These issues are not predetermined by fate, but are precisely directed by choice.
Steve Schroeder is a master of American medicine. Now he is professor of medicine at UCSF. He is distinguished past president of the Robert Wood Johnson Foundation. In his 2007, Shattuck Memorial Lecture published in the New England Journal of Medicine "Improving the Health of the American People," he wrote that over half of illness is attributable to lifestyle decisions made and not made. (1)
American medicine is deaf to this reality. Its fixation is on treatment, usually far remote from the fundamental behavioral cause. Prevention is undervalued.
Five years ago I became aware of the Institute for Lifestyle Medicine at Harvard School of Medicine. Wow! Brilliantly led by now good friend, Dr. Eddy Phillips, this fact made me jealous. I could not visualize that my institution, Stanford School of Medicine, would endorse such a concept. Accordingly, three years ago I sponged a few nickels and sent several of our bright students to spy on Eddy's activities.
They returned to Stanford and on their own initiative cloned a similar lifestyle medicine seminar series. This Thursday is the first of 10 lectures of this year's curriculum. The first year they had 20 attendees. The second year there were 40. Last year there were 90. We'll soon see what this year yields.
The topics and speakers, chosen by the second year med students, range widely. Exercise physiology, sleep, nutritional fundamentals, stress management are on the agenda. This year John Ratay from Harvard will return to talk about school exercise programs, (SPARK). So too, Dean Ornish of UCSF, brings his outstanding presentation that shows how prevention is very cost effective.
The central theme of the series concerns behavior modification. Techniques for motivational interviewing, and readiness for change are highlights.
Dr. Phillips has received a research grant to spread this idea widely in the bigger medical world. The student branch of the AMA is studying it. The NIH is aware. Our Stanford initiative is the poster child. One attention concentrating technique involves the insertion of some of the developing curriculum into the certifying examinations of the major societies. Surgeons, orthopedists, urologists, all medical societies need to include lifestyle ideas into their work plan.
As medicine seeks a nobler framework for its agenda, it will transcend its diminished focus on repair to one in which the newly informed domain of enlightened prevention by lifestyle modification is the rosetta stone from which the anticipated scientific revolution may proceed.
Its time is now.
Schroeder, S. We Can Do Better; Improving the Life of the American People NEJM, 2007,357: 1222-25.