Beyond the pills: take care in addition to treat | Science

Beyond the pills: take care in addition to treat | Science

Obesity, diabetes, anxiety, depression, stress … They are just some of the ills of our time that are increasing in recent years and that are expected to continue rising over the coming decades. Although Western societies allow us to live with life's hopes never before seen in the history of humanity, they also make us sick. Our western world is, paradoxically and at the same time, protective and hostile to different facets of our health. Thus, while our society has drastically reduced infant mortality or mortality from infectious diseases or cancer (thanks to multiple health advances from different fronts), a series of circumstances have also been created that favor the development of the diseases mentioned at the beginning. .

The accelerated pace of current life, long days at work with little family reconciliation, job and economic precariousness, lack of time to exercise or establish close social relationships with others, a diet rich in processed products and sugar. .. They are social factors that play an essential role in the emergence of various diseases. Beyond the biological causes of diseases, there are also psychological and social causes. Infiltrated in our culture, traditions and customs and, often, ignored by a society that looks for simple and quick solutions to their health problems. As they say, the zip code is more important to our health than our genetic code. Even so, in spite of the fact that socio-economic factors can influence40% in the health results of the population, are still the forgotten ones of current medicine.

Frequently, patients with certain health problems who come to consult do not really need a doctor, but even a union, a lawyer, a confessor, a friend… Unfortunately, our health care system is designed primarily for doctors to solve the biological causes of diseases, but little for psychological causes and practically nothing for social causes. When family doctors have only 5-10 minutes per patient, on average, it is very difficult to treat something beyond biological causes. Thus, the specific campaigns of public health and social services play a certain role to act where the doctor can not for lack of time and means. Even so, the scope is limited and does not reach all those who need it.

Often, medications become temporary or chronic patches that keep the symptoms of disease at bay, without really addressing the causes. Medicalizing health problems that really require a different and more complex therapeutic approach, direct to the root of the problem. Thus, for example, when Manuel goes to the doctor with a fracture in a leg bone, the treatment is not limited to analgesics exclusively to relieve pain. You have to solve the cause, which is the fracture, by surgery and other treatments. Not doing so would be considered a medical malpractice.

However, when diseases have a very clear psychological and social origin, treatment rarely reaches the cause. Imagine, for example, María, with a precarious official job that forces her to work in black elsewhere to make ends meet, at the expense of spending her days working without respite. Maria also has the constant anxiety that the bank will evict her from her apartment because, sometimes, she must choose between eating and giving her son the minimum necessary or paying the mortgage payments. As a result, Maria has been suffering from chronic anxiety for more than a year and her medical treatment is limited to anxiolytics (benzodiazepines) although, in theory, she should have stopped taking them long ago.

The main cause of Maria's anxiety is not biological, but social. Even so, medical treatment is limited to relief of symptoms. Because free access to social security psychologists is very complicated and because Maria has not been informed about the anti-suicide groups that could take care of her and help her, giving her psychological, moral, legal and resource support in the face of her main life anxiety. And it is a real pity, for Maria and for all those people for whom the care would be much more curative and cost-effective than medical treatments with pills.

Health conscious

Despite the difficulties and barriers imposed by our health system, there are highly conscious health professionals committed to the motto "take care as well as treat". Within their possibilities, they create initiatives focused on going beyond conventional medical treatments, to taking care of populations. A ambitious campaign, committed to this idea, is taking place in Asturias, thanks to Observatory of Health of this autonomous community. Their main missions are, on the one hand, to study and publicize the health characteristics of populations in Asturias with a focus on social factors in health. Thus, it is possible to design optimized strategies to address the social causes of diseases. On the other, they have launched a collaborative map where they collect more than 1,000 health assets.

What are health assets? In words from the specialist in Public Health, Rafael Cofiño: They are healthy resources that can improve the capacity of people, groups and populations to maintain and sustain well-being and to reduce inequalities. They can be associations of neighbors, pensioners and women, places where workshops or physical or solidarity activities are carried out, educational programs …

Thus, when patients go to Primary Care, doctors have this information that they can share and discuss with their patients when appropriate. It is about expanding therapeutic options, beyond drugs, giving patients other tools with which to treat the social causes of diseases. The ideas behind this initiative are gaining popularity and similar campaigns are taking place in other Spanish autonomous communities and even in other countries such as Argentina or Brazil.

It's about time that the famous aphorism on the main missions of medicine "cure sometimes, relieve often, console always" add another facet: "and take care, first of all". Because, sometimes, the best exercise of medicine does not depend on more resources, advances and technology, but on better strategies.


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