can be cured or soothed by diet and herbs, surgery may have saved the life of someone who dithered around with ineffective natural treatments before getting to the hospital.

But with insufficient unbiased science to compare the effectiveness of radically different approaches, we'll have to muddle toward sustainability, and depend upon the intuition, experience and good sense of all our healing arts practitioners, and patients.

Meanwhile, we offer these profiles of a few people who have been quietly working toward more sustainable methods — whether naming them as such or not — here in Rhode Island.