Searching Upstream For The Source of Sickness

Beverly Merz | The Atlantic | January 15, 2014

New “upstreamist” doctors are looking for the roots of illness in patients’ environmental and social spheres.

A new generation of health care practitioners is helping clinics and hospitals look for the sources of sickness in our everyday lives. Rishi Manchanda, M.D., a public health advocate, medical director at a clinic for homeless veterans in Los Angeles and assistant professor at the Charles R. Drew University of Medicine and Science, calls this group “upstreamists,” a term derived from a well-known public health parable: Three friends see children being carried away in a rushing river. One goes downstream to catch the children before they reach the rapids; another fashions a raft.

“The third friend swims away in the opposite direction,” Manchanda writes in his book The Upstream Doctors. “When her friends ask why, she answers, ‘I’m going upstream to find out who is throwing these children in the river.’”