Let me also suggest that we forward this essay to friends and colleagues who may be interested in the future of health care.

A hearty thanks to Dan Bednarz and Paul Roth for putting this information together and relating their interaction with public health professionals. We all owe them a big debt of gratitude for their hard work laying a foundation for future debates on how to reform the health care system as energy depletion becomes more apparent. My apologies for a such belated thank you but I was too busy last week to keep up with TOD.

We face much inertia in the area of substantive reform given the instutional biases that must be overcome. Jason Bradford provided excellent examples of two such problems: tunnel vision due to extreme comparmentalization/specialization; and a process whereby the pragmatic nonconformists tend to be weeded out and the strongest adherents of the status quo are promoted and go on to dominate policy making and the opinions of subordinates.

I strongly agree with the principle that prevention and wellness should be the main focus of a revamped health care system. It is also the reason that I decided 5 years ago to add an MPH degree. As I have stated before, after an in-depth analysis, I concluded that in the U.S. it is paramount to change the entire way we look at health care and not attempt to fix the serious problems with endless hand-wringing, more ineffective subsidies, and a gatekeeping system that does more to ration that it does to delegate appropriate levels of care and prevention based on severity of illness.

Advocacy for sustainable medicine may seem like an uphill for a group of health care mavericks, but sometimes mavericks succeed. Coincidently, in one of this weekend's drumbeats there was a brief mention of Barry Marshall, the once-reviled physician researcher who defied conventional wisdom proving the link between H. pylori infection and ulcer formation. There is also the case of Stanley Prusiner who, despite relentless criticism, was undaunted in his efforts to prove that prions were infectious proteins responsible for spongiform encephalopathies (e.g. BSE "madcow disease"). Pruisner went on to win the Nobel Prize in Physiology or Medicine for his work.

Even now, there are quiet but important battles brewing in the field of medicine. IMO, the most important is the battled being waged by investigators who are doing brilliant work to prove that the cholesterol model is flawed and thus putting statins, the number one selling prescription medicine, at risk for losing market share. Seven years ago, Uffe Ravnskov M.D., Ph.D wrote a groundbreaking book, The Cholesterol Myths, on the topic and until very recently few researchers were intrepid enough to dip their big toe into the swirling debate. Now there is a growing segment in the medical community that understands statins appear to have their strongest effect due to their ability to arrest an enzyme involved in the inflammation process. If their efficacy in preventing the progression of cardiovascular disease does not lie it reduction of cholesterol, then we must acknowledge that there are other methods of reducing inflammation and platelet aggregation that offer fewer side effects and provide a greater cost benefit and such an acknowledgement will not bode well for pharmaceutical giants.

Those of us who feel that the current medical model needs to be drastically altered both for sustainablity and a new paradigm based on wellness may be the mavericks of today but maybe in the not too distant future our pragmatism will be the driving force for a new more constructive dynamic.