Prevention or Prescription?

By Andréa Maria Cecil

In Medical/Injuries, Nutrition

April 20, 2014

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Thomas Edison said, “The doctor of the future will give no medicine.” But will the medical school of the future give enough education on fitness and nutrition? Andréa Maria Cecil investigates.

With wine comes honesty. Mike Roizen knew that. So he encouraged imbibing every Wednesday night, when he would meet eight medical students to find out who the good and bad teachers were at SUNY Upstate Medical University’s College of Medicine.

But Roizen got more than he bargained for when the students started talking about nutrition. What he discovered was “appalling.” Their nutritional ignorance made him shake his head. And he was the medical school’s dean.

That was 12 years ago. Today, not much has changed.

For decades, neither diet nor exercise has been discussed with any depth at most of the country’s medical schools. Some institutions spare a few hours here and there to explain the federal government’s food pyramid or how nutrients are absorbed and to vaguely advise that “moderate” exercise is good. Meanwhile, many Americans look to their doctors as they die younger or live their later years with more disease than citizens of poorer countries—despite the U.S. spending nearly $3 trillion on health care in 2013.

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7 Comments on “Prevention or Prescription?”

1

wrote …

Excellent article. The full Edison quote is "The doctor of the future will give no medicine but will interest his patients in the care of the human frame, diet and the cause and prevention of disease." Chiropractors use this quote often as we are specialists in the care of the human frame and research clearly shows chiropractors do counsel their patients in diet and exercise in our practices. My introduction to CrossFit came at a chiropractic seminar where the speaker repeatedly urged us to get our patients CrossFitting. I believe the tide is turning. 9000 + CrossFit gyms mean thousands and thousands of people are at least getting exposed to better nutrition, the wellness continuum coach Glassman speaks of and superior fitness. For the practicing chiropractor the big issue has always been patient compliance. We council our patients on nutrition and exercise, provide information, urge and influence them as much as possible but compliance can still be frustratingly low. I am seeing a general increase in folks willing to make the lifestyle change though, and we will keep on keeping on. We have been focused on “care of the human frame, diet and the cause and prevention of disease” since 1895 as our text of the period clearly show. Oorah!
Bill Houghton, DC

2

wrote …

The most important part of this quote can be found here:

http://www.snopes.com/quotes/futuredoctor.asp

3

wrote …

Interesting article but I disagree with the premise, specifically that a higher quality interaction with a healthcare provider will result in better overall nutrition and exercise habits. A dearth of information isn't at the core of our current health situation, it's a lack of effective follow through.
In the realm on nutrition (eating) and exercise (movement), the vast majority of the people I've encountered over 15 years as a healthcare professional can correctly answer basic questions regarding these subjects. The hard part is actually doing the right thing (they already know) over an extended time frame.
The idea that an extra 15-30min with a better educated MD is the solution is, well, silly.
What does work? It's usually one of two things; the tragedy or triumph of a peer. Watching a co-worker, friend or family member have a heart attack produces a behavioral change. The same person losing 35 lbs by joining a CrossFit box can also do the same thing (that's what happened in my case).
People, while basically good, are essentially lazy and don't change until they see the need to. An authority figure spending another 25 minutes telling them what to do isn't going to go far. Actually seeing someone next to them accomplish what they, themselves wish to, is all together different.
To use a different quote: "It always seems impossible until it’s done."- Nelson Mandela

4

wrote …

This article is SPOT ON.
As a medical school graduate in the 80's, a physician for 20 years, and a Level 1 cert graduate, I can agree with everything mentioned in the article.
I also agree with the above contention that people are basically good, but lazy. No amount of harping or coaxing is going to make patients/people do something they don't want to do, or stop what they want to do.
To wit: everyone knows that smoking is detrimental to their health (c'mon, we all KNOW it deep down!), yet smoking continues, and is even subsidized by the government (can't afford to lose that tax revenue…).

5

wrote …

Hello, my name is Rafael Ramirez and I'm a physician that graduated from a medical school in Chile. Like the article says, there is in fact a lack of teaching of nutrition in most medical school (reading this, I think I came from a fairly good medical school despite being in latin america, because I had a full nutrition course, and 6 weeks of rotation in Clinical Nutrition and a complete chapter of Exercise Physiology). But the lack of teaching shouldn't be accountable for the lack of interest that most medical students show to this field. At least from where I come from, if you want to know more about a particular subject is up to you to become the master of it.
Most of the doctors and medical students I know, don't care about nutrition (or exercise in most cases) not just regarding patients but also the nutrition you should have being a medical professional. Most of them eat, drink, and smoke just as the patients that they provide care. I decided that this was not my path, so I started learning and exercising on my own. There are studies, papers and information out there that is easily accessible to any medical or health related students with access to the internet. I know more now about nutrition, and exercise physiology because I've studied those subjects by myself after medical school.
The problem that we are facing is not the decadence of medical schools, it's the lack of interest and motivation in learning these topics. Medical school programs can be modified. It's the decadence of physicians and medical students.
It's the lack of interest in knowledge from caregivers is what should be alarming us. This does not apply only to Nutrition and Exercise, it extends to every subject in medicine. The new premise is: ''to know just enough'' to get certain title, and just enough to get into a medical residency in which you get paid a lot while doing little.
And today studying in most medical schools in US/Caribbean, is just about knowing enough to pass the USMLE, so programs only attend to those subjects.
A few days ago I was talking to a medical student from a caribbean medical school, and he told me that if some subject or disease was not asked in the USMLE he didn't care about learning it. That represents the essential problem that we should be trying to change. And I think that for a physician of any kind, of any age or from any medical school it shouldn't be an excuse not to know something as important as these subjects just because the fact that the medical school program was not complete enough. At the end of the day, when all things are said and done, as a medical doctor; you, and nobody else are accountable for your patient health.

6

wrote …

Adults find it very hard to change. As has been written, people most of the time will only change due to a personal tragedy or observing a person succeed. Also, eating healthily appears to cost more money than to eat porely, that is certainly the case here in the UK, and it takes time to make a meal, which cuts into sitting down and watching the television, which people want to do.
The answer may lie with our schools. Teach children from an early age about the link between eating healthily, varied exercise and long term health, and we may have a chance.
But do the drug and food companies want the general population to become healthy? Probably not. How much would this knock off their profit margin each year and make their stock holders cry?

7

Body Helix wrote …

Great article!

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