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Professionals tend to think they are in charge of whatever project, patient, or case they are working on. However, they must keep in mind that the person or organization who hires them does so with certain goals in mind. A government entity who hires an engineering firm to design a bridge, for example, will be very specific about their goals and expectations. They will be sure to write them into a contract and require the firm to sign that contract. This is the true nature of a relationship where a person or organization hires professionals.

The situation appears to be different when the hiring person is unsophisticated. When a patient walks into a doctor’s office and complains about vague pains, saying his friend told him he should get them checked, it appears the relationship has flipped; the doctor is now in charge. Here is where professionalism becomes very important; where the patient does not want to take charge of his condition. It is so easy to just do what you think should be done, and send the patient on his way. I feel this as a lawyer. Before clients even finish their story, I have a good idea what I want to do with their cases. But these are their cases, not mine. The client or patient lives with the consequences, not us. That is why it is essential to learn the patient’s or client’s goals before doing anything for them. Imagine the patient or client is a large, savvy organization hiring us; and, if they were, what would our relationship be like? That is the position we should place ourselves in every time.

Ask the patient what their goals are. Why did they come to you? What do they want? It may appear obvious, but you would be surprised. My father had patients who faked injuries to get worker’s compensation. He could tell because their descriptions of pain and loss of mobility were incongruent with any real injuries. My father refused to treat them or certify they were injured. The patients’ goals and the physicians’ goals must coincide for there to be a healthy professional relationship. When I get the sense clients want to use my services to hurt or punish another party, a misuse of legal services in my opinion, there can be no professional cooperation.

Some patients want you to make their pain go away. Others expect full recovery. Some simply want validation that they are indeed sick or injured. Many will change their goals or expectations when their physician presents what is realistically possible. If a patient is only willing to put in minimal effort to recover, you can rule out medications or procedures that require significant follow-up. The patient owns his body. It is his responsibility. His physicians are professionals he has hired to help him do something with his body. The physician is never to assume control over the patient and take action that is not in line with the patient’s goals. This is true even when a patient writes a “blank check,” so to speak, allowing the physician to do whatever she wants. A physician should not allow her patients to relinquish control over their own health.

Once the physician is satisfied she understands the patient’s goals; the patient has made an informed decision on what type of care he wants to receive; and the patient’s goals are within the realm of ethical options the physician can support, then a physician-patient relationship can begin. When this relationship begins, the physician now assumes – to the extent provided for in their agreement – responsibility for the patient’s illnesses or injuries. Then the physician should work diligently for the patient, as though treating someone in her own family.

Alexander Typaldos

I told a group of people that they need to be careful about alternative treatments. Some are highly effective, while others are entirely bogus and potentially dangerous. One of them asked me to read a book of hers on reflexology¹ and let her know what I think of it.

I only needed to read a few pages to confirm my initial reaction. In case you are wondering, reflexology is the practice of massaging hands and feet to affect and heal internal organs. Yes, it is bogus. However, I formed that conclusion before I even knew what it was by discerning the level of confidence the writer of the book displays.

“It should also be noted here that Reflexology is not a panacea . . . it is an adjunctive to medicine and must be regarded as such.” Note the passivity of this sentence from the very beginning of the book; not only the statement itself but the writing tone. I have quoted this exactly as it appears in the book, including the bold “not.”

These next statements are found in the first of five forewords. “It must be said that foot reflexology has not yet been proven as effective.” You will not find a wimpy statement like this in my father’s manual. “For whatever reasons, we do know that patients treated with foot reflexology feel better, function better, and often improve in the biological and psychosocial disorders that lead them to seek help.” For whatever reasons?! This statement is the epitome of subjective standards of evaluating patient improvement. My father did not tolerate subjective standards in his practice. When a patient said “I guess I… I kind of… I don’t know. Maybe I… feel better” that meant “no” according to my father. Furthermore, he measured improvement objectively by comparing speed, fluidity, and range of motion before and after treatment. There is none of that in this book; not even case histories. “Quite probably, it will eventually be shown that foot reflexology alters energy flow in the body.” Now it reveals its true colors. Any treatment dealing with “energy flow” apart from the measurable transmission of nervous electrical impulses or the circulation of nutrients is bogus, without fail. There is no need to bore you with any other details from this book.

We need to scrutinize alternative models and techniques rigorously. We should forcefully reject and oppose the ones that don’t stand up to scrutiny. The problem we have in medicine today is that conventional medicine rejects most alternative treatments, not based on their effectiveness, but based on their philosophy. Meanwhile, alternative medicine accepts almost all alternative treatments, once again not based on their effectiveness, but based on the fact that conventional medicine rejects them. Those of you who are practitioners know this is true. I think it became this way in alternative medicine because few practitioners wanted their own treatments to be scrutinized. They could not stand up to it. So there is an unwritten policy that I will not question yours if you do not question mine.

This practice must stop. We need to start asking the hard questions. How do you know that touching the center of someone’s foot will affect their kidneys? If you do not have a logical, rational, reasonable explanation, then I will reject your model and oppose it. There are large variations in the effectiveness of alternative models and treatments. To build an alternative healthcare system – one that will become the standard system – we must take what works from alternative medicine, and also from conventional medicine, and leave behind what does not.

A confident practitioner should be able to stand up in front of other practitioners and, as my father did, ask for their most difficult patients. It is a bit counterintuitive that this confidence comes from being willing to recognize failure and then taking the necessary steps to improve techniques and adjust the model.

Alexander Typaldos

¹ Byers, Dwight C. (1991). Better Health with Foot Reflexology. Saint Petersburg, Florida: Ingham Publishing, Inc.

As physicians we practice modern medicine. However, we must not become confused about what this means. True, we may be more medically knowledgeable than our predecessors of a generation or two ago; but let this not suggest that our knowledge is reality and theirs was not. Reality is massive and intricate, paradoxical and overwhelming. As humans, we simply do not have the perspective to gauge it accurately.

Medical knowledge is limited to our own personal experiences, the perspectives of others who have told us what they think reality is, as well as hard data that has been recorded over lengths of time. Consider this unsettling hypothetical: What if all forms of medical knowledge suddenly disappeared? What would we do to rebuild our knowledge banks?

We would probably do what medicine has always done. Break our understanding of the world into pieces, form conclusions, and test them. We would, in essence, make models of the world; small insights of predictability that represent a working knowledge. And this is exactly what we do today. We work with medical models – not reality.

Some of today’s models seem to sensibly represent the world. They appear efficacious for the most part. Other models, however, make little sense. They survive because the political clout which birthed them continues to fight for their existence today.

We must be careful about what we believe. The history of science is filled with preposterous “truths” that stood lifetimes – even centuries – to be finally discarded as rubbish. Certainly, some of today’s most cherished medical beliefs will meet a similar fate. “Why?” you might ask. For the same reason those others were discarded: they are not tenable. Once the political and financial matrix that holds them in place disintegrates, they will lose support. Other models with more efficacy will nibble at their edges, then devour them. Old models will be replaced by new models; which will, hopefully, be more workable mechanisms of thought. However, if stronger political or financial incentives arise that support less workable models, they may replace their predecessors instead. When this happens, medicine, in a sense, steps backward.

Medicine is constantly marching. It may take two steps forward, one step back, then a step to the side. This is not a march to reality, but rather from one vague point in the past to another vague point in the future. Surely, some aspects of medicine will improve, while others will actually become more harmful. Many models and treatments will change neither for better nor for worse. Technology continues to improve, yet breast cancer is increasing. Bubonic plague may no longer be a threat, but AIDS is a pandemic. Tuberculosis was well-controlled twenty years ago, but more and more resistant strains are developing around the world. Although immunizations have saved millions of lives, only one disease has been completely eradicated.

Many of our twentieth century victories may be hollow. They may not even be victories at all. Instead, they may be no more than a natural or technological reprieve from the onslaught of future ills.

. . . .

Stephen Typaldos, D.O.
July 1994

It is easy to point out what is wrong with healthcare. It takes somewhat more thought to discover why those problems exist, and still more thought to make policy recommendations about how to solve the problems. Here is such a recommendation, one that will improve healthcare financing. If your agenda is to shrink government, you will dislike this proposal. If your agenda is to enlarge government, you also will shun this proposal. However, if your agenda is to create a system that works for most Americans and is sustainable in the long-term, you may find merit in this plan.

Auto Warranty

Health insurance is more like a car’s warranty than auto insurance. Third party liability, as exists in auto insurance, is not envisioned in health insurance. It offers only the equivalent of “collision” coverage, which covers damage to your own vehicle in an accident without regard to fault; plus a warranty covering damage to parts and systems during normal use.

There are two types of car warranties: powertrain and bumper-to-bumper. Powertrain warranties cover the engine, transmission, and drivetrain – the components necessary to “power” your car. Bumper-to-bumper warranties cover almost everything, including the powertrain.

Powertrain Health Insurance

When discussing health insurance, it would be useful to differentiate between “powertrain”-type health insurance and full “bumper-to-bumper” health coverage. Here are definitions of the terms:

Definition of Powertrain healthcare: insurance covering treatment to a person’s vital organs and systems if it is necessary to maintain the person’s life and basic functions.

Definition of Bumper-to-bumper healthcare: insurance covering the full spectrum of non-elective treatments that are reasonably expected to improve a person’s quality of life.

Details can be worked out. We may want to include treatments for Type I diabetes but not Type II, for example, in powertrain coverage. For the broader purposes of this article, the category of treatments now considered “medically necessary” is being split into two categories, vital and non-vital. These definitions disregard whether a condition is an emergency. This means regular ECGs are more likely to be covered than a fractured ankle under a powertrain plan.

Role of the Federal Government

Powertrain issues – heart problems, cancer, stroke, Alzheimer’s – destroy lives, put people out of work, and bankrupt families. This area is where Americans need help from their government. Limitations on treatments for life-threatening and disabling conditions are more often a product of availability than price. Therefore, the quality of care has little to do with who pays.

The U.S. government should provide powertrain coverage for all Americans. However, it should leave additional bumper-to-bumper coverage to businesses and individuals if they so choose. It should also make self-insurance for bumper-to-bumper conditions a viable alternative.

Big Government versus Small Government

Here is an enduring debate between fiscal liberals and conservatives. Each side would love to savor the taste of victory. Unfortunately for both sides – and perhaps fortunately for our nation – this debate is unwinnable.

Usually, when two sides are deadlocked or engaged in a back-and-forth over long time periods, it is because neither side is addressing the real issue. The question to ask in this debate is how big does government need to be to fulfill its role effectively? The size our government needs to be is the inverse of the private sector’s effectiveness plus the square of its corruption, written in the formula: Size of Government = (Size of Overall Economy – Private Sector Effectiveness) + (Private Sector Corruption)².

Corruption is squared because as it increases, it is seen as more acceptable; and there is less will within the private sector itself to discourage and expose corruption. Of course, this formula applies to government involvement in the economy only, not in social or foreign policy matters.

Problems with National Health Coverage

What turn off many Americans are anecdotal complaints from citizens of nations having a form of national healthcare. Most of these complaints center on two problems, rationing and lack of choice. The problem of rationing is really a blessing in disguise. When people think that if they become ill they can have access to quality healthcare, they are not as inclined to care for their bodies. This concept is no doubt unpopular, but it is established truth in the insurance industry. Rationing is therefore desirable in a national health plan.

Lest anyone think rationing healthcare is totally unacceptable in a modern society, understand that if we do not control rationing, the system will ration itself – and it may not be in a way that we would prefer. Healthcare’s growth as a percentage of GDP is unsustainable. Soon society, including the federal government, will no longer be able to pay, and services will diminish. And even now, the idea that Americans with health insurance have ready access to quality care is a myth. Many Americans hold onto this myth until they or a family member becomes ill. It is then that the reality of healthcare’s limitations becomes apparent; and oftentimes, prevention offers no second chance.

A Pro-Choice Policy

Perhaps the most important healthcare choices are vital in nature. However, on a practical level, the choices Americans really care about are in non-vital matters, such as who their family doctor is and whether they get access to new medications. Life and death matters requiring procedures such as kidney dialysis, appendix removal, and insulin injections are not what they think of when asking for more healthcare choices.

This proposal preserves these choices by limiting government-sponsored healthcare to matters of vital importance, where there is general agreement about proper methods. This broad outline leaves room, as well, for building choices into a government insurance plan.

Perfection is out of reach

While it is utterly impossible to develop a system that satisfies the desires of all Americans and interest groups – so long as corporations profit from bad care, and Americans live dangerously unhealthy lifestyles – it is still quite easy to create a system better than the one we have now. Therefore, you should view this proposal as a new perspective; a different, and perhaps better, way of seeing the issues. This is not a quick fix. Anyone who tells you they have found a quick fix to healthcare is lying. There are just too many factors to consider.

The foremost factor in healthcare reform is the false, illogical theories upon which the medical profession is based. Until medical theory and practice are reformed, tinkering with the financial and business aspects of healthcare will accomplish little. This does not mean we should replace “conventional” medicine with “alternative” medicine. Nor does this mean we should take the best of both schools and form hybrid practices. Rare is the person who does not subscribe to one of those two camps. Alternative or “complementary” medicine is no longer a catch-all category for rejected methods. Instead, it has become a defined, competing branch of medicine; sadly, with illogicality similar in degree to that of conventional medicine.

Instead, what this means is that we should set aside ambiguous studies and marketing claims, and go through the evidence – studies, patient testimonies, physicians’ observations – with an eye for correlations among facts. Patterns of correlations can be used to theorize. Then we test those theories, not only with double-blinded placebo-controlled studies, but by logical, rational, and reasonable analysis. Are patients responding the way we would expect them to? Are there any symptoms that cannot be explained by our theories?

Tested theories are truth. They do not become truth because truth was present already; it was found, if you will. Various truths can be placed within a framework and cohered. When there are enough truths known in a particular branch of medicine for them to present as a mental image, they can be intellectualized into working models. Such are a physician’s most valuable assets. Technology, formal education, facilities, and skill are dwarfed in significance when compared to reliable medical models that explain why patients get sick and suggest what needs to be done to help. Penicillin would have been useless without the germ theory; or never discovered in the first place.

Many of the treatments in both conventional and alternative medicine are working for reasons other than the ones physicians think. Conversely, treatments physicians claim will work do not for reasons they cannot explain. This indicates, to those who are analyzing evidence logically, rationally, and reasonably, that their models are incorrect. All this talk about truths and models might appear abstract and even irrelevant. However, the Fascial Distortion Model reveals that once physicians correctly understand disease and injury processes, successful treatments will naturally follow. Models, theories, and philosophies ought to be discussed and debated openly, for they are the gems of healthcare reform. Financing is the gold in which they are set.

Automotive Safeguards

Here in Michigan and in other states too, auto repair shops are required to present a written estimate of repair costs. This law prevents an awkward scenario where a car owner discovers, to his dismay, that charges are far higher than he expected. A similar law would be nice in the healthcare industry. Granted states do have laws requiring doctors to post their office visit fee schedules, but this applies primarily to out-patient care.

When it comes to emergency and in-patient care – and prescription medications – patients can do little more than cross their fingers, hoping the hospital bill is not as bad as their reason for the visit. The argument for “surprise billing,” presumably, is that the patient’s health is more urgent and important than financial matters in a crisis. This may be true, but anyone who has gone to the Emergency Room with anything less than an immediate, life-threatening condition will tell you they always find time beforehand to check your insurance.

It is a principle that systems operating behind closed doors are easily subject to corruption. In the healthcare industry, openness is compromised not only by entrenched interest groups, but by the system’s sheer complexity. It is well nigh impossible for any single entity other than the federal government to oversee it. This is not to say the government is unsusceptible to similar corrupting forces. Therefore, a form of national healthcare such as powertrain coverage should be seen as merely the beginning of reform; logical, rational, and reasonable medical models as the end.

Alexander Typaldos

Send in the soldiers (chemotherapy), fly the bombers overhead (radiation therapy), and roll the tanks over the enemy (surgery). Maybe with superior firepower, we can win the war on cancer.

If drugs, radiation, and surgery are the weapons, cancer is the enemy, and physicians are the generals, then what is the patient in this war? The patient’s body is the battlefield! What does a battlefield look like after the fighting is over? Not so good.

Yet again, medical philosophy bottlenecks medical science. As long as physicians possess a war mentality, they will continue blasting cancer with steadily increasing firepower and success. Eventually, they will discover that the easiest way to kill cancer is to kill the patient. It will cease growing immediately!

Cure for Cancer

Is this possible? The answer is no. Cancer doesn’t work that way. It is not a foreign invader we need to fight; it is our own cells gone bad. Genetic material in numerous types of cells becomes corrupted through various means – chemicals, pathogens, radiation – and these cells grow out-of-control, damaging healthy tissues.

Medicine can cure tuberculosis; it can cure smallpox. Medicine cannot cure different cell types in different parts of the body from failing to replicate properly in different ways and for different reasons. Physicians should recognize that diseases like cancer require a different approach.

The important thing to remember is that while certain causes of cancer come from outside our bodies, the cancer itself is a part of us. Because of this fact, the only safe, sustainable solution is to make sure the cellular reproduction mechanism continues to function as it should. And to do this, we need to understand what causes it to malfunction.

Practical, Workable Solutions

I hate this awe, reverence, and almost magical hope that many Americans hold, believing that scientists and doctors will some-day find a cure for cancer. This mystical hope wreaks havoc on logical, rational, and reasonable thought that is directed toward practical, workable solutions to clearly-defined problems.

What I love is good common sense and a balanced, realistic outlook. It is not glamorous, but it is very powerful. This is one thing I loved about my father. Unlike his peers, who were obsessed with their status of being able to prescribe medications, my father approached injuries more like an engineer approaches his projects. He knew what the problem was and what he needed to do to fix it, and he did not think twice about shopping at Home Depot to find the right equipment.

No hype, no self-promotion; just concrete, measurable, reproducible results.

Balanced Hope

Americans are starting to get what needs to be done to fix the cancer problem. Live a healthy lifestyle, avoid carcinogens like the ones in cigarette smoke, and keep your immune system in good shape. The public may be catching onto this idea faster than physicians, who apparently prefer their reactive, combative approach, whether or not it works.

The medical profession’s idea of cancer prevention is regular screenings. What to screen for depends on statistical risk factors, such as age and sex. In this case, statistics are misleading. One man’s risk of prostate cancer may be 100 percent; another man in his same demographic may have a risk factor of 0. It is incompetent and lazy for doctors to tell them they both have a risk factor of, say, 2 percent, as if cancer is random.

Do you think that if only the American Cancer Society had more money it would have found a cure by now?

Alexander Typaldos