Do We Have The Healthcare We Deserve? The Dandruff Model.

English: Photograph from an advertisement for ...
English: Photograph from an advertisement for a Listerine dandruff treatment. Advertisement from the pulp magazine Weird Tales (September 1941, vol. 36, no. 1). (Photo credit: Wikipedia)

It is often stunning to me what people go through to try and get well within the healthcare system.  Tens of thousands of dollars in testing.  Hundreds of thousands of dollars in surgeries.  Because of how I work, I get these people in my office after nothing else has worked.  In many cases very simple, cheap, and relatively painless solutions provide as much or better results.

The simple fact that what I do is not commonplace has always bothered me.  But I came across the solution a few days ago.

I was looking for Nizoral as a dandruff shampoo.  As an antifungal, it is remarkably effective at removing dandruff.  A few applications is all that is necessary, repeated every few months.  A single bottle might last a person ten years.

The Nizoral is an antifungal (Ketoconazole) and much more effective than anything else on the market.  It outperformed Selsun Blue or other Selenium sulfide shampoos with fewer side effects. (Study)  And it really outperformed Head and Shoulders and the zinc pyrithione brands. (Study)

In the truly evidence-based world, Nizoral would be king.

But when I went to the supermarket, there wasn’t any Nizoral.  Instead, there were thirty different types of Head and Shoulders.  There were four different types of Selsun Blue.  But no Nizoral.

The store clerk told me that the full-service pharmacies would have it, but I went to Walgreens and again I faced a rank-upon-rank of inferior, over-priced competitors.  Nizoral may still be available online, but it isn’t being stocked anymore.

How can we explain that a more effective, cheaper treatment hasn’t become the standard treatment?  It’s because it is more effective and cheaper.

A person using Head and Shoulders or Selsun Blue has to use them every few days.  They are basically using metals (zinc or selenium) to prevent growth of the fungus without killing it off.  So to get the same results one would get with a single application of Nizoral, one would need to use half a bottle of one of the lesser shampoos.

Less effective solutions get to sell more at a higher price.  That means more profits, and more marketing dollars.  Pretty soon, everyone else is using the inferior products because of the marketing success.  We think that it must be the most effective product, when its inferiority and built-in obsolescence have created its success.

Isn’t this the healthcare model we have created? We know that lifestyle and diet choices contribute dramatically to chronic illness. But rather than focus on these options, we look for pills that manage the disease process.  Selling more pills means more marketing, and eventually everyone is using the pills.  It doesn’t matter if there is a better, simpler, and cheaper solution.  That won’t keep the juggernaut of a healthcare system affloat.

So we can all look at the healthcare system and shake our heads.  But perhaps we have created the healthcare system we deserve by assuming the most commonplace solutions are the best ones.  I’ve often thought that the simplest route to health might be to make healthy food less expensive.  As we move a trillion dollars into our healthcare machine, maybe looking at simpler options is worth it.


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