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President's Desk, April 2014
David L. Katz, MD, MPH

Health Care: From Reform, to Revolution

Introduction by Past President, Liana Lianov, MD, MPH

"I am honored to introduce and welcome David Katz as our new ACLM president.  He has had an illustrious career and many of you may already be familiar with his work. I am challenged to adequately summarize so many achievements! To name a few, David is the founding director of Yale University's Prevention Research Center, the current Editor-in-Chief of the journal Childhood Obesity and the medical director of the Integrative Medicine Center and Griffin Hospital. He is also well known in the media, as a medical expert for ABC News/Good Morning America; writer for the New York Time Syndicate; columnist to O, the Oprah Magazine; contributor to US News and World; and blogger for Huffington Post, among other contributions. I encourage you to read his bio on the ACLM website for more details.

I am certain David will advance our organization's visibility and standing in the broader medical community, as well as significantly expand awareness and engagement in the public's eye about lifestyle medicine. Under his leadership, we can promote, as he likes to say, the need for "lifestyle in medicine" and "lifestyle as medicine." Welcome, David!"

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Heart disease is not the leading cause of death among men and women in the United States.  Cancer, stroke, pulmonary disease, diabetes, and dementia are not the other leading causes of early mortality and/or chronic malady either.

Don’t get me wrong- these are the very diseases immediately responsible for an enormous loss of years from life, and an even greater loss of life from years. In that context, heart disease is indeed the most common immediate precipitant of early death among women and men alike.  Cancer, stroke, and diabetes do indeed follow close behind. It’s just that these diseases aren’t really causes. They are effects.

We got this message loud, clear, and first- at least in the modern era- in what really should have been a culture-changing research paper published in JAMA in 1993 entitled ‘Actual Causes of Death in the United States.’ In that analysis, two leading epidemiologists, Drs. William Foege and J. Michael McGinnis, looked into the factors that accounted for the chronic diseases and other insults that immediately preceded premature deaths. When they were done crunching numbers, they had a list of ten factors that accounted for almost all of the premature deaths in our country every year.

Let’s digress to note we cannot ‘prevent’ death. But what makes death tragic is not that it happens- we are all mortal- but that it happens too soon. And even worse, that it happens after a long period of illness drains away vitality, capacity, and the pleasure of living. Chronic disease can produce a long, lingering twilight of quasi-living, before adding to that injury the insult of a premature death. And that, we can prevent. We can preserve vitality, and we can postpone death to its rightful time, at the end of our full life expectancy.

Now back to our regularly scheduled program. There were two astounding things about McGinnis and Foege’s list of ten factors*. First, we as individuals have substantial control over everything on the list, and virtually complete control over most of the entries. Second, just the first three factors on the list - tobacco, diet, and physical activity - accounted for fully 80% of the action. In other words, the actual, underlying “cause” of premature death in our country fully 8 times in 10 comes down to bad use of our feet (lack of physical activity), our forks (poor dietary choices), and/or our fingers (holding cigarettes).

I trust you immediately see the up-side to this.  If bad use of feet, forks, and fingers accounts for 80% of premature deaths (and a bounty of chronic disease), it stands to reason that optimal use of feet, forks, and fingers could eliminate up to 80% of all premature mortality and chronic illness. This proves to be exactly true. Feet, forks, and fingers are the master levers of medical destiny.

We know this not just from McGinnis and Foege’s seminal paper, but from a steady drumbeat of corroborating research spanning the two decades since. Scientists at the CDC replicated the findings in the original paper in an update a decade later. Population-based research published in 2009 showed that people who ate well, exercise routinely, avoided tobacco, and controlled their weight had an 80% lower probability across their entire life span of developing ANY major chronic disease- heart disease, cancer, stroke, diabetes, dementia, etc.- than those who smoked, ate badly, didn’t exercise, and lost control of their weight. Flip the switch on any of these factors from bad to good, and the lifetime risk of serious chronic disease was reduced by nearly 50%.  But firing on all four cylinders produced a greater net benefit than perhaps any advance in the history of medicine. These very findings have been replicated again, and again- and have been shown to extend that same influence over the expression of our very genes.  DNA is not destiny, and to a substantial extent- dinner is. By changing what we eat and how we live, we can alter the expression of our very genes in a way that immunizes us against chronic disease occurrence, recurrence, or progression.

And so it is we have the knowledge to eliminate fully 80% of all chronic disease and premature death. The contention isn’t even controversial. 

But knowledge, alas, isn’t power unless it is put to use. And for the most part, we have not leveraged the astounding memo we first got in 1993. 

And so, as I embrace the privilege and opportunity to serve ACLM as President, this is our mandate. Lifestyle is the best of all medicine - but we have yet to find the means of getting this medicine to go down for the masses, most in need. Certainly the last thing we want is more spoons full of sugar!

Lifestyle IN medicine is part of the answer - adept, constructive, compassionate clinical counseling and effective programs.  We will devote resources of the college to this.

But lifestyle AS medicine, at the level of our culture, is of even greater importance. The Blue Zones are not places where people live the longest and best because of great clinical programming; they live the longest and best because lifestyle is medicine, and culture is the spoon.

Health care reform is really about improving disease care systems. That’s quite important.  But lifestyle both in and as medicine is a true revolution whose time has come - with unrivaled potential to advance the human condition. More years in life, more life in years is the promise to be kept. We have miles to go. Onward!

*the list is: tobacco, diet and activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit use of drugs




AMERICAN COLLEGE OF LIFESTYLE MEDICINE

The American College of Lifestyle Medicine (ACLM) is the world's flagship professional medical association for physicians, clinicians and allied health professionals, as well as those in professions devoted to advancing the mission of lifestyle medicine.

       

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