In medicine we sometimes talk about adequacy of treatment with medication in terms of whether or not the patient is receiving a therapeutic dosing of the medication. In some cases we check can check the blood to see if the level of the medication in the blood is high enough to be “therapeutic.” That doesn’t mean that the medication doesn’t work, it just means the patient isn’t quite getting enough to have the desired effect. We don’t stop the treatment, but rather we bolster it.
When it’s come to medications, it’s an easy thing to determine. We have objective* data telling us what a good blood concentration of a given medication should be. We are not as good at determining “therapeutic” levels when it comes to other types of interventions. While there are general guidelines for other types of intervention; how many fruits and veggies we should eat, how much exercise we should get. But these are more general guidelines, and what may work for one person may be sub-therapeutic for another. With psychotherapy, it’s seems the jury is still out as far as frequency and duration.
I also then think about social interventions. Having spent a good amount of time in the street medicine space and with people experiencing homelessness, I’ve also been exposed to countless initiatives and projects aimed at serving underserved and vulnerable communities. Not all programs are created equal, but there are definitely ones out there that seem to have a lot of promise, but they don’t have the resources to have the impact that the could. The funding isn’t there, or the staffing isn’t there, often because interventions of societal sickness don’t have any inherent profitability so society doesn’t care (just like managing chronic disease doesn’t immediately make a person feel better).
As an example, enhanced care management (ECM) has recently become a provision as part of some medical insurance in California. ECM is meant to provide comprehensive, focused care for individuals with complex medical and social needs through intensive case management. While the idea of this is amazing and would likely benefit many, many people, the need is large and the providers are few (and reimbursement I’m guess is small). Having had the chance to work with some ECM providers, they are stretched thin with their current empanelment as it is and have a lot of people who likely need services that they just are not able to get to.
If we are thinking of the injustices that exist in our community as society sickness, these interventions are sub-therapeutic. That doesn’t mean they are ineffective, it may just mean that the dose is just too low.
nANIMOv 