Let's make it concrete

Let me take a break from blowing vapor about the bio-psycho-social conception of health and make it real for a bit. We're collaborating with a researcher who I won't name just yet because I didn't ask permission on a project which is really terrific. It's a randomized controlled trial of a program to teach therapeutic massage to caregivers -- spouses, siblings, children, friends, whatever -- of people with cancer. There is an orientation, and a DVD, and a manual, which don't just teach techniques but put massage into the context of loving relationships and the emotional and spiritual (deity free) consequences of serious illness.

Massage has been shown to have powerful palliative effects for people with cancer, reducing pain, nausea and other symptoms as much or more than drugs. This project goes one better, by replacing the professional massage therapist with a loved one who also benefits from knowing that she or he can do something effective to help the cancer sufferer. That feeling of helplessness is one of the hardest things about facing a serious illness in a loved one, of course. And the relationship between the two also benefits. We hope to demonstrate these benefits using the gold standard methods of biomedical research. (I take no credit for developing the program, we're just helping our colleague with the trial.)

Here's the bad news: no matter how powerful the effects turn out to be, and no matter how much the participants love the program and feel they benefited from it, it will be very difficult to see this program widely adopted and available. The reason, of course, is that no insurance company in the world, nor Medicare nor Medicaid, will pay for it. That's just not what they do.

For my commenters who who ask whether physicians should get involved in the psychological, social and spiritual dimensions of their patients' lives, I would say, not very deeply. That's not their job. They are trained in the biological dimension of health and it would, in my view, be positively destructive to start medicalizing social well being. We've already medicalized psychological well being, and as my readers know, a big part of what I do here is criticize and complain about that. But that doesn't mean that we can't integrate biomedicine with a broader understanding and approach to health and well being. In part, that has to mean a shift in resources away from biomedicine -- in other words, for the United States to become more like the civilized countries of the world.