How Can We Navigate the Wellness Craze for Our Patients?

\r\nHe has published in several medical journals, including recent research on use disparities in telehealth visits & effective community outreach interventions to encourage COVID vaccination. His weekly MedPage Today column, \u201cBuilding the Patient-Centered Medical Home,\u201d focuses on improving patient care.<\/p>“,”affiliation”:””,”credential”:”MD”,”url_identifier”:”fp4223″,”avatar_url”:”https:\/\/assets.medpagetoday.net\/media\/images\/author\/Pelzman_330px.png”,”avatar_alt_text”:”Fred Pelzman”,”twitter”:””,”links”:null,”has_author_page”:1,”byline”:”Contributing Writer, MedPage Today”,”full_name”:”Fred Pelzman”,”title”:”Contributing Writer, MedPage Today, “,”url”:”https:\/\/www.medpagetoday.com\/people\/fp4223\/fred-pelzman”,”bluesky”:””}]”/>

How do we reconcile the explosion of longevity and wellness businesses in healthcare, with the woefully inadequate healthcare delivery system we have that fails to provide the basic fundamentals that we know can help people live longer and better lives?

Right now, much of the stuff out there belongs to people who can afford it, the ultra-wealthy who are willing to pay tens of thousands of dollars or more for sometimes wacky treatments with little or no scientific evidence to back them up.

Red light therapies, cold plunges and other cryotherapies, all sorts of electrical and other stimulation devices, a vast array of supplements and vitamins, complex new ways to do something as simple as eating, all are pushed online through social media influencers and other peddlers to convince patients that this is the way to lead a longer and healthier life.

Some of this stuff likely has some scientific merit, some real-world evidence to show some modest benefits, and much of it probably can’t hurt and may have a strong placebo effect. When patients ask me about some of these therapies, I can try to find out if there is any evidence to support their use, and their safety and efficacy, but it often feels like patients are doing this stuff anyway, often without doing so many of the other things we think they really do need to do.

The basics of making sure all your vaccines are up-to-date, your cancer and other screening tests are done, you’re not smoking, moderating your alcohol intake, keeping hydrated, getting good and adequate sleep, engaging in regular physical exercise, doing things to keep yourself cognitively and emotionally intact, having social interactions to build connections to one another, all probably do more to keep a person healthy than all of the medicines I have to prescribe, all the treatments we have for diseases once they have already ravaged our patients, and certainly more than many of these lifestyle longevity and wellness interventions that people are so readily doing.

We live in a society where people who have the resources will always turn to do the things that make promises to help them beat the odds, give them that extra edge, but when they do these without doing everything else that we know works, it seems like a waste of time, effort, energy, and money.

Just like for all of the social determinants of health, if we had the resources to make sure our patients had access to good housing, a decent education, safe communities, clean drinking water, a well-paying job with which they can support their family, ready access to good fresh and nutritious foods, robust prenatal care, and all the basics of a truly comprehensive and inclusive healthcare system, we might not need to try and eke out the extra bits that longevity interventions seem to promise.

But even those who can afford these basics, who have the insurance and the finances to make all of this happen, don’t always do it.

Most people don’t really need to take extra vitamins if they are eating a balanced and nutritious diet; I once heard someone describe taking mega doses of vitamins as creating expensive urine. And most people shouldn’t use taking a statin as a license to eat cheeseburgers.

But the divide between the haves and the have-nots in our society results in people that are even more desirous of pushing the edges of the envelope, finding that last little bit that can help them live longer and avoid the ravages of age, disease, and even death. And the have-nots, through no fault of their own, are denied the basics, and probably can’t even think about getting these extras that cost so much more.

In a capitalist society there will always be those who prey on the desires of people to avoid illness and live longer, and it’s just a question of making sure that everybody has the nuts and bolts of a foundational healthcare system to give folks an equitable field on which to play.

Some of this stuff may be snake oil, some of it may be miraculous, and maybe one day instead of prescribing the medicines and surgeries we do now we’ll be offering up a whole different realm of treatments to our patients. And we have to admit that even our best treatment therapies, such as medications to control diabetes, high blood pressure, heart disease, and cancers, still don’t treat the individual patient, but are studied in populations of people like them, and that a certain number of patients like them may have the benefits seen in these studies, but they themselves may not.

Maybe someday we’ll get to a point where everybody is given the resources by our society that they need to get those basics done, and then equally have access to this newer stuff, that may give a little benefit around the margins. Right now, it feels like there are too many entrenched interests fighting against us to make this happen, whether it’s the bureaucracies of the federal government or the interests of insurance companies and healthcare systems, but over time it feels like we’re slipping in the wrong direction, away from truly patient-centered care that gives every patient the right care at the right time.

We have to reach out to our patients where they are, in their communities, in their homes, and in their lives where they’re struggling, and if we can apply all of the basics equitably, then everyone will be on a better footing.

Then we can begin to look towards these longevity and wellness frills to enhance and extend and improve the lives of everybody, rather than just the few that can afford them.