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America spends nearly a fifth of its economy on health care, yet chronic disease keeps rising and prevention lags. Narinder Singh Parhar, an internist and intensivist with four decades of experience across outpatient, hospital, and ICU care, argues that American medicine has grown top-heavy, brilliant at acute rescue but neglectful of the everyday habits that keep people well. This episode is based on his article “Why scientific medicine alone is not making us healthier,” published on KevinMD. You will hear why splitting the body into specialties can lose sight of the whole person, how a few minutes a day of simple exercise may reduce falls and even ease sleep apnea, and why cutting back on unnecessary medications matters as you age. You will also hear his case for paying and respecting primary care physicians more and letting nurses and therapists help patients build lasting habits. Press play to hear which small, repeatable habits he believes do the most to keep you healthy.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Narinder Singh Parhar. He is an internist and intensivist. Today’s KevinMD article is “Why scientific medicine alone is not making us healthier.” Narinder, welcome to the show.
Narinder Singh Parhar: Well, thanks very much, Kevin. It’s nice to be on the show and talk about the article that I published.
Kevin Pho: All right. Well, why don’t we start by just briefly sharing your story, and then telling us why you decided to write this article in the first place?
Narinder Singh Parhar: Yeah, definitely. You know, Kevin, I was born in Punjab, India, and I had my undergraduate medical education at Punjabi University in India. I migrated to the U.S., and then I did my postgraduate training at St. Luke’s Hospital in eastern Pennsylvania. I have about 40 years of experience in clinical medicine, both outpatient and inpatient ICU, as well as in several leadership roles.
Over these years, I observed that despite the best that scientific medicine has offered to the patient population, the burden of chronic disease continues to rise. So I thought I would explore whether there are some missed opportunities to enhance individual health, which could be a great asset toward not only prevention but also disease management.
Kevin Pho: The title of your article is “Why scientific medicine alone is not making us healthier.” For those who didn’t get a chance to read your article, just tell us what it’s about.
Narinder Singh Parhar: You know, basically, number one, I’m a fan of the two greatest scientists humanity has produced, Newton as well as Einstein. Newton for his keen observations and his ability to decipher mechanics on bigger and bigger proportions, the solar system, the velocities, interstellar travel, et cetera. Gravity, of course, to begin with. Then Einstein, who had an amazing ability to look outside the box and imagine things that are not necessarily visible or can even be proven with the available technologies. So these two scientists have impressed me very much, and they keep me grounded in applying both of those principles to health care and medicine.
I am convinced, like everybody else, that the American health care system is doing great things, many of them in acute health care, like organ transplantation, treating septic shock, trauma care, heart transplants, et cetera. However, the chronic disease burden continues to increase. I think we need to do more there. As the population is aging, the load of these diseases will continue to increase, and we need to come up with strategies for how to mitigate that effect, because our budgets are limited both time-wise and resource-wise. So I think that as a society and as health care systems, we have underinvested in individual health enhancement strategies.
I also found it amazing how many doctors, health care leaders, and intellectuals in the general population understand that the affordability crisis, the accessibility crisis, polypharmacy, as well as the chronic disease burden, continue to increase despite all the progress we have made. In my opinion, Kevin, health enhancement at the individual level should not only complement traditional scientific medicine, it should be an integral part of it.
Kevin Pho: So you do have that unique perspective, because you are an intensivist but also an internist, so you’ve seen both outpatient and inpatient. And one of the things that you noted in your article was that American medicine has become too top-heavy, right? And we need to do more when it comes to enhancing our health and when it comes to disease prevention. Now, from your unique perspective, just give us some examples or scenarios about how American medicine has become top-heavy, and what are some of those implications to our patients?
Narinder Singh Parhar: Yeah, definitely. Number one, one correction. I am an internist. Although I worked as an intensivist and hospitalist, I’m not a board-certified intensivist. And I also do not practice medicine at present. I do population health online, and I do writing, et cetera. So I just want to make that correction.
To answer your question, I think when systematic medical education was initiated and standardized, it was compartmentalized into organ systems for the convenience of medical students, which was appropriate, because understanding the whole body’s complexity at one level might be challenging. So we divided it into, say, the heart, the cardiovascular system, the central nervous system, the digestive system, et cetera. And as time went on, with the narrower focus of the specializations and subspecializations, we kept getting away from the single human body as a unit.
So that created very talented and capable subspecialists who can do wonders when the need arises. However, number one, they are so focused on their own field. Number two, the technology at this time, or the payment system, is encouraging more intervention, more imaging, and less scientific curiosity, in my opinion. You know, America spends nearly 20 percent, to be precise 18 or 19 percent, of the GDP on health care. And we cannot boast of the best health care system in the world. Our population is still suffering. The chronic disease burden is going up. And many people, despite their insurance, despite working a lifetime, cannot afford their medications. So that is something to worry about.
So in my opinion, all of this can be mitigated if we spend more resources and time and effort on individual health enhancement. For example, I have focused on fall prevention. As the population is aging, more people have decreased balance and impaired ability to stand on their own feet, and multiple other factors are coming in, especially medications, which can impair balance. So strengthening the extensors of the spine, the glutes, and the adductors of the hip is an important remedy, in my opinion, to decrease fall risk and thereby reduce hip fractures, femoral shaft fractures, and all that. That is one.
I think we should pay more attention to sound nutrition, sleep hygiene, as well as individual simplified health education, and empower PCPs, nursing staff, as well as the therapists. I think that will go a long way in enhancing individual health and reducing the top-heavy burden on our health care system, and still keep the society healthier and happier.
Kevin Pho: So from a patient standpoint, I think that you wrote that there are some things that they can do to become more proactive in terms of enhancing their care and focusing more on the things that you talked about. So what are some things that patients can do?
Narinder Singh Parhar: Well, there are some simple exercises which, if somebody does them for say 5 to 10 minutes a day, strengthen the spine extensors and the adductors of the hip, as well as daily walking to keep up the glute strength, as well as the motivation for repeating it on a daily basis. You build healthy habits that are repeated consistently. That is one.
Number two, of course, avoiding obesity. You know, watching calories, doing some daily exercises, not very intensive at that age. So that, as well as learning some simple strategies like, say for example, sleep apnea is an issue that I have been working on also. Age-related obstructive sleep apnea, in my opinion, could possibly be a reversible or at least a reducible entity through five-minute daily exercises of the upper airway, including the diaphragm. So that is another important area that I think people could benefit from. Just 5 to 10 minutes of daily involvement with their simple exercises.
And of course, polypharmacy is another issue, so minimum medication will go, you know, a long way to reduce the complications of multiple medications as well as the side effects.
Kevin Pho: So as we know, there is a primary care shortage, right? Because it’s very difficult for some of our patients to find primary care clinicians to do some of the things that we’re talking about today. Now, if you were in charge of our health care system, from a policy standpoint, what are some things that need to be done to balance out our health care system so it’s less top-heavy?
Narinder Singh Parhar: Yeah. Number one, I think our primary care physicians need to be rewarded more, encouraged more, and respected more than they currently are. And that will reduce some of the frustration and burnout and lack of interest or lack of enthusiasm for them to go to their daily offices.
Number two, I think we should utilize the paramedical staff, especially the nursing staff and the therapists, to help patients enhance their health at an individual level. That will work to reduce the patient load, the office visits, and the emergency room visits. So in my opinion, that will help reduce the need for our three-month waiting time to see any specialist in any general area. And I would also, I think I mentioned, that the financial rewards for the primary care physicians should go up compared to what they are rewarded at present.
Kevin Pho: We’re talking to Narinder Singh Parhar. He’s an internist and intensivist. Today’s KevinMD article is “Why scientific medicine alone is not making us healthier.” Narinder, just want to end with your take-home messages that you want to leave with the KevinMD audience.
Narinder Singh Parhar: We should always keep the scientific curiosity: Why is this patient coming to see me today? What are the other reasons that can be simple and effective? Two, we should of course be active listeners to the patient. They tell us so much about their problem when they tell us their own story. Third, repeated simple biological interventions are very powerful. We should not lose sight of the impact of simple biological interventions done consistently, like walking, exercises for the spine extensors and the hip adductors, and upper respiratory muscle strengthening.
Kevin Pho: Narinder, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Narinder Singh Parhar: Thanks, Kevin. Thank you very much.
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