From a speech by Dr. John McDougall to a group of M.D.s. These are Dr.
Flora van Orden's notes...
Why is diet and lifestyle medicine so unpopular?
The main problem is its low profit. If we could change the
profitability of lifestyle 'medicine', it would change overnight. But
there is also the excuse that it takes some patient 'compliance'/effort.
But, of course, that's taught to us, isn't it?
We are taught that patients aren't very smart, right? And, they're
not going to do this. That's what I was taught when I was in medical
school.. that patients were barely smart enough to sign the check at the
end of the office visit and take our drugs. They're stupid and
disinterested, and that's part of the education that goes on still
today.
I believe that patients are very willing, if we give them half a
chance, to make these changes. I see it every day in my practice, and
they are very grateful. It's not high-tech.
I had an experience one time. I read an article by Dr. Pannish about
how to cure rheumatoid arthritis in the Annals of Internal Medicine.
I was doing a radio show at that time and I wanted him as a guest on my
radio show. So I tracked him down at the University of Florida in
Gainesville. Originally, that's where I looked for him, but he wasn't
there anymore - he was at a big university of the East Coast and had
become the Department of Internal Medicine head.
I called him up to invite him to be a guest, "Oh, Dr. Pannish, I'm so
excited to talk to you. here you are, a man who's really stood up and
said you can cure rheumatoid arthritis with diet."
And he said "Wait a minute, I don't want to talk about that."
I said, "What do you mean?"
"I don't do that anymore," he said.
"Well, what do you do?" I asked him.
He said, "I'm at this big university. Real doctors don't talk about
diet and disease."
"So, what do real doctors talk about?"
"Well, you know, things like genetics and viruses and biochemistry
and things like that. You see, it's not sexy. The person you saw at the
front desk can teach you about diet and lifestyle. You don't have to be a
doctor or a dietitian. I mean, anyone can teach you. It's not really
sexy, is it? So, it's not very popular. And then, when you give
patient control, then you as a doctor lose control and this is an
ego-centered business, isn't it?"
Yeah, it is an ego-centered business. That's why we have operating
theaters.
Then Dr. McDougall showed a pie chart of chronic illnesses.
"OK, let's get down to the treatment of disease. I'd give us medical
doctors a report card. I'd give us an A for treating acute illnesses and
I'd give us, at best, a D- for treating chronic illnesses. So, we've
made great contributions in terms of people's health in several areas
such as sanitation... Antibiotics, of course, are really wonderful;
trauma care, and immunizations. They have made a huge difference in the
welfare of people throughout the world. But, these are acute illnesses
that we are dealing with primarily.
When it comes to chronic illness, seven of the leading causes of
death are due to chronic illness. They are the diseases you see up there
like heart disease, cancer, strokes, lung disease, diabetes, liver
disease and atherosclerosis. And it represents 3/4ths of the health care
dollars spent in this country - chronic diseases. The treatment of
chronic illness with drugs, with medication, can't possibly work. Just
the fact that it's called chronic, and continues to be called chronic,
is an admission of failure.
Americans are sick, they're sicker than ever, and most Americans over
the age of 55 have at least one risk factor for diseases. For example,
1/3rd have elevated cholesterol, most are inactive, 1/3rd have high
blood pressure, 30% are obese, more than 65% are overweight, and 10% are
diabetic. I mean, those are the facts and we treat those patients
primarily with drugs. What we treat, of course, is not the patient or
the disease, but we treat the risk factors, the signs and symptoms of
the disease."
He introduced us to a term called 'disease mongering.' A monger is a
derogatory term for a dealer, like a used-car dealer. Dr. Ray Moynihan
defines disease mongering:
"It's the selling of sickness that widens the boundaries of illness
and grows the market for those who sell and deliver treatments. It's
exemplified most explicitly by the many pharmaceutical industry funded
disease-awareness campaigns. Disease mongering turns healthy people
into patients."
The most common way in which we disease monger is to treat risk
factors and not diseases. In fact, it's not just risk factors we are
treating anymore - it's risk factors for risk factors: pre-hypertension,
pre-diabetes, pre-osteoporosis (osteopenia), etc.
So that's what we treat as risk factors: symptoms. I've been in
practice for 40 years and I've never seen a patient die of high
cholesterol! I've never seen a patient die of high blood pressure and I
have never seen a patient die of high blood sugar, ever. These people
who have these risk factors die of real diseases, don't they? I mean,
they really are sick.
Unfortunately, we don't treat the underlying sickness that kills
them, and we see tragedies in people's lives. 1.2 million people have
heart attacks every year. 700,000 have strokes.
What would happen if instead of dealing with the risk factors, which
we treat very effectively with drugs, we instead dealt with the
underlying diseases? We might have to do something drastic, like change
people's diets! Or, make them exercise! Or, cause them to quit
smoking! But the problem is, how do we charge for that? How do you
make a living doing that?
OK, lifestyle is what it's all about, correcting the cause
through a change in lifestyle. Most of you understand that it's a
plant-based diet, it's modern exercise and it's clean habits that work.
Let me give you an example of disease mongering just so you all get up
to speed on this and see how it works:
Treatment of hypertension. The end points for treating high
blood pressure, how do we succeed? Do blood pressure lowering
medications lower blood pressure. Definitely, no question about it. In
fact, when you read the scientific studies on high blood pressure, what
do you find?
Yes, Drug A lowers blood pressure as well as Drug B.
Do they reduce the risk of dying of heart disease? No.
Do they reduce the risk of stroke? A little bit.
Do they have side effects and complications? A LOT!
We are taught by the provocatively dressed drug representatives and
by the drug companies that high blood pressure medicine is very
effective, it cuts the risk of stroke in half. And you think that
there's a practitioner who thinks, "I would be foolish if I didn't treat
my patients with high blood pressure pills," because they cut the risk
of stroke nearly in half... Well, if you look at scientific research,
this is what you find:
The risk of stroke for 5 years: People who have mild hypertension
between 90 and 110 mm of mercury, if you don't treat them they have 15
chances of having a stroke out of every 1,000 people untreated. But, if
you treat them, their risk is now 9 chances out of every 1,000 patients.
So, what do we have here? We have a risk reduction over five years.
That's 15 minus 9, which is 6, divided by 15 we have a relative risk
reduction of 40%. That's a relative risk reduction, but that's not the
way we should look at things, is it?
The risk of stroke for five years, in terms of absolute reduction is
six strokes per 1,000 people. That's one less stroke per year by
treating 1,000 people with medication. It looks a little bit different
now. So what we do is talk in terms of relative and absolute risk
reduction which means no sense at all. It makes a profitable sense but
no sense in the terms of the welfare of our patients.
Disease mongering expands the definition of sickness. When
Walter Kempner was taking care of high blood pressure patients, his
blood pressure patients came in with blood pressures of 200/140. He got
60% of them down to normal blood pressures. When I started in medicine,
it was called mild high blood pressure when it was 160/100. Soon, it
became 140/90. Then there was a report, the first came out about 18
years ago, but another one came out a couple of years ago that said that
if your blood pressure was 120/80 or greater, that you had twice the
risk of dying of heart disease. It made national headlines. I'm sure the
PR people, the spin doctors, at the drug stores. It made national
headlines.
I'm sure the PR spin doctors, at the drug companies made sure that
everybody learned about that. Now that is true, if your blood pressure
is elevated, it is an indication that you have higher risk of having
diseases associated with a western diet. It's a sign that says you're
sick. But does treating signs necessarily solve the problem? Well, the
drug companies think we should do that even though the results of those
treatments don't show those benefits. So we have doctors out there
treating people with blood pressures of 120/80 or higher or maybe 110/70
or higher. Remember, that's pre-hypertension. So, you expand the
market greatly by expanding the definition of sickness.
Now, this is the guideline that I use and the one I would encourage
you to use, from the British literature. It's the most current guideline
on treating high blood pressure. And that is why I don't feel
uncomfortable at all taking patients off blood pressure lowering
medications. That is why I don't feel uncomfortable having my patients
blood pressures at 140/90 or 150/95 without medication, because of the
British guidelines, which have looked carefully at the scientific
literature and have made some profound statements that should dictate
our practice.
In these guidelines, there are summary points that all people with
high blood pressure, borderline or high normal blood pressure should be
advised on lifestyle modifications.
Now how many doctors do you think do that? I mean do you think a
patient goes into a doctor's office and when the blood pressure is
detected, the first thing the doctor does is say, "You're going to take a
10-week diet and lifestyle course before I put you on drugs."
You think that ever happens? Or do you think maybe, more likely what
happens is, when the patient comes into the doctor's office, the first
reading of elevated blood pressure dictates a life-long treatment for
high blood pressure. Do you think that's possible? I think so.
Then they go on and say that you should initiate drug therapy if
there is a sustained, as in not 15 minutes, but months, 160 systolic and
100 or greater diastolic. That's what the British guidelines say. Now,
if you feel uncomfortable about not initiating high blood pressure
therapy, for what you know is less than mild hypertension, or if you
feel uncomfortable about taking people off high blood pressure
medication, just use the British guidelines. It's the most current
recommendations out there, and I believe much less biased because I
believe the British literature is much less influenced than the U.S.
literature.
More on disease mongering. Here's another way to do it. You
exaggerate the goals of treatment. The goal, I can't think of a patient
who has come in with anything but the goal of making the blood pressure
normal with drugs. 110-78 or less, that's the goal.
Well, using medication, reaching that goal results in more death
and disability, more heart attacks. What happens is when the
diastolic is high and you treat, say it's 120, the blood pressure, the
risk of heart attacks and death decreases until you hit a level of about
95 mm of mercury in diastolic. Certainly, no lower than 85 mm of
mercury. Then, the risk of death increases. It's called the "J" or "U"
phenomenon of mortality. It's been written about for over 30 years. It
makes a lot of sense, doesn't it?
Here you have a patient whose blood vessel system is all clogged up,
it's full of sludge from what they ate, their arteries are in spasm.
The heart and the body perceive these problems: "We are not
delivering the nutrients to the tissues because of all this peripheral
resistance. So, what do we need to do?"
The body says to itself. "Well, we need to increase the pressure in
the system," so the pressure goes up. So, what do we do as agents of
medical care, agents of the pharmaceutical industry? We poison the
system at various levels. We poison the heart with beta blockers, we
poison the arteries with calcium channel blockers, we poison the kidneys
with diuretics. And the blood pressure comes down, as expected.
But what happens to all that effort the body is making to deliver
nutrients to the tissues? What happens is, that effort is stopped.
The consequence is you decrease pressure to the tissues and the
patient dies. But, at least he died with a normal blood pressure, right?
[Emphasis added.]
Peace and Love Be With You,
Dr. Flora van Orden III
PhD, Nutrition
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