Thursday, February 5, 2009

Take Charge of your Health

Modern medicine can be a secular miracle. But, we should not depend on the health system to keep us healthy. The Institute
of Medicine and researchers at the prestigious Robert Wood Johnson Foundation report that two-thirds of our health is determined by how well we take care of ourselves and the environment in which we live, not by the medical care we receive.* Many of the diseases that cause premature death and disability, even those influenced by genetics, are preventable by not smoking, an excellent eating style, getting moderate regular exercise, adopting good sleep habits, nurturing good family and social relationships, maintaining a healthy weight, and managing stress. No pill or medical procedure is as effective at maintaining health as a great lifestyle.

A close friend in his mid-60s has had various health problems including prostate cancer, high blood pressure and high cholesterol. He changed his eating style several
months ago and lost over 25 lbs. He avoids processed foods, eats mainly vegetables, fruit, beans/legumes, whole grains and a little fish. His cholesterol and blood pressure have dropped and, in consultation with his primary care physician, he has stopped taking cholesterol lowering and blood pressure medicine.

My friend and I agree that there is no need for annual physicals and most “early detection” testing. Our avoidance of the obligatory annual trip to the doctor’s office is controversial. Our decision is, however, supported by The American College
of Physicians, the AMA, and other professional organizations that recommend against the annual physical exam because they have not been proven to extend life or make us healthier**. Yet, a high percentage of doctors office visits are annual physicals because they are heavily promoted. Each encounter with the health system opens us to the risk of being overtreated and misdiagnosed. Taking control of our health involves making careful decisions about the appropriate use of physicians,
tests and drugs.

Consider the follow in deciding how to use the health system:

Western medicine is often excellent at treating serious acute conditions, but not effective at preventing illness
- Some early detection, such as pap smears and screening for precancerous polyps in the colon is useful; much is not. Everyone needs to reach his/her own comfort level with whether or not to seek out health screening tests. Many
experts agree that it is often a reasonable decision to avoid them.***

Medical Care is a business – There are many excellent physicians, but today’s medical care system looks nothing like
the days of Marcus Welby, M.D. The financial pressure on doctors has increased. Doctors are the target of advertising,
and promotion, including gifts, from the pharmaceutical industry. Much of the so-called research that supports drugs
and devices is sponsored by manufacturers and is not objective.* In addition, insurance companies and the government
have reduced payments to health care providers. As a result, the business of medicine does not always work to
our benefit. Doctors are torn between generating income and doing what is right for their patients. As a result, too
many unnecessary and ineffective tests are ordered, referrals made, and drugs prescribed. As a nation, we are seriously over-medicated, often to the detriment of our health.

Primary care physicians who emphasize prevention are a rare breed - A really good primary care doctor provides
invaluable advice on maintaining health, takes the time to listen, and addresses patient’s individual needs. Such physicians
are scarce. Medical students receive virtually no training in nutrition. The public is largely on its own in learning
good health practices. Weeding out the good information about wellness is a major challenge. The media is loaded
with awful health care advice and fad diets. Physicians are busier than ever today, and if they don’t take the time to
listen, it may be time to make a change. ****

We have too many specialists - About two-thirds of the medical doctors in the US are specialists. Specialists are a
much higher percentage of total doctors than in most other countries. We pride ourselves with having the most sophisticated
medical technology, yet we rank poorly in deaths from cardiac disease, stroke, diabetes, cancer and many other
chronic diseases. All this specialty care and sophisticated technology have not made us healthier. If a specialist is necessary,
it is important to choose one who is conservative about ordering tests and medications and who is deeply experienced
in treating your specific condition. As with primary care physicians, two-way communication is important. When a specialist recommends treatment, it is a good idea to first discuss it with your general doctor, if you are lucky
enough to have a good one. One of my favorite questions to a physician, “Is there objective, peer-reviewed research to support what you are recommending for me?”

In sum, leading a healthy lifestyle, especially an excellent eating style, is one of the most important things we can do for
ourselves and our loved ones. Taking control translates into a longer and healthier life and time not spent dealing with the
business of medicine.
*See Dr. John Abramson’s Forward in Eat for Health by Joel Fuhrman, M.D.
**The complete annual physical examination refuses to die - Editorial Journal of Family Practice, June, 1995 by Paul S. Frame
***Overtreated: Why too Much Medicine Is Making Us Sicker and Poorer, Shannon Brownlee and Should I Be Tested for Cancer: Maybe Not
and Here's Why, H. Gilbert Welch, M.D., M.P.H.).
**** For more information see How to Choose a Primary Care Doctor by John McDougall, M.D at


kneecap said...

HI Howard,

nice post. I only quibble with your statement about modern medicine being a miracle. how so? most of it seems barbaric to me: knives and drugs.

By the way, about influencing other people: I learned that a person who took my healthy vegan cooking class last Fall has become a vegan and has lost 56 lbs! She was already motivated and losing weight when she took the class. But it's nice to know we have an influence every once in a while. I think we just have to be happy with small numbers--still better than 0. Another friend of mine is turning vegan too, so that's 2 people I've influenced that I know of.


Howard Veit said...


That's great. Influencing two people to be healthy is quite an accomplishment. I have influenced one of my sons...although he isn't all the way yet. I am frustrated with my mens' club because of the 8or so that have attended my classes I only see miniscule changes. Most people think I am nutty.

I think medicine can be miraculous, properly applied. I am walking around normally today because of a terrific Orthopaedist who repaired a nasty fracture of my hip and femur. He was against most of the drugs commonly perscribed, like blood thinners after the surgery, and found other mechanical approaches to prevent clotting. He had me take only a few mild pain killers. There are other examples I could mention where people's lives have been saved and/or pain suffering relieved due to moder approaches to surgery or medicine.

Unfortunately, lots of medicine is misguided and overkill in the interest of generating revenue. Most people don't know how to use the health system for their best advantage and end up overusing it. The number of uninsured, which now must be well over 50 million, is a tragedy.