We Cannot Manage What We Do Not Measure

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Pay attention to the whimper or be forced to cry uncle. Those are your choices. Those were the choices that faced the nation ten and twenty years ago as naysayers to the economic policies certain to bankrupt our country became evident, but they were ignored or lambasted as fringe. The collective wisdom forged forward with derivatives, with the merging of investment and saving banks, against the whimpers of many, only to cry uncle in 2008 as the catastrophe loomed.

As the ‘other 99%’ seek to realign our political and economic situations, women must lead the changes in the health industry. We must pay attention to the whimpers, to the evidence that something is off, and more importantly, we must take heed before uncle is cried. How do we do that within such a flawed system of industrialized, profit-based medicine? Education, measurement, transparency and responsibility.

Education. The number one factor contributing to health is education. The more educated women (and men) are the better health they experience. Why? Better decision-making. Although there are clear associations between income and health, the association between education and health is stronger.

Education allows one to navigate the morass of medical marketing, cut to the truth, and identify the untruth in advertising. Education permits women the confidence to seek alternate directions in health and not simply take what is prescribed to them as gospel. Quite simply, education permits responsibility in health choices. It doesn’t necessarily lead to taking responsibility or making the right choices; we’ve all seen really smart, highly educated people do really stupid things. Rather, education creates the environment where those choices can be made.

Nowhere is this more critical than in our modern pharmaceutically-based symptom management approach to health. As is evident by the personal hormone health stories highlighted in this blog, without a basic understanding of physiology, biochemistry and endocrinology, many women face years of mis-diagnosis, over medication, and general ill-health. In some cases, the suffering is enormous and even deadly.

Measurement. We cannot manage what we do not measure. Ladies, we would not run our businesses or our households without some sort of accounting system. Why do we accept the management of our health, absent data or measurement? Remember, only 30% of Ob/Gyn clinical practice guidelines are based on data and evidence . Imagine if we ran our household or business budget accounting for only 30% of the transactions- we’d be broke in no time. Worse yet, the other 70% of medical decision making, guided by consensus and expert opinion, may be bought and paid for by companies with a vested interest in selling us their products or services. This is the state of medicine today. This is why we do not hear the whimpers of ill-health (5-10 years of suffering before diagnosis is common for many Gyn conditions). Without metrics or basic accounting, it is difficult to do anything other than treat the symptoms and wait for the cry of ‘uncle’.

Transparency. Mischief thrives in the dark. Think derivatives. Think off-book accounting. Think a ridiculously convoluted regulatory environment that permits collusion of politics and money to hide actual data. The lack of transparency in banking and policy is rife with examples of purposely muffled whimpers that disallow us from heading the warnings of catastrophe. So to, is the health industry; a gargantuan, purposefully opaque, mega-marketing machine that privatizes data and hides the evidence of ill-health and adverse events.

From a personal perspective, your health data belong to you. Arguments to the contrary are based upon fear and retention of power. Moreover, your health data ought to be in a format that is readily useable for you and your doctor, not the endless stack of papers from multiple labs, doctors, and other providers. This antiquated and overly convoluted format prohibits integration of information, pattern recognition, and understanding. This must be changed.

From the public’s perspective, research data and clinical trials data ought to be readily available, not hidden behind subscription based journals that only Universities can afford. How can we evaluate the research if we don’t have access? We can’t.

Responsibility. The current system is setup to eschew personal and corporate responsibility to health (ethics too, but that’s another discussion).

By codifying the notion that only the experts can make decisions; by preventing or failing to measure key health variables; by hiding research either via outright deception (think DES, Vioxx, and more recently Yaz/Yasmin), mega-marketing, or behind the ivory towers of academia; by preventing patient access to their own records or keeping those records in such disarray that they become useless; we sever the connection between action and reaction. Responsibility does not and cannot exist under these circumstances.

We must reclaim control over our own health and the health industry.

Next time you see your doctor and have your hormones measured, ask for your lab reports. Take a look at the reference ranges. Notice anything? You should, they are huge. Ask how normal was established and is interpreted. Next time you are prescribed an oral contraceptive for non contraceptive purposes, ask about the evidence supporting this decision. Have a frank discussion about what these tests and medications mean for your health. If you’re not satisfied with the answers, do something about it. Learn; ask more questions. Next time you have symptoms or hear the whimpers of your body, pay attention.

Become the expert in your own health, and then share your expertise with other women.

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