LETTER TO PRESIDENT OBAMA
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From the Desk of Kamau Kokayi MDJanuary 16, 2009
Let me begin this letter by saying thank you for honoring the democratic process and using technology to allow Americans from around the country to share their thoughts and expertise. I am a physician, graduate of Yale Medical College, class of 1982, with completion of a Family Practice Residency and Board Certification in 1985. More importantly I have been largely in private practice for the last twenty three years developing an integrative approach to health care that includes a preventive and multidisciplinary approach to health care.
I have trained in such diverse fields as Chinese and Japanese medicine, classical homeopathy, clinical nutrition, chiropractic and bio energetic healing. For the purpose of this letter it’s important for me to state that I have no ties to the pharmaceutical industry and no vested interest in any product or system of health care. I lecture regularly and have a weekly radio program on Pacifica radio, WBAI 99.5FM in New York. I was formerly a Clinical Assistant Professor of Medicine at Downstate Medical Center where I supervised a medical acupuncture clinic.
I do wish to add my voice to the commentary on the direction that health care needs to take in this country. More specifically I am uncharacteristically prompted to share my thoughts with government at this time because I perceive that change is possible and there is a sense that we need to do things differently.
I do want to commend Barack Obama and the transition team for looking at the general lack of affordability of health care and its growing costs as well as the lack of high value preventive services being provided to the American public. It does appear that a universal health care system will be put in place during the tenure of the Obama-Biden administration so it behooves all of us to look at its philosophy, inclusiveness, and cost very carefully so that we do not create a bigger problem.
The problem with medicine and health care as I see it in this country is three fold. The first is that there will be no end in sight to the rising cost of sick care, not because of inflation or any specific economic index, but because our health care system is ill equipped to uncover and treat illness where there is not a direct cause and effect reaction leading to a disease. If it’s not amenable to surgery or a short round of medication then problems develop and the treatments can be as problematic as the issue in question. Moreover if we do not uncover causes, mitigate against them, and provide tools and incentives for patients, health care practitioners and insurance companies, to address problems at a more causal level we have little chance of containing the expression of illness in a diverse, growing, an increasingly sick population.
The Columbia School of Public Health has stated that 95% of all cancers are directly linked to diet an environmental exposure yet we have not identified and utilized existing therapies that can help rid the body of the over 70,000 largely untested manmade chemicals that Americans are regularly exposed to. We speak about proper diet in the context of preventive medicine but allow foods and additives that have more than questionable value to flood our market place. Allergies, cancer, autoimmune disease and autism are just some of the diseases that are on the rise and there is every indication that their increasing incidence relates to our imbalanced relationship to the environment and the host of chemicals and their unknown combinations and permutations that we have set in motion. A screening test that just tells you whether you have a disease process that has reached a pathological threshold allowing for detection is not enough and must be coupled with programs that are preventive in nature so that people are empowered to assume more responsibility for maintaining their health.
Concepts of detoxification to assist the body in removing chemicals and toxic residues are still not openly discussed in the mainstream of medicine yet such practices have been used by indigenous societies for a millennium. Additionally stress is considered the mother of many illnesses yet there is no reimbursement for programs that show people how to minimize their stress. All of the above are areas that the government needs to address at least by way of incentives and committees for further investigation.
The second major problem that faces the authors of change in health care and health care delivery is the entrenchment of the forces that control and shape major health care policies. In a word there is too much incentive for profit and as we have seen with the financial sector, unregulated industry in a free market economy will focus on increasing the profit margin and not necessarily to the benefit of people. While medicine must be cost effective, the desire to implement profit centers in medical care must be pruned and replaced with a more patient centered focus that builds relationships between health care providers and their clients.
Every aspect of health care delivery and research, from the education of doctors to the things that are deemed worthy of research are impacted by the need to profit. Patients and practitioners are caught in the middle. Most doctors are truly middle income wage earners whose performance and survival has more to do with navigating a bureaucracy and following pharmaceutical company inspired protocols and directives than taking the time to heal people and elevate the science an art of medical practice.
Under the present system of health care the stress level of many doctors far exceeds the patients they are expected to help. Patients are even more confused because of the emphasis being placed on taking medications which they are told in TV commercials may cause serious morbidity and mortality. Consider that nutritional information has come full circle in many quarters from low fat, high CHO diets, to low CHO diets with liberal amounts of fats. The public is confused by these changes. Even cholesterol has come under scrutiny as the risk factor for heart disease. And in the world of fitness the mainstream and its physicians have not caught up to the science of how to effectively approach losing weight with the proper emphasis on strength and resistance training over aerobics.
Moreover the history of the FDA has shown us that it is very difficult to find impartial scientists without compromising links to the pharmaceutical industry. The government elect must explore ways to check the profit motive behind so much of what constitutes medical care and the efforts of insurance companies and pharmaceuticals, while rewarding doctors and care that truly produces measurable results in the lives of patients.
The third major challenge that faces the authors of health care change is that what we are calling universal health care is not universal with respect to the modalities and therapies that it would cover. In the year 2007 the majority of American adults have visited alternative health care practitioners and billions are being spent in this arena. How can we have a universal health care system that does not include these modalities which are subject to critique and regulation from the competing pharmaceutical driven allopathic medical paradigm? There must be a more open system that allows people to find the therapies that most resonate with their needs. If states can license acupuncturists, massage therapists, clinical nutritionists and the like, then these practitioners need to be covered by universal insurance coverage.
The documentation of alternative medicine and its techniques and therapies is also difficult because many of these therapies cannot be evaluated in a double blind placebo based model and outcome studies really reflect the skill of the practitioners involved and need not be a reflection of what the whole field can and cannot do. There needs to be a vetting process that is recognized in the field of alternative medicine, in the same way that there are boards in different disciplines of allopathic medicine. This vetting process needs to take place by recognized authorities and organizations in the respective non allopathic fields.
Essentially all medical practices are applied cultural technologies. Western science represents one way to interface with reality and to develop treatment protocols. While it has been successful in certain areas, especially as it relates to fields where a more mechanistic orientation can deliver results, there are other cultures that have developed medical arts that can treat a wide range of problems more efficaciously than western drugs and surgery. The incorporation of these other systems in an integrative fashion with allopathic medicine would improve treatment outcomes because there would be a broader focus from which to understand and treat the patient.
Plant medicines cannot be ignored and need not be turned into pharmaceutical agents. The Kings of antiquity had their own medicinal gardens and medicinal gardens with simple and well known plant medicines with clear indications for their use. Such plant medicines can be grown locally in community based initiatives.
The community based initiatives are the crux of what I want to address because if we only focus on a delivery system for sick care this country will never improve its health in a meaningful way. In the same way that the president elect was involved at a community level in helping groups of people empower themselves, there is room for the development of community health advocates who fall somewhere in between being barefoot doctors, public health advocates, and personal coaches.
The health practitioners at my radio station have been involved in developing diabetes and hypertension support groups that empower people to come together and share health practices and information that can help them to improve their health conditions beyond the prescription of medications. These support groups have group leaders that are trained by an interdisciplinary team of practitioners and serve as a resource to these leaders.
Of course nutrition is a key factor but some groups have ventured into meditation, Tai Qi and Qi Qong practice, stress reducing medicinal foot soaks, and affirmations. Also group members will share information from on line sources as well as do presentations and review the materials provided by their medical back up team. All of this work has been supported by volunteers but if such efforts were funded this would have a tremendous impact.
From my film work with traditional societies in Africa and my work in communities in this country it’s clear that there are people in every community that naturally gravitate toward the health field and want to be of assistance. Community based leadership programs could serve as a good entry point into the health field with educational and financial incentives given to those showing a commitment and ability to effectively engage people. Associated with this effort is the idea of neighborhood gardens being developed for organic food production as well as medicinal plants.
Our communities need to reflect more the message of vibrant health and people caring about people. I would suggest the funding of pilot programs in rural, urban and suburban areas. A multidisciplinary team of practitioners with local ties would be the main spearheads in each community. The best way to determine who are the health practitioners or clinics making a difference is to survey the people in a particular area rather than focus on particular titles or the expected institutions.
The team would create and evaluate all the possible ways to implement change and get community involvement through support groups, growing groups and at the very least conversations about their health and how to improve it. There could be any number of incentives developed for community participation since essentially this would be a government sponsored program. This is my suggestion toward building a primary health care system from the community level up. Doctors in clinics just aren’t in a position to spearhead such community based programs and create the incentives and connections needed to change the health of a community.
I realize that the Barack Obama administration will have some heavy duty challenges to face in the upcoming years. I am hoping that the universal health care that is created is inclusive enough of therapies and modalities that truly take us from being a population that is medicated to one that is being healed. All the best and I am available to fill in any details with respect to points that I have raised.
Respectfully,
Kamau Kokayi, MD
448 West 57th Street
New York, NY 10019
212-792-6010
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