Millenium Editorial:

Self Care and Cognitive Enhancement

If present trends continue, the 21st century will likely be very different from the 20th century. The creation and utilization of new technologies, which have characterized the twentieth century, still appear to be accelerating at an exponential rate. This ever-increasing rate of discovery and technological change will pose challenges to individuals and institutions alike.

The message within the traditional Chinese curse, “May you live in interesting times,” suggests that change offers both opportunity and danger. In many important ways, the new opportunities facing us are increasingly tied to how we use our brains and minds (as opposed to our brawn). For example, how can we effectively learn new things in middle and older ages? This issue was already becoming important in the 20th century, and will only become more so during the 21st. How can we better recognize the opportunities inherent in change? How can we enhance our personal productivity to better accumulate value (in terms of both wisdom and wealth)? And on the other side of the curse, how do we avoid the dangers of maladaptation to change? Maladaptation can occur in individuals, on both physiological and psychological levels. Or it can be a public problem, on social or institutional levels. The adaptability of individuals and institutions varies widely.

To a very real extent, these are personal questions that require individual answers. But there are also personal questions that are difficult for individuals to answer. How do we deal with the incumbent health problems that arise from our slow drift away from the “wild” environment to which we are genetically adapted? Can we recognize the long-term consequences of exposure to electromagnetic fields, the use of plastics and mercury amalgam dental fillings, of consumption of engineered, processed and refined foodstuffs that cause trace mineral depletion? Can we cope with decreased fertility, hyper and hypoimmunity, and developmental changes in our children?

While to some extent these are rhetorical questions, they do get back to my earlier point about adaptation. We adapt to stress and change on two very different levels. We deal with it personally, as individuals, and we deal with it institutionally. Even institutions can be subdivided into two groups, personal institutions like relationships, families, and communities, in which we choose to belong, and impersonal institutions, like big business and government, with which many of us merely coexist. The capacity for adaptation is very different between these categories.

These distinctions are important where empowerment is considered. People have considerable personal power in their individual lives, and in their relationships with their families and friends. Consequences of decisions and actions tend to be immediate, and therefore feedback is effective. I would also say that most people are empowered in their churches, community groups, small businesses and special interest groups. Although decisions and actions are slower and feedback is delayed, such groups tend to respond and adapt to change in a reasonably functional manner (i.e., we stay in them).

However, the same cannot be said for large corporations and big governments. Many people feel disempowered and alienated by institutions that are larger than families and communities. The impersonal relationships and lack of accountability in such institutions makes then significantly dysfunctional in their ability to adapt to change. I suggest that “modern” (orthodox) medicine is suffering from exactly this kind of dysfunction.

Although biosciences may be advancing rapidly, the same cannot be said for the practice of medicine. While scientific discovery may be significantly unfettered by regulatory institutions, medical practice is severely restricted by medical licensing institutions. Regulatory concepts like “the standard of care” and the newer and more insidious “practice guidelines” have mired medical practice in a pit of mediocrity that victimizes so many people so frequently that we accept it without debate. The idea that health is far too important to be allowed to suffer the risks of innovation is a rationalization not a reason. The exact oposite is true. Health is far too important to be condemned to dysregulation (dysfunctional regulation) at the hands of anticompetitive institutions that deliberately bypass the issue of patient welfare.

Let’s be completely clear about this last point. Medical boards do not now consider whether a non-standard medical practice does or does not benefit the patient more than a standard practice. If it is not the standard of care, the doctor is disciplinable. It is that simple.

Take the case of professor and physician Robert Sinaico, who lost his license at the hands of the California Medical Board because he did not treat his attention-deficit-disorder patients (children) with Ritalin. As you might guess, such regulatory practices are a prescription for conformity, not excellence — for stagnation, not advancement.

If we applied such principles to business and industry, we would necessarily sacrifice competition and innovation. We would end up with a kind of “guild” system that was dominant during the economically, culturally and politically stagnant Middle Ages. Imagine what would happen if we set up a “standard of tires” and took away the licenses of manufacturers that exceeded that standard. There would be no belted tires, no radial tires, no high-speed tires, and no special-duty tires. There would only be one standard, and all tires would be expected to match that standard.

Would we like that? Would we accept that?

Before you answer no, try to imagine what you might think 1) if you didn’t know about aramid-belted radial-ply tires, and 2) if you had been told all your life that the “standard of tires” was necessary to save lives on the road, and 3) that it protected consumers from unscrupulous manufacturers of substandard tires? Wouldn’t that sound like a good thing?

It is a political reality that the standard-of-care concept has been so well sold to the public, politicians and media that it is not even an issue for discussion. Just as with the war on drugs, Democrats and Republicans alike agree that this is “a good thing.”

The “standard of care” certainly does not survive by consumer pressure. Dr. Sinaico’s patients and their families were extremely distraught by Dr. Sinaico’s delicensure. Here they had finally found a physician who had given them better results than all the physicians before, and he is taken from them by the California Medical Board, at the behest of Dr. Sinaico’s competitors (i.e., the former physicians of Dr. Sinaico’s patients). The testimony of his patients and his physician peers was ignored. The standard of care was Ritalin. That’s all that mattered.

Who defined the standard of care in the Sinaico case? Other physicians. Which physicians in particular? The physicians who use Ritalin. Those physicians who didn’t use Ritalin and didn’t approve of using Ritalin were not allowed to contest this standard of care nor to define a different standard of care. It didn’t even matter that more physicians testified against Ritalin than for Ritalin, and for Dr. Sinaico than against him. Consumer interests, patient welfare, and scientific and medical evidence of efficacy were and are moot issues.

The Health-Care Lag

One of the consequences of this kind of medical dysregulation is an ever increasing lag between knowledge and practice. The systematic dismissal of nutrition education in medical schools during the 50s, 60s and 70s created such profound ignorance among orthodox medical practitioners that consumers were driven in droves to alternative practitioners. Medical institutions were so rigid, so intransigent and so out of touch with their clients needs that consumer spending for alternative (innovative) medical services reached an all-time high during the 1990s. When it became obvious that serious money was involved, medical institutions suddenly “woke up” and started making token statements about bringing alternative practice into the mainstream. Despite these token gestures, orthodox medicine remains just as deeply entrenched in marginal pharmacological modalities.

I think there is a good chance that this gap between knowledge and practice will begin to close during the first decades of the 21st century. First, the economic burden of delivering purposefully substandard care is becoming intolerable to a variety of influential institutions. Second, consumer access to knowledge about medical alternatives is now wide open, thanks to the Internet. And third, so many doctors have defected into a variety of alternative practices that it has become logistically impossible for medical boards to discipline them all. De-facto, the standard of care is now in a state of flux. Regulatorily, it is still completely in the eye of the beholder.

Personal Empowerment

The good news is that the dysfunctional adaptive abilities of the medical profession and governmental institutions have not yet effectively restricted individual access to modern, innovative self-care options in the United States. The bad news is that the world-wide trend in consumer access to self-care modalities is going exactly the opposite direction. The governments of Switzerland, Germany, France, Greece, Finland, Norway, Spain and Italy have already implemented Draconian (or even Naziesque) regulations denying public access to dietary supplements (see sidebar).

Access to supplements and pharmaceuticals offer individuals new approaches to health-enhancement that are becoming increasingly important as the pace of change increases.Although the development of new technologies may be favored by increased intelligence, the utilization of new technologies is much more limited by our abilities to learn than our intelligence per se. Keeping the brain youthful (plastic) and functional (metabolically efficient) facilitates learning, creativity, and emotional flexibility at older ages. It postpones the debilities of aging.

In the 20th century, it was common that a person learned only one job during their lifetime. At the close of the 20th century, a significant number of people have begun to change careers midlife. Such individuals have been able to maintain their learning abilities into their older ages to a degree that would have raised eyebrows 100 years ago. This can now be cultivated with cognitive-enhancement tools that we have only begun to explore in depth. During the 21st century, changing careers may become commonplace.

Within technologically advancing fields, learning ability is already a prerequisite for a career. Computer programming skills of 20 years ago are seriously outdated today. Scientific techniques for investigating immunology, genetics, biochemical metabolism and the role of free radicals, in both degenerative disease and healthy metabolism have replaced techniques of ten to twenty years ago. Sustained learning into middle and older ages has become a matter of survival.

The pace of change is so fast that many patients now know more about specific aspects of their disease conditions than their physicians. This is not due to any fundamental difference in access to information, but in a difference in the motivation to learn. Medical doctors have immense pressures to deliver services, and this decreases the relative priority of learning. Patients, on the other hand, have strong incentives to learn everything they can about their malady, and often have large amounts of time to indulge that incentive. With a narrow focus and ample time, patients are able to assimilate information more completely than their physicians, who must maintain a necessarily broad focus to their educational pursuits.

How will medicine adapt to these kinds of pressures? What will medicine of the future be like? How will future health-care institutions be different if we 1) maintain our nutritional freedom, or 2) lose it to the Codex conspiracy? Please think about it.