From disease management to healthcare

Today’s world is characterized by a constantly growing number of chronically ill people. The predominant medical thinking and action here is focused on the pathogenesis of the diseases. As the causes of chronic diseases are still largely unclear or unknown in almost all cases, it is often not the diseases themselves that are treated, but their consequences and symptoms. An improvement in this situation can only be achieved by shifting the focus of treatment options towards stabilizing health and thus towards salutogenesis.

A plea for salutogenesis

In Germany, approx. 210,000 “new” hip joints and approx. 175,000 “new” knee joints are surgically implanted as total endoprostheses for the first time every year. At state level, the operation rate varies by a factor of 1.7. Bavaria has the highest rate with 260 knee endoprosthesis implants per 100,000 inhabitants. According to a recent Bertelsmann study, the probability of receiving a knee prosthesis there is 70% higher than in Berlin with “only” 153 arthroplasty operations per 100,000 inhabitants. This can hardly be explained by the particular incidence of illness in Bavaria.

The increase in the under-60 age group is particularly striking: in 2016, 31% more patients from this age group received an artificial knee joint than in 2009. However, younger patients in particular have a high risk that the joint will need to be replaced again and even several times in the course of their lives. These revision operations are fraught with complications and can be very stressful. The use of the first artificial joint should therefore be delayed as long as possible with the help of conservative therapies.

At the same time, shoulder joints, upper ankle joints and elbow joints are increasingly being replaced with total endoprostheses – and the trend is rising! Added to this is the disproportionate increase in revision operations (replacement of the TEP). The cost explosion on the one hand and the increase in the number of patients who continue to suffer pain after TEP surgery on the other require a rethink. This raises the question of alternative treatment options.

Prevention: biological properties and resilience

Knowledge about the prevention of osteoarthritis and pain syndromes has been steadily increasing for years within the various scientific fields. But are general practitioners and specialists consistently using this knowledge for prevention and later also for treatment in the professional environment, in recreational and competitive sport? Are we paying sufficient attention to the concept of salutogenesis developed by the WHO, the OECD and the EU?

The aim is to move away from researching diseases towards well-founded interventions to develop, maintain or restore health. Only healthy people train successfully and achieve a stable high level of performance!

Internal health examinations of the organ systems and metabolism, the functional orthopaedic-manual status of all regions of the body can provide clues for early detection of disorders of well-being, the musculoskeletal system and performance. In this context, questions of nutrition and daily stress outside of sport (e.g. school, training and studies) and the professional environment are also essential.

As the developmental pathway of osteoarthritis is very long, it is now assumed that the foundations are laid in childhood and adolescence by insufficient development of the cartilage structures as a result of inactivity on the one hand, or by chronic mechanical stresses that exceed the limits of resilience on the other. From this perspective, primary osteoarthritis is a disease of the first stage of life.

Nutrition is an important factor

For the physical development of young people and the maintenance of good performance in adults, the provision of all building blocks of the building and functional metabolism (vitamins, electrolytes, trace elements) is necessary. Working and training people have an increased need for valuable nutrition due to the increased functions and the goal of increasing the body structures for performance.

Prevention requires qualified education and personal attention!

So we need to rethink and focus on our resources. This includes the fact that vitamin C, vitamin D3 and omega-3 fatty acids, zinc, selenium and others stabilize the immune system thanks to their high antioxidant capacity and that sport gets the circulation up to the necessary speed. All of this is scientifically proven – what is lacking is the effective dosage! Here, “knowledge” is more important than “belief”! The Academy for Human Medicine, in which the two authors are involved, also operates according to this principle. It is the foremost task of holistically thinking doctors (!) to determine an individual status through physical functional examinations and laboratory diagnostics. Only in this way can precise individual suggestions for the effective dosage of health-relevant vitamins, minerals and possibly dietary supplements be justified.

Our health is more vulnerable than we thought!

Nutrition is our most important medicine! The majority of the immune defense is actively regulated from the gut. A more conscious approach to food, sustainable agriculture and environmental protection are essential for stable health! More quality than inferior mass – not to mention the still often unacceptable production conditions!

Humans are part of an “earthly biomass”

What was unknown until recently, however, was the fact that humans are not independent living beings, but part of an “earthly biomass” with which they are in constant exchange, just as they are with the physical environment. This biomass consists – listed in evolutionary order – of bacteria and viruses, plants, animals and, ultimately, humans. The exchange between the various organisms takes place within the framework of epigenetics, i.e. the interaction of environmental influences of all kinds with our genes, the genetic material anchored in the cells. This ingenious system, tailored to the specific situation on earth, has developed over billions of years, leading to ever more complex life forms and culminating in the human species.

This insight into the history of evolution is of far-reaching importance, as man has massively changed his environment, the earth, which has produced him under defined conditions – without realizing that he is questioning the conditions for his existence and sawing off the branch on which evolution has placed him. (Fig. 1)

Starting point: Agriculture and livestock farming

This process began relatively slowly around 10,000 years ago with agriculture and animal husbandry. However, technical progress over the last few centuries has seen development pick up speed considerably, culminating in space travel a few decades ago. It seems as if nature has now put a stop sign in front of us. In the form of the current catastrophe of epidemically rampant diseases of civilization as quantified by the WHO. And as if that weren’t enough: not only are the numbers of people affected and dying from familiar companions such as diabetes, heart attacks and cancer increasing, but other diseases of civilization are also on the rise. In particular, psychiatric and neurological non-communicable diseases such as dementia, depression and schizophrenia, formerly known as mental illnesses, are booming.

While contemporary medicine, which is still reductionist in orientation, diligently tinkers with the symptoms of various diseases, it has now become clear that the diseases of civilization are rightly named: they are the result of the technological progress we are so proud of. However, this progress not only leads to a contamination of the natural environment with toxic substances (pesticides, herbicides, endocrine disruptors and BPA as well as lead, aluminum and mercury, to name but a few), but also to the loss of numerous natural resources such as silence and the dark of night, clean water, sun exposure and vitamin D, physical exercise and good social relationships – to name but a few. The totality of these influencing factors is now being scientifically researched as the so-called “exposome”, although this research is still in its infancy. The “Academy for Human Medicine”, founded by Prof. Spitz, has coined the term “nature deficit effect” to describe the consequences of these changes in our environment.

These findings and correlations give rise to the burning question of why so many people behave incorrectly, even though some of the key data – for example in relation to diet and exercise – has been known for several decades. Intensive reflection makes it obvious: It is not the individual who makes the wrong choices, but is born into a society that has failed to develop as a whole.

No one who comes into the world asks for a sedentary job in a stuffy office, but practically everyone gets one. No one wants an apartment above a fast food restaurant, but there is one on every corner. This means that we live in an environment in which we are exposed to a multitude of factors that make us ill and which are difficult for individuals to escape. This circumstance also explains the recurring figure in the studies of only around 10 percent of the population who do not behave incorrectly. But for the majority, all the preaching is of no use: 90 percent of people simply cannot stand up to the mainstream in the long term. And the result is obvious (Fig. 2).

Salutogenesis – time for a new health culture

However, these depressing findings also offer hopeful prospects. In view of the systemic connections and human needs, concepts can be developed that can overcome the disease tsunami of civilization. However, the content of this new health culture must no longer be limited to people, but must also take into account their environment and living environment. In addition to the interactions of humans with the physical environment, this view also takes into account the interplay with all living beings present there, their symbionts in the biomass of the earth.

An increasing biologization of medicine is the most radical and only effective response to the enormous challenges posed by the many age-related musculoskeletal diseases that we are confronted with on a daily basis. Curative and preventive medicine is always better than purely symptom-based medicine. However, both are not so simple. Against the backdrop of civilization diseases and the current pandemic, we need many more qualified people in systemically relevant professions with emotional intelligence and acceptance in society!

In this fateful situation, we have the opportunity to influence our future together and internationally on the basis of a protected environment and healthy lifestyles and behaviors, while putting aside the inequalities we have experienced so far!

An article by
Dr. med. Ulrich Frohberger | Center for Orthopaedics and Regenerative Medicine
and Prof. Dr. Jörg Spitz | AAM