As spring training winds down and the hope for a pennant burns bright for all baseball fans, the dark side of sports continues to rear its head. Players have been visiting with investigators in the US and Canada to talk about Dr. Anthony Galea, a sports medicine physician whose clientele included the brightest stars of the game. His claim to fame was the use of platelet rich plasma to help rehabilitate injuries but his downfall might be the discovery of human growth hormone among other chemicals being smuggles across the border by his associate.

It is no surprise that athletes try to find cutting edge treatments to heal injuries to allow them to return to competition sooner than later. Their careers can be measured in months instead of years and there is always a younger player waiting in the wings to take their place (see Wally Pipp). The question becomes: when does a treatment become performance enhancing instead of part of an accepted rehabilitation process.

Platelet rich plasma injections have been around for decades but have garnered little attention until recently. The American Academy of Orthopedic Surgery has published a variety of articles describing the procedure but it is still considered alternative therapy. Not enough research has been done to answer a few basic questions like what injuries are appropriate to be injected, how many injections are required, what is the timing between injections and what are the use restrictions afterwards. It may be that athletes will be the guinea pigs to help out the nation’s weekend warriors.

Cutting edge doesn’t always mean safe, effective and available. Patients with terminal illnesses sometimes seek alternative care as a last hope of life. Laetrile was a last hope for many cancer patients and while it was banned in the US as a cancer treatment, patients would travel to Mexico for care and hope. As with many treatments, there was a grain of truth in its history. Laetrile had been used for over a hundred years but its benefits couldn’t stand up to scientific analysis. It didn’t help that side effects included cyanide poisoning.
As with any therapy, there are cutting, edge early adopters and those who wait until the treatment is proven. Athletes may search out doctors who are innovators, just like patients with chronic or lethal illnesses seek providers who can return quality and quantity of life. Eye surgery is a prime example. Today’s techniques done to improve vision continue to evolve and the high tech computer surgeries like LASIK, PRK, EPI-LASIK and C-TEN make the hand made cuts of 1970s radial keratotomies look barbaric. But barbaric worked for many people; the newer procedures just work better without as many complications.

Deciding what works and what doesn’t requires research and that may takes years of study that many patients don’t have. Trying a new or experimental treatment may be the only option left for an athlete wanting to add another year to a career or a patient wanting another six months to be with family. If only doctor or drugs could stop time.

While Washington politicians may celebrate passing health care reform, it is important to realize that they did no such thing. This is the case where words really do matter. Congress passed health insurance reform but did little to address the failing health care of this nation.

There is no doubt that providing the ability for every citizen to have insurance to pay for medical bills is an important step to increase access to medical care. People should not fear poverty and bankruptcy as a consequence of illness or injury to themselves or a loved one. Society has a responsibility to care for its members who need help. But does the individual also have a responsibility to maximize their health status to minimize their cost to society.

A story in the March 24 edition of my hometown newspaper, the La Crosse Tribune, may be helpful in understanding the issue. A 16 year high school student was credited with recognizing the symptoms of her mother’s heart attack, chest pain radiating down her left arm associated with sweating, and getting her to the hospital where she had stents placed to open three blocked arteries to her heart. There was a medical response system in place to provide emergency rescue of this lady’s heart. Society was ready to look after her disease. But later in the story we learn that the woman smoked, was overweight and had poorly controlled diabetes, all significant risk factors for heart attack and stroke. Her responsibility to society to maintain health resided where?

Health care reform has yet to happen. Health care begins by teaching people to look after their own bodies and perhaps demanding that they do so. Is it a big leap from demanding that every person buys health insurance to demanding that every person live a healthier lifestyle? It may be easier to legislate the paying of an insurance premium than it is to exercise for 30 minutes a day, but having everybody walk a couple of miles to work or school would probably make health the country a lot more healthy.

The real path to health care reform is prevention. Providing high quality preventive care to a population needs to be matched by providing high quality health education. Dental checkups for all kids are important but they need to be paired with teaching about brushing and flossing teeth. Basic food education to tame the obesity epidemic in the country would improve the health of half the population. Twenty five percent of the population could improve their health and increase their savings by stopping smoking; yet health care reform did not remove tobacco, a legal but deadly product, from store shelves.

Health is something that we’re given when we’re born and it is ours to maintain for a lifetime. Some people work hard to maintain it while others watch health transform into disease. Society has a responsibility to provide the tools for a person to maintain their health and perhaps that person has the responsibility to use those tools wisely.

Insurance is the tool society uses to maintain its responsibility to provide care for injury and illness. Congress has worked to update that responsibility and now may be the time for each person to update their responsibility to society by working on health maintenance and prevention.