Prevention or Medication?

A special thanks to Pete Larson over at for helping me out with getting access to the full text of this research paper. I met Pete in February at a conference. Nice guy, great blog to read if you get a chance it.
This editorial piece was published in the British Journal of Sports Medicine a few days ago. The article essentially is criticizing the idea of taking medications to fix our health ailments instead of making better lifestyle choices to help avoid certain health problems in the first place. There are a lots of referenced studies and statistics in the article, but my own take on it was that our society continues to lazily stroll further into the idea that we can all do what we want and in the end, there will be this giant safety net called “medicine.” Fortunately, this article points out that for many conditions, drugs are not nearly as effective as lifestyle changes, and it’s about time that this country gets some self responsibility in our choices. Yes, I clearly understand the soapbox I’m standing on, and yes, I fully understand that I’m preaching to the crowd here – most, if not all of you on this distribution list are runners, so you have likely made good choices to begin with.

The impetus for this editorial in the journal was the approval of the $1 billion government drug development center to help create medicines. The authors of the editorial go on to argue that spending our tax payer dollars would be put to better use by promoting a proper lifestyle instead of the idea of another “magic bullet” drug.

I don’t want to bore you with statistics, so here are some bullet points:

· Healthcare spending is spiraling out of control

· Many diseases/conditions (obesity, diabetes, depression etc) are increasing at an alarming rate

· Sedentary and nutritionally sparse lifestyles are increasing.

· “What happens in a society in which people are told that pills are available to put them to sleep, wake them up, stimulate them, calm them down and control appetite and body weight? We argue that the answer is in the growing number of people with mental disorders including depression and anxiety, sleep disorders, deteriorating nutritional status and increasing rates of obesity unprecedented in human history.”

Again, not to bore you with statistics, but the authors go on to show some examples:

· [Patients with high cholesterol/blood lipids] who participated in just three or four sessions with a dietitian had a reduction in their total and low-density lipoprotein cholesterol, which is equivalent to the effect of taking statins (about 15 mg/dl over the course of the year).

· Another study of 3234 patients at high risk for Type II diabetes compared lifestyle changes vs. drugs to prevent the onset of diabetes. Lifestyle intervention was approximately twice as effective as drugs in preventing diabetes.

To sum it all up, the authors state,

“Rather than continuing to pour more resources into developing single-agent, magic-bullet approaches intended to cure diseases that are easily prevented, we propose a radical idea: to develop means for disseminating and implementing programs of lifestyle improvement proven to enhance individual and population-level health…We understand that while changes in diet and physical activity are conceptually easy, they are diabolically difficult to do in practice. The promise of even easier solutions to cure the consequences of years of sloth needs to be debunked.

Obviously, there are many conditions that are unavoidable and many conditions that drugs are absolutely needed for. However, many conditions are simply due to lifestyle choices and most people are making the wrong choices. This is difficult to do when all we see are quick fixes. For example, according to the NYT piece referenced above, drug companies spend about twice as much on marketing as they do on research.