What is medicine?
Dr George Cho MFSc CEP ND
Clinic Director, Pathways Lifestyle Medicine Clinics / Medical Director, Lifestyle is Medicine / Certified Exercise Physiologist, Cleveland Clinic Canada
Imagine that you have been recently diagnosed with coronary artery disease. To address this your family physician prescribes drugs including a statin to manage cholesterol. However, over time your condition worsens and you are sent to your cardiologist who decides to adjust the medications and recommends a surgical procedure which will place a stent into the narrowed vessels to keep them open. This is really distressing to you because you do not want to undergo a surgery. So out of desperation, you start to do some research yourself and discover a book by Dr. Esselstyn Jr entitled: “Prevent and Reverse Heart Disease.” (1) In this book, you learn that Dr Esselstyn recommends switching to a whole-foods plant-based diet as a powerful way to manage and potentially reverse heart disease.
I have a question for you: In the above scenario, which of the three doctors gave you medicine? Was it the family physician who prescribed statins? Was it the cardiologist who recommended surgery? Or was it Dr. Esselstyn Jr who recommended the lifestyle approach? If you were to ask most people, they would say only two of the three doctors gave them medicine: the one who prescribed the medication and the one who recommended the surgery. Why? Because in the minds of most individuals, “medicine” is composed of: lab tests, pills, tablets, injections and surgeries. This is “medicine” for the vast majority of us.
But should this be the case? Should we broaden our understanding of what constitutes medicine? How about whole foods plant-based nutrition derived from, vegetables, fruits, nuts, seeds, legumes and whole grains? How about meeting the physical activity guidelines or getting adequate sleep? Is there scientific evidence to suggest that lifestyle behaviors should also be included under the umbrella of “medicine” ? I believe the answer is yes. There is a growing acknowledgement in the medical and scientific communities that a broader picture of what constitutes medicine is desperately needed. The argument is being made that how we live our life is also medicine. Lifestyle is medicine.
Disease burden has changed in the past 200 years
This broadening of the concept of “medicine” is being spurred on in part because the types of diseases we are wrestling with now are different from those of the past. This is well demonstrated by an investigation made by the New England Journal of Medicine (NEJM), a very well-respected medical journal, in which they reviewed the shifts in diseases by comparing what doctors and scientists were writing about in the early editions of the journal (1800’s and 1900’s) compared to current editions of the journal (2).
In the 1800’s, they found that doctors were concerned about conditions like spina bifida, epilepsy, rabies, fainting spells, gunshot wounds, and even cannonball injuries. Consumption, diarrhea and pneumonia were major killers, but teething, worms and even “drinking cold water” made the list as well (2). In the early 1900’s, doctors were writing about: tuberculosis, gonorrhea, syphilis, diphtheria, measles, pneumonia, scarlet fever and typhoid. There was even a mention of a leper colony in Massachusetts! (2). But, once we rolled into the 2000’s, heart disease, cancer, diabetes, non-infectious airway diseases, etc, were center-stage in the medical journal (2).
The authors of the report also noticed a shift in what was documented as the leading killers in America. The leading killers in 1900 were conditions like pneumonia, tuberculosis, and gastrointestinal infections, but a hundred years later, heart disease, cancer, non-infectious airway diseases, cerebrovascular diseases, alzheimers, diabetes, etc were the leading killers. (2) Other medical journals concur with this observation. In 2018, the Journal of the American Medical Association (JAMA) reported that the leading killers in America were diseases like: ischemic heart disease, pulmonary cancers, chronic obstructive pulmonary disease, Alzheimer’s disease, colorectal cancer, diabetes and stroke (3).
A momentous shift
I have a question for you: Do you notice a shift, a change in the nature of diseases over the past 200 years? The answer should be an emphatic “Yes.” Diseases have shifted from mostly infections to now those caused mainly by poor lifestyle habits: poor diet, tobacco use, high blood pressure, high body mass index (3).
What we are noticing here is a major shift in what is causing us to be sick and causing us to die. The World Health Organization estimates that by the year 2020, two-thirds of all diseases will be the result of lifestyle choices (4). Now, pause and let that sink in for a moment. In less than two years, more than 6 out of 10 diseases causing sickness among us will be the result of how we are eating, sleeping, moving, loving, stressing, etc. We are not dealing here with a minor change, we are dealing with momentous shifts in the whole landscape of disease and health.
Medications still our primary solution
The above information is bad news but unfortunately, it gets worse. Though the nature of diseases has changed, the practice of medicine has not seen a proportional change adequate enough to match this seismic shift. We used synthetic nostrums and concoctions in the past until more sophisticated pills, injections and surgeries came along and these have remained as our main modalities to this very day. In the United States, 68% of men and 82% of women in the 18 – 44 age bracket, are using medications. (5) This number jumps to 81% and 89% of mid-aged men and women. Among seniors, it is above 90%. (5) 44% of male seniors and 57% of women seniors are on 5 or more drugs. More than one in ten are on 10+ drugs (5). This is a travesty.
A report from the Canadian Medical Association Journal says that prescription drugs are placing a major burden on the health system in Canada, to the tune of billions of dollars. And which drugs are estimated to be the greatest cost to health care in Canada? Number one are anti-hypertensive drugs, costing the health care system about 1.4 billion dollars (6). Number two are cholesterol-lowering drugs. Number three are biologics for inflammatory conditions. Others on the top ten list are: acid-lowering drugs, non-insulin diabetes drugs, insulin, anti-depressants, anti-psychotics and opioids (6).
The scales are not tipping
Do you notice that most of the drugs mentioned above are used to address diseases caused by a poor lifestyle? Hypertension, diabetes, high cholesterol, etc are in the vast majority of cases, caused by a poor lifestyle. Yet our main method of treating these is through medications. This may explain why patients are not doing very well. The drugs just do not really address the cause of their health problems.
You would think that with all the money, drugs and surgeries we are throwing at these diseases, that the disease burden would have decreased and that patients would be doing better, but that is simply not the case for many. On the contrary, a common experience is one in which the disease progresses despite medical care and patients end up having to take more drugs, often for life. (7) Though we have a mountain of drugs to address heart disease, cancer, hypertension, diabetes etc, these diseases and the burden they cause, are still out-weighing all our pills, tablets, injections and surgeries combined. The disease burden caused by these lifestyle-related diseases is not going away. In fact, it is worse, the burden seems to just be increasing. The outlook is negative, not positive.
Another momentous shift
However, there is another momentous shift happening in medicine that has the potential to really match the dramatic changes in the disease landscape discussed above. Since “medicine” up until now has not met many of our hopes and expectations, a growing number of physicians, researchers and patients are seeking for alternative answers, and the place from which the most promising answers are arising is in a new and cutting-edge field called lifestyle medicine. Lifestyle medicine is shifting, redefining and revolutionizing medicine. Backed by an ever-growing flood of research and energized by well-crafted, research-based documentaries like: Forks Over Knives, What the Health, and Eating you Alive, the lifestyle medicine movement has been broadening the concept of “medicine” in the minds of doctors and patients alike. According to lifestyle medicine, medicine is not just: lab tests, pills, injections, tablets and surgeries; the idea is that your lifestyle is medicine.
Your lifestyle is medicine
Lifestyle medicine is not a fad. It is a legitimate force taking hold within the medical community, and for good reason, the nature of our diseases has changed drastically and this means that our medicine needs to adjust as well. If a poor lifestyle is the main problem then a good lifestyle must be part of the solution. We all need to embrace the idea that medicine includes a healthy lifestyle.
So what is medicine? For sure it includes: pills, tablets, injections, surgeries, and lab tests, but it also includes your lifestyle as well. Living a healthy lifestyle is indeed medicine.
References
Esselstyn Jr, C. Prevent and Reverse Heart Disease. 2007
Jones D., Podolsky S & Greene J. The burden of disease and the changing task of medicine. The NEJM. 2012, 366; 25. p. 2333 – 2338
Murray C et al. The State of US Health, 1990 – 2016. Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018; 319 (14): 1444-1472
Egger, G & Egger, S. Lifestyle Medicine: The Australian experience. Am J lifestyle medicine. 2011. Vol 6, 1: 00. 26-30
Kaufman, D et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA, January 16, 2002. Vol 287. No.3, p.337 – 344
Morgan S et al. Estimated cost of universal public coverage of prescription drugs in Canada. CMAJ. 2015 Apr 21; 187(7):491 – 497
Hyman, M., Ornish, D & Roizen, M. Lifestyle Medicine: Treating the causes of disease. Alternative therapies. Nov/Dec 2009. Vol. 15. No 6. pp. 12-14
