So, what do we do with too much healthcare?
Just last week, while I was out and about in my neighborhood, doing some errands and taking the dog for a walk, I saw the signs for a new enterprise that’s opening up, offering something called “hyper wellness” services. I think I know what wellness is, but I’m not really sure what the “hyper” modifying it means.
All of the windows of the storefront were papered over, and we couldn’t see inside, but outside were images that showed IVs, some other medical technologies, and some tech-y and science-y images meant to evoke, I guess, tech and science.
Through the pandemic there been lots of pop-up urgent care centers in our neighborhood and across the city, as well as countless little tents and narrow storefronts offering rapid and PCR testing for COVID-19. But this idea, for some sort of concierge extra health for those in need of something more, seems to be a fairly new phenomenon, at least in our neighborhood.
For years I’ve heard of these services where they’ll come to your hotel room and give you an intravenous infusion — usually of saline, some vitamins, and other supplements — all labeled with names evocative of their purported health benefits, what they’re aiming to fix. A hangover cure, or to give you a little something extra before a big meeting.
On the website of this particular company, and several others I looked at, it seems they’re offering a lot of services from intravenous fluid, vitamin, and supplement infusions, through many other modalities of questionable medical benefit. All of these are couched in a language extolling wonderful healthful benefits, always with a “may” in front of them: this “may” improve your sleep; this “may” improve your energy; this “may” improve your immune system.
It makes me wonder if the people who are using these services have already exhausted all of their other healthcare options, if all of their health maintenance and vaccinations are up-to-date, if all of their medical conditions are optimized, if they’re doing everything they can for themselves in terms of exercise, quitting smoking, good nutrition, stress reduction, and getting enough sleep. Or is it that this particular targeted audience just has a lot of disposable income and wants to seek any additional edge, any other way they can live longer, live better, outlive the rest of us?
A friend of mine recently showed me the website of a doctor he is seeing. The website listed the extra amenities beyond the normal history, physical examination, and blood testing. Of course there were lots of tests that fell in the middle ground, such as ECGs, x-rays, MRIs, ultrasounds, and a wide range of more advanced cardiac testing, all available to anybody through a menu system for them to peruse and choose. Digging deeper, there were all of these other “boutique” services they could get, from cryotherapy to light therapy to off-label infusions with micro dosing of multiple medicines for unclear indications.
I know that in the past few years there has been a lot of talk about how since we have the technology to test and treat so much, why shouldn’t everybody get everything all the time? The businessman Mark Cuban has espoused something along the lines of near continuous testing, getting blood tests and imaging much much more often than recommended, because, well, why not, you never know, why wait?
Those of us in practice have all had patients come to us after they’ve gone to one of these sites and gotten a total body MRI, that detected something that ended up saving their lives. But we’ve also seen countless instances of incidentalomas, unearthing nothingness, chasing ghosts, working things up that just weren’t there and never needed to be looked for, never needed to be found. I guess it’s going to be hard to convince those who have the means and the opportunities and the money and the access to not seek these out.
But as long as we live in a society where the bare minimum of health needs, things as basic as good nutritious food and clean water, unlimited access to vaccines and all of the preventive medicine and chronic care and acute care that everybody needs, are not available to everybody, having all of this platinum excess access seems like we’ve gone too far.
I’m sure we’re never going to be able to convince those providers offering these services to turn their attention to those more in need, to serve communities where there just aren’t enough healthcare providers and isn’t enough healthcare to go around. But if we can live in a world where some can get so much, can’t we insist that it also be a world where everyone gets just enough?