Can medicine heal itself?
Dr. Walter Bortz offers plan to restore medicine's mission
After a decades-long career in medicine, Dr. Walter Bortz knows a thing or two about diagnosing illnesses and writing prescriptions to help cure the sick.
Although he's no longer a practicing physician, Dr. Bortz recently wrote the most expansive prescription of his career — one he hopes will help cure a profoundly sick and stubborn patient: Medicine.
"Next Medicine: The Science and Civics of Health" was published in January — the seventh book by the longtime Portola Valley resident and community health leader.
In the book, Dr. Bortz details symptoms of what he calls the "giant anachronism" of medicine as practiced in the United States today. It's a system burdened with skyrocketing medical, pharmaceutical, and insurance costs.
"U.S. medical care expenditures are larger than the total GDP of most nations," he writes, citing figures that show a spending increase from 11 percent of the country's GDP in 1984 to 17 percent in 2009.
Meanwhile, this costly system is serving a population increasingly unable to afford health insurance, and afflicted by soaring rates of obesity, diabetes, heart disease, and other preventable illnesses.
A well-known geriatrics and fitness expert — at 81, he's still running marathons — Dr. Bortz has written health-related books such as "Dare to Be 100" that have sold well. But, he says, writing the earlier books was "rehearsing" for "Next Medicine," which he considers his most important.
In it, he issues a troubling diagnosis for the profession that he has loved since childhood, when both father and uncle were respected physicians in their communities and his father was elected the youngest-ever president of the American Medical Association.
The term "next medicine" describes a new model that will return medicine to the path of its original, nobler mission, he says. "Medicine's current paradigm is not cost-effective, fair, safe, honest, efficient, or relevant," he writes in "Next Medicine."
"It falls far short of fulfilling Medicine's mission of asserting and assuring human potential."
Today's medical system "has been corrupted by money," Dr. Bortz says during a recent interview in his Westridge district home, where he writes every morning. "Doctors can only think in terms of 'we want to repair you.'
"I recommend that the whole system become a ... pre-paid system rather than one that encourages doctors to say, 'Please bleed so I can get paid more' — which is just perverse."
His argument, however, does not pit capitalism against that oft-cited boogey man, "socialized medicine." In "Next Medicine," he writes: "We need not deny capitalism's practical benefits; all we have to do is change the product it sells from disease to health. Why not?"
That question logically leads to another: How?
Dr. Bortz's new model for medicine is built upon three key elements: a reassessment by the medical profession of its mission, including a shift in emphasis from curing disease to preventing it; personal responsibility for one's health; and "a larger embrace of the community, of collective responsibility."
Personal responsibility would include more healthful lifestyle choices, especially in the areas of nutrition and exercise. But broader, collective responsibility would manifest itself in joint government and community efforts toward a healthy society.
Dr. Bortz has been involved in such efforts since moving to the Bay Area with his wife, Ruth Anne, and four children in the early 1970s. A former practitioner at the Palo Alto Medical Clinic and a clinical associate professor of medicine at the Stanford School of Medicine, Dr. Bortz established the nonprofit Active Living Institute to fund research and public lectures.
He has helped establish or been deeply involved with other health education and support nonprofits, including senior centers in Palo Alto and East Palo Alto, and Healthy Silicon Valley. Out of that organization came Fit for Learning, which developed health curriculum for public schools, aimed at educating kids about health issues such as obesity and diabetes and their causes.
Dr. Bortz was one of a group of "like-minded Stanford runner friends" who founded the 50-Plus Runners Association" — since renamed 50-Plus Lifelong Fitness Alliance, he writes in "Next Medicine." That group developed a "fitness ambassador" program to spread health messages among the senior community.
A family tradition
Born in Pennsylvania, Dr. Bortz grew up in a Philadelphia home in which his father practiced medicine on the first floor. When he was growing up, his father and Uncle Walter, also a doctor, took him on house calls and hospital rounds, he writes in "Next Medicine."
Ruth Anne Bortz also grew up with first-hand knowledge of a slower, more personal medical world. Her father was the beloved doctor of a Massachusetts community where many of the male babies he delivered "were named Charles in his honor," Dr. Bortz writes.
Dr. Bortz earned his medical degree from the University of Pennsylvania in 1955, and spent the next phase of his life completing his training, practicing medicine, and doing research in various locations — from San Francisco and Berkeley, to New Orleans and Philadelphia, to Munich, Germany.
Dr. Bortz says he reached a major turning point in his life when his father died in 1970, and he sank into a clinical depression. As painful as that event was for him, he says, he now looks back at the period and finds three silver linings.
Realizing that running was considered "very, very good therapy for depression," he took up the activity, and within a year ran the Boston Marathon.
The senior Dr. Bortz's death also prompted Walter and Ruth Anne's permanent move West, Dr. Bortz says. And the third change was "my immersion in geriatrics," he writes.
When he began work in the field, geriatrics was a little-explored area of medicine, he says, "with no science or money." He jumped into the field with enthusiasm, and now lectures and writes widely on the topic of aging.
Dr. Walter Bortz will speak about "Next Medicine" at 6 p.m. Wednesday, March 2, at Stanford Bookstore, 519 Lasuen Mall on the Stanford campus. The event is free.