Though I was trained as a general practitioner, my chosen specialty is lifestyle medicine. Most of the reasons we go see our doctors are for diseases that could have been prevented. But lifestyle medicine is not just about preventing chronic disease—it’s also about treating it. And not just treating the disease, but treating the causes of disease.
If people just did four simple things—not smoking, exercising a half hour a day, eating a diet that emphasizes whole plant foods, and not becoming obese—they may prevent most cases of diabetes and heart attacks, half of strokes, and a third of cancers. Even modest changes may be more effective in reducing cardiovascular disease, high blood pressure, heart failure, stroke, cancer, diabetes, and all-cause mortality than almost any other medical intervention.
The key difference between conventional medicine and lifestyle medicine is instead of just treating risk factors, we treat the underlying causes of disease, as Drs. Mark Hyman, Dean Ornish, and Michael Roizen describe in their landmark editorial Lifestyle medicine: treating the causes of disease. Doctors typically treat “risk factors” for disease by giving a lifetime’s worth of medications to lower high blood pressure, elevated blood sugar, and high cholesterol. But think about it: high blood pressure is just a symptom of diseased and dysfunctional arteries. We can artificially lower blood pressure with drugs, but that’s not treating the underlying cause. To treat the underlying cause, we need things like diet and exercise, the “penicillin” of lifestyle medicine.
As Dr. Ornish is fond of saying, disregarding the underlying causes and treating only risk factors is somewhat like mopping up the floor around an over-flowing sink instead of just turning off the faucet, which is why medications usually have to be taken for a lifetime. As Dr. Burkitt describes, “if a floor is flooded as a result of a dripping tap, it is of little use to mop up the floor unless the tap is turned off. The water from the tap represents the cost of disease, and the flooded floor represents the diseases filling our hospital beds. Medical students learn far more about methods of floor mopping than about turning off taps, and doctors who are specialists in mops and brushes can earn infinitely more money than those dedicated to shutting off taps.” And the drug companies sell rolls of paper towels so patients can buy a new roll every day for the rest of their lives. Paraphrasing poet, Ogden Nash, modern medicine is making great progress, but is headed in the wrong direction.
When the underlying lifestyle causes are addressed, patients often are able to stop taking medication or avoid surgery. We spend billions cracking patients’ chests open, but only rarely does it actually prolong anyone’s life. Instead of surgery, why not instead wipe out at least 90% of heart disease through prevention? Heart disease accounts for more premature deaths than any other illness and is almost completely preventable simply by changing diet and lifestyle, and the same dietary changes required can prevent or reverse many other chronic diseases as well.
So why don’t more doctors do it?
One reason is doctors don’t get paid for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. Presently, physicians lack training and financial incentives, so they continue to do what they know how to do: prescribe medication and perform surgery.
After Dean Ornish proved you could open up arteries and reverse our number one cause of death, heart disease, with just a plant-based diet and other healthy lifestyle changes (see Resuscitating Medicare and Our Number One Killer Can Be Stopped), he thought that his studies would have a meaningful effect on the practice of mainstream cardiology. After all, he had found a safe and effective cure for our number one killer! But, he admits, he was mistaken. Physician reimbursement, he realized, is a much more powerful determinant of medical practice than research.
Reimbursement over research. Salary over science. Wealth over health. Not a very flattering portrayal of the healing profession. But if doctors won’t do it without getting paid, let’s get them paid.
So Dr. Ornish went to Washington. He argued that if we train and pay for doctors to learn how to help patients address the real causes of disease with lifestyle medicine and not just treat disease risk factors we could save trillions of dollars. And that’s considering only heart disease, diabetes, prostate and breast cancer, leaving out the myriad of other conditions that could be ameliorated. The Take Back Your Health Act was introduced in the U.S. Senate to induce doctors to learn and practice lifestyle medicine, not only because it works–better, but because they will be paid to do it. Sadly, the bill died, just like millions of Americans will continue to do with reversible chronic diseases.
By treating the root causes of diseases with plants not pills, we can also avoid the adverse side effects of prescription drugs that kill more than 100,000 Americans every year, effectively making doctors a leading cause of death in the United States. See One in a Thousand: Ending the Heart Disease Epidemic and my live presentation Uprooting the Leading Causes of Death.
Michael Greger, M.D.