Treating Disease or Preserving Health? Why Modern Medicine Needs Better Incentives

Modern medicine is powerful. It can save lives, control infections, perform complex surgery, stabilize trauma patients, replace organs, reduce pain, measure biological risk, and manage serious disease. In emergency care, intensive care, diagnostics, surgery, and acute treatment, modern medicine is indispensable.

But this strength can hide a deeper problem: a healthcare system can be medically advanced and still be poorly aligned with long-term health.

The key question is not whether medicine works. The key question is: what does the system reward?

Does it reward early prevention, long consultations, root-cause analysis, metabolic stability, muscle preservation, sleep quality, deprescribing, lifestyle medicine, palliative honesty, and long-term functional capacity? Or does it mainly reward diagnosis codes, billing pathways, prescriptions, procedures, repeat monitoring, insurance authorization, standardized protocols, liability protection, and chronic disease management?

This is the central issue examined in the scientific article. It describes a structural problem called incentive-misaligned medicine: medicine may officially aim at patient health while its practical incentives often reward disease classification, treatment pathways, monitoring, prescribing, procedural intervention, and institutional throughput more reliably than prevention, resilience, and patient autonomy.

This is not a simple attack on doctors. Many physicians act with responsibility, skill, and dedication under difficult conditions. The problem is deeper. It lies in the economic, legal, administrative, institutional, and educational forces that shape which treatments become visible, reimbursed, recommended, prescribed, delayed, denied, or never meaningfully discussed.

What can be billed becomes easier to deliver. What is legally safer becomes easier to choose. What fits guidelines, forms, insurance rules, and institutional routines becomes easier to implement. What requires time, individual interpretation, prevention, long-term monitoring, or delayed benefit often remains marginal.

The result is a form of medicine that can manage disease extremely well, but does not always cultivate health with the same intensity.

The article identifies four recurring distortions. The first is overuse: unnecessary tests, procedures, medications, follow-ups, or interventions that provide little benefit or create avoidable harm. The second is underuse: prevention, conservative treatment, lifestyle medicine, deprescribing, functional health support, and palliative care may be used too late or too rarely. The third is misprioritization: the option chosen may not always be the one most aligned with long-term patient welfare, but the one that is easier to reimburse, document, defend, standardize, or institutionalize. The fourth is selective disclosure: patients may not receive enough clear information about alternatives, side effects, uncertainty, lower-cost options, non-treatment, or the reasons a therapy is offered or refused.

This shows that the problem is not only overtreatment. It is also the disappearance of reasonable alternatives.

A central concept in the article is therapeutic visibility. Some treatments become visible, credible, reimbursed, normalized, and easy to access. Others remain invisible or marginal, even when they may be relevant for specific patients. This applies not only to drugs and surgery, but also to prevention, healthspan medicine, lifestyle intervention, biomarker monitoring, conservative treatment, second opinions, deprescribing, and carefully monitored individualized therapies.

Medical authority plays a major role in this process. Physicians hold diagnostic power, prescription authority, technical language, institutional legitimacy, medical records, and access to treatment pathways. Patients are often ill, anxious, dependent, less informed, and under time pressure. This asymmetry is unavoidable in medicine, especially in acute care. But it must be balanced by transparency, explanation, and meaningful patient agency.

Patient autonomy does not mean that every patient should receive every requested therapy. But it also does not mean passive obedience to professional authority. Real autonomy requires clear information: What options exist? What are the risks? What alternatives were not chosen? What uncertainties remain? What costs, conflicts of interest, insurance rules, or liability pressures may shape the recommendation? Why is one therapy offered while another is refused?

A signed consent form is not the same as informed consent if the patient does not understand reasonable alternatives, side effects, non-treatment options, lower-cost choices, or comparable therapies.

The article also makes an important point: this problem is not limited to conventional medicine. Cash-pay longevity clinics, aggressive supplement markets, unvalidated biomarker panels, whole-body scans, hormone programs, peptide protocols, and expensive healthspan services can reproduce the same distortions under a different language. They too can create overuse, selective disclosure, patient dependency, commercial pressure, and exaggerated promises.

The real question is therefore not conventional medicine versus alternative medicine. The real question is: Is the medical decision evidence-based, transparent, proportionate, individually justified, and aligned with long-term patient welfare?

Another major focus of the article is the gap between disease-centered medicine and healthspan-oriented medicine. Conventional medicine often acts when thresholds are crossed, diagnoses are established, or symptoms become obvious. Healthspan medicine asks earlier questions: How stable is the metabolism? How strong is the body? What is happening to muscle mass, sleep, inflammation, glucose control, blood pressure, cardiovascular fitness, hormonal interpretation, recovery, and functional reserve?

Health does not begin only where disease has not yet been diagnosed. A person can be formally “not sick” while already losing strength, metabolic flexibility, sleep quality, mobility, mental clarity, and biological reserve.

That is why a medicine of reference ranges alone is not enough. What is needed is a medicine of trajectory: How are markers changing over time? Which risks are forming early? Which functions are declining? Which intervention preserves autonomy, resilience, and quality of life before irreversible disease appears?

The article does not call for reckless access to every desired treatment. It does not weaken evidence standards. On the contrary, it calls for stronger evidence, better physician education, clearer patient communication, more transparent therapeutic refusal, and incentive systems that reward prevention, conservative care, deprescribing, healthspan monitoring, and long-term biological resilience.

When a therapy is refused, the refusal should be as clearly justified as a prescription. When a procedure is recommended, alternatives should be visible. When medications are used long term, the possibility of reduction or deprescribing should also be considered. When a diagnosis or intervention is serious, a second opinion should not be treated as distrust, but as protection against one-sided commitment.

The medicine of the future cannot only manage disease. It must preserve health, explain uncertainty, respect informed agency, and examine its own incentives.

The decisive measure is not how many services a system produces. The decisive measure is whether people remain healthier, stronger, more independent, better informed, and more capable of shaping their own lives for longer.

The full scientific article is published in the Journal of Advances in Developmental Research:

Elias Rubenstein: Incentive-Misaligned Medicine: Medical Authority, Patient Autonomy, and the Structural Economics of Disease Management

DOI: in process

Elias Rubenstein: Incentive-Misaligned Medicine: Medical Authority, Patient Autonomy, and the Structural Economics of Disease Management.pdf