Broken Watermain Analogy

"Il medico pietoso fa la piaga puzzolent" ("The doctor that does not address the root-causes allows the disease to do a lot of damage.")

Peasant proverb, Ciociaria (Italy), Time Immemorial

Treating Symptoms vs Curing Root Causes: The Broken Watermain Analogy

In several medical books and articles that review the methods used by Big Med to treat diseases, often one finds statements that in effect say that " Modern Medicine treats disease symptoms but not diseases root causes". Most people likely wonder about the difference between treating diseases symptoms and treating diseases root causes. Using only words it is difficult to "drive home" the dramatic difference of these two approaches in terms of the health consequences. So I thought of describing this difference using an analogy as follows.

Cities have several underground watermains. Consider a situation where one such watermain breaks causing a lot of water flooding the street above. In this case, the symptom of the problem is "water flooding the street"; The root cause of the problem is the "broken watermain". This problem can be addressed in two way as discussed below.

1. Treating the Symptom Approach

    This approach would have the City address the symptom of the problem, namely, the "water flooding the street". Accordingly, the City would mobilize their maintenance crews to set up pumps on the street to keep pumping the water away, day in and day out, to maintain the street passable. In the mean time, the water escaping from the broken watermain below starts causing more problems such as water seeping into people's basements, underground soil erosion, and sink holes.

    It is obvious that this approach will never solve (cure) the problem. It will keep the street passable, but it will allow the water escaping from the broken watermain to keep flooding the street above and cause more problems underground. Clearly, dealing with all of these problems adds significant costs to the city road maintenance budget and adds significant inconveniences to the people living in the area. And , of course, all costs and inconveniences are borne by the taxpayers and may increase with time but never go away.

   Also notable is that this approach is a very effective "job creation program". Jobs such as for the people manning the pumps, for pump repair technicians, for tank trucks drivers to carry the water away, for truck mechanics, for pump manufacturing industries, and for public relation staff to explain and justify what is being done to the tax paying public. And, we should not forget, this approach also creates more work, and thus more costs, to deal with the additional damage done by the water that keeps escaping underground.

In sum, this approach results in a meagre benefit, significant ongoing cost increases, the creation of several jobs in related industries, and never "cures" the problem.

2. Curing the Root Cause Approach

This approach would have the City address the root cause of the problem, namely, the "broken watermain". Accordingly, the City would mobilize their maintenance crews to repair the broken watermain. In this case the costs increase to the road maintenance budget are limited to the cost of the repairs, the people inconveniences are limited to the duration of the repairs, and the "job creation program" for related industries lasts only for the duration of the repairs. As soon as the repairs are completed, everything gets back to normal.

In sum, this approach results in cost increases limited to the cost of the repair, creation of jobs only for the duration of the repairs, inconveniences only for the duration of the repair, and totally "cures" the problem.

It is clear from the above analogy that every time that we go to see the doctor because we are not feeling well, we would like him/her to uncover the root cause of why we are not feeling well and cure it. But, based on my experience, this is not what happens. To exemplifies what usually happens, I will use two examples. One that many of you have already experienced, and one that I experienced myself.

Many of us usually go to see the doctor for a "check up" even though we are feeling quite well. We go for the check up just to make sure that there is not anything that needs attention.

The check up shows that are in general good health but your blood pressure is too high and you leave with a prescription for a hypertension drug, such as an ACE Inhibitor.