Most people who are sick with a chronic illness don't choose to be so. Most cancer patients don't develop tumors because they did something wrong.
Somehow these, what should-be-obvious statements about the nature of disease, certain to most thoughtful and experienced physicians, have become controversial in our media-riddled culture. A subtle, insidious, shifting attitude toward people who are sick - a loss of empathy - arises in the context of a popular notion that we can control our health. Maybe even fend off cancer.
Best-selling strategies suggest that if we eat sensible amounts of whole foods and not the wrong foods, exercise, don't smoke and maintain balance in our lives - yoga and stress abstinence might just do the trick (and turn a profit for some) - we'll be just fine.
These ideas appeal to the well - that we're OK, on the other side, doing something right. Things happen for a reason. There is order in the world, etc.
The problem with the "knowledge is power" approach is that, in reality, we can't always determine our medical futures. The young are not really invincible even if they think they are. Leukemia, kidney failure and freak accidents can happen to anyone among us.
Fault for illness is implicit in the notion that we can take charge of our health. Finger-pointing at the infirm is becoming OK; lending a hand, optional. Worse still, a tax.
Addressing this problem, "blame the victim" creep, will take more than one medical education such as mine, a lot more research, and better education in America. For those of you who've never told a 35-year old wife and mother of two young kids that her colon cancer's come back despite her best efforts, I'll share part of one patient's story. She was thin. She was pretty. She was nice. She didn't smoke. She didn't drink. She ate lots of vegetables. She died.
Like most readers, I'm drawn to the concept that we can improve our physical condition by informed decision-making and a vital lifestyle. As a doctor, and as a mom, I encourage anyone who'll listen to adjust their behavior knowing they're accountable for the consequences.
In my home we have blueberries and bananas at breakfast. Beets are on our dinner table, along with broccoli and Brussels sprouts. Leeks too. I've learned to cook them all.
To the extent we can influence our well-being and lessen the likelihood of illness, of course we should adjust our lack-of-dieting, heavy-drinking, texting-while-driving, anything-smoking, unprotected-sexing, arms-firing, smog-inhaling, boxing, speeding and whatever else we're doing that damages our bodies, our selves.
It's very American, really. You, too, can be healthy.
So I don't mind the positive outlook upon which others insist, that we should take the medical cards we're dealt and cope. Better still, we should do the best we can to be productive and well.
But I won't sit back and listen while some writers and leaders falsely distinguish themselves from those who are sick and uninsurable like me.
Last summer the CEO of Whole Foods offered an unsympathetic op-ed in the Wall Street Journal on the subject of health care reform:
...Unfortunately many of our health-care problems are self-inflicted: two-thirds of Americans are now overweight and one-third are obese...Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years...
I'm not the first to take on the moral and self-serving implications of this sort-of reasoning. But most of a year later, the issue festers, in part because our collective lack of science and medical education renders us susceptible to falsehoods regarding the causes of disease.
For the sake of discussion, I'll refer here to smoking - a habit that clearly contributes to the overwhelming majority of lung cancer cases and with which we're all familiar. In 2009 nearly 220,000 people in the U.S. learned they had lung cancer and roughly 160,000 died of the disease. The American Cancer Society estimates that as many as 87 percent of cases arise in people who've smoked.
But what about the other 13 percent of us who get lung cancer? (My math: that would be approximately 28,000 cases and 21,000 deaths from lung cancer in non-smokers in the U.S., per year.) These figures are nothing to sneeze at.
To be clear, smoking does cause most cases of lung cancer, additional malignancies, heart disease, peripheral vascular disease and other health problems. Still, there's a danger in assumptions, and in blaming people who are sick for their illnesses.
My position is that except for a few models among us, we could all lose a few pounds. One way or another, we all contribute to our nation's pathology.
We all stand to gain from better health care, for all.