In every walk of life, there are challenges. Among these challenges is the need to find a balance between accomplishing what is expected of us today with what may be expected of us in the future.
I began my career as a pediatrician only to discover that many problems I faced required knowing the whole family. This led me to pursue a board certification in family medicine where I often have the opportunity to treat the entire family.
Alas, the best laid plans often change as we experience life and learn. In this regard, the practice of medicine is no different. My original career plan was to be a doctor that cared for the sick. After many years of school and internships, I became a doctor that could identify hundreds of symptoms and prescribe hundreds of pills. As the years passed, I learned to use new medicines, new procedures and discovered better ways to help patients navigate the healthcare system. At each step along the way I found myself asking, “What new training will give my patients the best care?” As it happens, the answer wasn’t more pills and more procedures. Certainly, science has produced and continues to produce amazing treatments. The dilemma is that lifestyle is most often the root cause of most modern ailments. With ‘a pill for every ill’, the wonders of science too often become a permission slip for continuing a lifestyle that results in higher medical cost and lower quality of life in our later years.
The commonly practiced reductionist style of medicine typically addresses symptoms with a pill or procedure for each illness. For an acute situation where relief is urgently needed this can be the best solution. For a chronic condition, however, the miracles of modern medicine usually come up short when compared with what the human body can do for itself given the right conditions. Complicating matters, a patient seeing two or more specialist can easily end up taking 8-12 prescription medications without addressing root causes that could better respond to lifestyle changes. The cost and potential for side effects make these multipharmacy treatments problematic at best. Making matters worse, it’s rare to encounter a patient with a dozen or more medications that can remember what they are for, when to take them, and what side effects to be vigilant about. Of course, I’m glad to have medications available to treat a broad spectrum of illnesses. In some cases, they can be lifesaving.
This brings me to sharing with you that I recently completed a board certification in a second medical specialty called lifestyle medicine.
To appreciate the difference between traditional medicine and lifestyle medicine it helps to appreciate why each came into existence. For traditional medicine, the original goal was to alleviate pain and suffering from acute conditions. For these purposes, traditional medical approaches are very good but only apply to about 25% of the patients that primary care doctors see. The other 75% of patients suffer from progressive lifestyle diseases.
Where evidence-based lifestyle medicine can be applied, it offers advantages because it treats the root cause of chronic disease and not just symptoms. Lifestyle medicine can also provide a better quality of life along with remarkable cost savings. By reducing the demand for expensive “sick care”, Lifestyle Medicine stands as the only practical solution for reversing the continued upward trajectory of health care cost by reducing the need for expensive pharmaceuticals, surgical procedures, and hospitalizations. The advantages for treating chronic conditions with lifestyle medicine are hard to ignore unless you are a politician running for office on contributions from interests vested in high medical cost.
Although the following statistics are approximate, they capture the essence of why America must change the way healthcare is provided.
- About half of all adults have one or more diagnosed chronic health conditions related to lifestyle. One in four adults has two or more diagnosed chronic health conditions.
- Seven of the top 10 causes of death are chronic diseases related to lifestyle. Two of these chronic diseases (heart disease, and cancer) together account for nearly 46% of all deaths.
- Trends indicate that one in three children born will be diagnosed with type 2 diabetes in their lifetimes, and one in two for Hispanic children.
- Fifty years ago, two million Americans had been diagnosed with type 2 diabetes. Today, estimates are as high as 160 million who are pre-diabetic or have already been diagnosed with diabetes.
- 80% of heart disease, stroke, and type 2 diabetes and 40% of cancer could be prevented with improvements in lifestyle.
- Unhealthy diets are the major contributor to almost 700,000 deaths annually in the United States.
The economic impact of healthcare in the United States is approaching 20% of the Gross Domestic Product (GDP). Of that astronomical sum, about 86% of the nation’s annual health care expenditures are tied to the treatment of chronic disease and mental health conditions. Of the chronic physical conditions, the majority have a root cause in lifestyle behaviors. Similarly, as a first-line therapy, lifestyle choices also have a positive effect on mental health.
While not an economist, I would venture to guess that the anemic productivity growth and wage growth over the last decade is not quite the mystery they are usually portrayed as. Unless people are healthy they are not productive. As for the near 20% of GDP that pays for healthcare, well, that has to come from somewhere and paychecks end up being directly or indirectly that place.
Creating meaningful change in healthcare will require a re-education of doctors that were primarily taught acute care medicine. At present, the average physician receives less than 20 hours of nutritional education in medical school. Of the 171 medical schools in the United States, only four have a nutrition department.
The good news is that the inaugural cohort of more than 250 physicians trained in lifestyle medicine returned to their traditional medical practices one year ago and are beginning to make a difference as they treat patients and educate fellow doctors. This year, including myself, 300 more joined the ranks of board certified lifestyle medicine physicians.
As you read my closing thoughts about lifestyle medicine and its importance to you and the nation, rest assured I have you covered with the best that traditional evidence based medicine can offer. Hopeful, you will also take as good news that I have joined the ranks of board-certified doctors in lifestyle medicine.
Want to brag about your doctor? Well, now you can. Just say she has been board-certified in three medical specialties over her career and is currently dual certified in family practice, the specialty that treats 25% of conditions that people need primary care physicians for, and lifestyle medicine, the specialty that covers the other 75%.
Nancy Neighbors, MD
A Few Thoughts About Heart Disease
While cardiovascular disease remains the number one killer of women and men in the United States, it is unfortunate that with evidence of how to prevent and reverse most heart disease with lifestyle changes that this strategy has not been promoted as the first line therapy for the vast majority of patients. The reason, of course, is how physicians have been traditionally trained.
Most physicians receive minimal nutrition training in medical school and almost none during their training in cardiovascular health. Nevertheless, during their post-graduate years some will have heard about the work of doctors Kempner, Pritikin, McDougall, Ornish, Esselstyn, Ostfeld, Barnard, etc. and the power of whole food plant-based nutrition to halt and reverse cardiovascular disease. Sadly, most physicians today that attempt to have their patients adopt whole food plant-based nutrition fail because of an assumption that plant-based nutrition is unrealistic given that patients will not adhere to it.
Dr. Esselstyn offers an explanation for the dilemma with a quote from one of his mentors, “Inappropriate application of the method is no excuse for its abandonment.” In other words, it is not that the message is wrong but how it has been articulated that is at fault. Physicians with no training in lifestyle transitioning who attempt this approach during a single ten-minute office visit without the patient’s significant other in attendance are inviting failure.
Today, doctors with lifestyle medical training are obtaining almost 90% success in arresting heart disease with significant success in reversing heart disease for a wide range of conditions. No pill or medical procedure offers that opportunity for the majority of patients.