"Nothing in Biology Makes Sense Except in the Light of Evolution" is a 1973 essay by the evolutionary biologist and Russian Orthodox Christian Theodosius Dobzhansky.
What this means for medicine is that all organisms are adapted to survive and thrive in a particular environment and when that environment changes faster than an organism can adapt, there is a mismatch that occurs and disease starts to develop.
We are experiencing a fast increasing rate are chronic inflammatory diseases as well as drug resistant diseases. 1 in 2 children have some sort of chronic illness. Autism has doubled since year 2000, almost 20% of children between age 6 and 11 are overweight, over a billion of people around the world suffer from diabetes and obesity combined, depression increases by 20% every year and all of this is not just because of increased detection and diagnosis.
According to the Kings Fund, about 15 million people in England have a long-term condition. Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example: diabetes, chronic obstructive pulmonary disease, arthritis, hypertension, depression. Drugs rarely address the real problem. Typically they suppress symptoms but also suppress important functions like blood flow to an inflammed area which means less nutrients and immune substances for tissue repair as in the case of taking Ibuprofen for pain relief.
To understand how we have become a culture of sick, obese and unhappy people riddled with chronic inflammatory diseases it helps to understand the evolution of medicine and culture.
Modern scientific medicine and laboratory science are very new in terms of evolution. Penicillin has only been around for about 100 years. Scientific medicine was created as a reaction to acute infections and traumas which were prevalent in the 19th and early 20th century.
There is no doubt we have achieved tremendous improvements in emergency medicine and trauma care. We can re-attach limbs, restore sight to the blind and many other amazing things thanks to stem cell therapy and nano-robots but at the other end of the spectrum our medical system is incapable of providing real healing for the chronically ill. According to the president of Imperial College London, there is conclusive evidence that antibiotic resistant diseases are a real threat to our nations health. In terms of evolution we may actually be part of a very small generation where antibiotics actually worked.
The design of a system that works for chronic diseases cannot develop out of the same thinking that produced our present medical system which was created for acute diseases. Instead of being reactive and prescriptive, the system for treating chronic diseases needs to be proactive and engaging.
Instead of focusing on a specific diagnosis and target the disease, professionals need to be trained to offer proactive treatment, engage the patient and the community and inspire behaviour change on a wide scale. Patients and communities are in my experience the most overlooked but most important renewable and sustainable resource. As professionals we need to learn how to access and engage this most important and abundant resource.
While thinking about ways of motivating and inspiring behaviour change that scales I came across Shilpa Saxena pioneering work at the Cleveland Clinic in the US. To get to the underlying cause of a chronic disease she teaches professionals to go on group visits. She also promotes the training of health coaches who are trained in functional medicine and have a good general understanding of nutrition, psychology, exercise and other natural healing methods. She recognises the power of vulnerability in peer groups and how vulnerability inspires connection and trust which is a powerful resource for behaviour change.
Please get in touch if you are interested in learning more about group visits and how this could help to transform the way we do healthcare.