Medicine is a multi-faceted and complex field, made even more complex by political and social realities which influence our health and our access to healthcare.
Usually, when we think of medicine we think about it straightforwardly, however. We think about going to the doctor or hospital, being prescribed some medicine or undergoing some treatment or procedure, and then returning home afterwards. The reality is not so simple.
Even in the example I gave, there are a number of questions to be asked such as: How do you get to the hospital? (transportation), how do you pay for the medicine? (pharmacare) what led you to be in need of treatment in the first place? (socio-economic conditions, random chance, social determinants of health) once you return home, do you have a carer or are you well enough to continue your own treatment? what, if any, follow up procedures will there be and why?
Even beyond this question and situations, things become so messy so fast when you figure in things like disability, chronic pain, palliative care, mental health care, addiction, and so on. These things seem so disparate and require so many different kinds of treatment, which leads me to beg the question, should medicine even really be about “treatment” at all?
Some recent headlines have touted so-called “new” prescriptions, where doctors are able to mandate that their patients get out into the community and engage socially in things like art.
I am not opposed to these things, quite the opposite. There is good evidence that not all of our “illnesses” can be fixed by a visit to the doctor and some medicine, but there are also reasons that we might be suspicious of this similar kind of bandaid fix, when what might be required is something like a stable source of income and a home environment that is safe and secure.
So what is medicine’s role in a world where medicine simply cannot treat all problems, even problems that result in medical ills that need treatment? Is medicine’s role even to treat illness, or should it be something else entirely?
In some ways, medicine already does do more than treat illness. Healthcare providers are often charged with educating their patients on so-called preventative healthcare measures such as eating well, dieting, quitting smoking, etc. In the broader sphere, orthodontists exist not only to correct potentially inhibiting oral healthcare needs such as overbites, but also to make faces more socially pleasing and therefore more likely to be successful (which, given the lack of public funding for such interventions, is it’s own can of worms). Similarly, mental health care providers may provide therapy to those without diagnosed illnesses, or to those who have experienced trauma which is caused by some external circumstance rather than an underlying condition. Finally, at the end of life, we provide palliative care, pain management, and housing to elderly patients even if there is no suggestion that a treatment at that point is either possible.
In all these cases, it seems that medicine is already going beyond the goals of “treatment” and into something more, something that doesn’t just make people better, but helps them live better lives. This is a good thing, especially because in some cases, framing things as “illnesses” when they are not, merely so that healthcare resources can go to a group in need, can be extremely damaging. This is apparent when it comes to issues of disability.
In previous posts, I have dissected various aspects of disability, and why it doesn’t make sense to understand disability as a purely medical issue. Individuals with disabilities deserve funding not just to “cure” them, but also to allow them access to resources that will let them live valuable lives that they choose for themselves.
Is a prosthetic that lets a person, for example, put on makeup, a “treatment”? Well, maybe, we if think about treatment in the way that doctors prescribing visits to art museums do. Makeup can be an important part of how people see themselves, their creative expression, and can be part of participating in society. In that way, being able to apply makeup can be very beneficial to someone’s mental health and holistic well-being.
On the other hand, thinking about this kind of prosthetic as a “treatment” means re-conceptualizing that persons’ disability again as an illness. It implies a wrongness that needs rectifying, as opposed to something of neutral value such as say, a step stool, that allows them to participate in an activity and part of public life that they enjoy.
There is definite push-back to conceptualizing medicine this way, and many of the criticisms of this kind of standpoint essentially comes down to: where do we draw the line?/Who pays for it?
And to those people I say: I am a dirty fucking socialist, and there is good evidence that we will save money in the long run if people are healthy and happy, and that means whole, big picture health. I also understand that not everything can happen all at once. For now, I’d be happy if we could just goddamn get some decent pharma and mental health care.
But for the rest of you dreamers out there, I ask you, I challenge you to figure out:
What does healthy look like for me?
Can the healthcare system help me with those goals? How?
In many ways, health is a means to an end- the end being a good life, so let’s just skip the middleman and get there already.