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Achieving and maintaining optimum health is a philosophy; a way of life; a life style. It means commitment to the best health possible for each individual, every family and the community. It starts with individuals giving careful and continuous thought to the concept of health for themselves and the community. Education, personal and community values, belief systems, art, religion and spiritual life prepare individuals for this task. Socioeconomic culture plays a role through the influence of personal interaction and the impact of business and finances on decisions and choices. Good health is as much a group activity as it is individual responsibility. The thoughts and ideas of a society determine what actions the society performs.

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Knowledge, beliefs and faith are a triad of human existence and relations between them are complex. Beliefs do not have to be true or rational and they might not respond to knowledge which itself might change with new information. Terry Eagleton observed that "faith is not primarily a belief that something exists, but a commitment and allegiance - faith in something that might make a difference to the frightful situation in which you find yourself." (Terry Eagleton, Reason, Faith, and Revolution: Reflections on the God Debate, Yale University Press, New Haven and London, 2009) Because knowledge is limited and the unknown vast, human behavior is based substantially upon beliefs and faith.

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From the laboratory to the clinical setting to everyday life, data are gathered, analyzed, interpreted and organized to reach conclusions that shape medical care. The conclusions are reached in a context of biological variability, biological adaptability and behavioral uncertainty. Every step is subject to error, bias and ignorance. The unknown vastly exceeds the known and the boundary between the two moves slowly and erratically revealing contingent truths subject to additional unknowns. Advancement in science and medical care is at all times a work in progress and whether or not it is oversold, it is overbought. The paradox in medical care is that progress increases risk for untoward outcomes due to the increasing sophistication of technology, the advancing level of biomedical intervention and the demand for rapid deployment.

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Public support of research in biomedical sciences and expansion of medical care comes with high expectations that frequently bear no relation to the nature and status of those endeavors. The public is interested in cures and they are conditioned to expect what they want to be true, which is misunderstood and overstated. If the current utilization and costs of medical care are justified, we are a sick population indeed. Should that be the case, the sustained growth in medical care speaks to the limited ability for it to cure or prevent illness and disease. Or, perhaps the fear of sickness overwhelms trust in the pursuit of good health. If so, it would be a conditioned response.

The hope for cures fuels the growth of medical care. But the hope for cures has given way to long-term maintenance therapy yielding chronic health problems with the possibility of discovering a cure in the future. Chronic diseases are generalized throughout the body but often manifest around an organ system. Practitioners have concentrated upon organ systems in order to increase their level of expertise. Application of specialty expertise for diagnosis and treatment involves technology that can be documented as applied. Regardless of whether there is benefit, the documentation assures payment. That is the basis for a medical care industry which has overwhelmed the personal interaction at the core of medical practice and usurped consideration of life styles as the primary pathway to optimum health.

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For sixty years following World War II large sums of money were spent on biomedical research. The expanding body of knowledge in science and technology required a conceptual framework for utilization. Society responded by giving preference to the quest for cures over the quest for good health and focused upon treating sickness to protect health.

Medical care is an action oriented response to sickness. It relies upon the expertise of certified professionals to diagnose and manage illness, disease, injury and disability as they occur in each individual patient. The expanding influence of commerce and politics created a medical care industry that surrounds and shapes the professional core of medical care to favor diagnosis and treatment of illness, disease, injury and disability over achieving and maintaining optimum health. In that context the dominant national mind-set for health became the response to sickness.

More Health for the Care, continued

I come to praise medical care, not to defend it. The praise is justified for providing relief of pain and suffering, for saving lives of the injured, for rehabilitation of the sick and disabled, for amelioration of chronic disease processes, for participating in the increase of life expectancy and for expanding the boundaries of knowledge for the biomedical sciences. But there is no defense against expectations and demands for results beyond the current capabilities of medical care. Nor is there a rationale for failing to learn and live the life styles that shape and support the pathways to good health.

More Health for the Care-Not Without Honor

Friends, Americans, patients, come lend me your ears:
I come to praise medical care, not to defend it.
The evil in society is amplified and repeated;
The good often retreats from high expectations;
So let it be with medical care. The noble body politic
Has told you medical care is too costly:
If it is so, it is a grievous fault,
And grievously medical care answers for it.
(Here under leave of the body politic and the rest -
For the body politic are honorable people;
So are they all honorable people)
I come to speak in medical cares dark hour,
The practice of medicine has served me well:
But the body politic says it is too costly;
And the body politic is composed of honorable people.
Medical care has relieved many physical ills,
Bringing comfort to society's members:
Did this in medical care seem too costly?
When that the sick had cried, medical care agonized.
Affluence should be made of sterner stuff:
Yet the body politic says medical care is too costly,
And the body politic is composed of honorable people.
You all did see that in the halls of government
Diseases are given costly crowns,
And health is forsaken: what nod to cost is this?
Yet the body politic says medical care is too costly,
And, sure, they are honorable people.
I speak not to disprove what the body politic spoke,
But I am here to speak what I do know.
You all did love medical care, not without cause:
What cause withholds you then to appreciate it now?
O judgment! Thou art fled to brutish beasts,
And people have lost their reason! Bear with me;
My heart is in sympathy with medical care.
But lest I forget,
Medical care is not everything in health;
It is not most of health or the first thing in health;
It is the last thing when health fails;
It is the response to illness, disease, injury and disability.
America expects more,
But must learn to achieve it.
(With thanks to William Shakespeare, Julius Caesar)