Imagine we found the cure for heart disease or diabetes, but as a society chose to withhold that treatment from those who need it most. Would it be ethical to withhold effective treatments when the result is unnecessary suffering and death that costs our health care system hundreds of billions of dollars a year?
The answer is obvious, yet that is exactly what occurs today in America. We know the most effective treatments for some of the deadliest diseases of our time, but millions are denied access to them. In effect, we are conducting a large experiment on our population without their consent. This happened in America once before. It is a dark stain on our scientific history that most of us would rather forget. It was the Tuskegee experiment.
Tuskegee: Human Experimentation Without Consent
From 1932 to 1972 scientists from the US Public Health Service conducted the Tuskegee syphilis study on 399 impoverished African American sharecroppers from Tuskegee, Alabama without their consent. They withheld a known effective treatment for syphilis--namely penicillin--in order to observe what happened over time to those with untreated syphilis. Scientists wondered how the disease affected the body and mind, so they drew blood from these men and monitored their progress but did nothing to stop the progression of the illness even though they knew they could cure it and prevent horrid disability with a few simple shots of penicillin.
Right now we are in the midst of a similar experiment, but few know about it. The tragedy of this experiment happened in my own family. My stepfather, who had diabetes and heart disease, was a victim of our modern Tuskegee experiment. He ultimately died last year as a result, and cost our health care system $400,000 along the way. If he were simply provided the choice of a different treatment--a treatment that is proven to be more effective and cost less than medication and surgery--namely a program for sustainable and comprehensive lifestyle change, perhaps he would still be alive and our national debt would be reduced by $400,000.
My stepfather was diabetic. He had the best medical, pharmaceutical, and surgical care available. Nonetheless, he suffered from very poor health and functioning. He went to the emergency room with chest pain and was treated with a cardiac bypass operation, even though evidence has shown no reduced mortality for cardiac bypass or angioplasty in diabetics.(i) Not providing effective treatment is one thing, but providing harmful, costly, and ineffective treatment like this is unethical.
Physicians do what they know (often as a result of training in a medical educational system dominated by Big Pharma) and what is paid for by insurance. Having a cardiac bypass after experiencing chest pain isn't the best treatment option for diabetics, but it is what is paid for by insurance. After the bypass post-operative infection of his sternum with MRSA (an antibiotic-resistant staph bacteria) lead to a month in the intensive care unit, plastic surgery to repair the chest defect, and "mini-strokes" following bypass surgery which led to memory loss or "pre-dementia",(ii) and a protracted recovery from hospitalization requiring months of home care.
The surgery and subsequent medical therapy with blood pressure medication, cholesterol-lowering medication, and blood thinners did not enhance the quality of his health and life. In fact, he continued to be sedentary, craved sugars and refined carbohydrates, and rapidly declined physically and mentally.
My stepfather was not offered a treatment that exists today, would have cost less than 2 percent of the $400,000 his care cost, and would have likely created an infinitely enhanced quality of life. It should be our right to have access to proven treatments that provide better value for the individual and for the health care system. This shift must be made if we are going to significantly impact our chronic disease epidemic and the frightening convergence of the GDP and health care cost curves.
How is our modern Tuskegee experiment happening today? How did this happen to my stepfather? What treatment was he denied that may have saved his life? Let me explain.
Treatments We are Denied by Conventional Medicine
Overwhelming evidence proves that the most effective prevention and treatment for chronic diseases such as heart disease and diabetes is what we eat, how much we exercise, how we handle stress, and our social connections. These factors are often referred to collectively as "lifestyle medicine." Environmental toxins are also known to play a role in these epidemics but are less modifiable.
Lifestyle medicine is not just about preventing chronic diseases but also about treating them. It is often more effective and less expensive than relying exclusively on drugs and surgery. Nearly all the major medical societies recently joined in publishing a review of the scientific evidence for lifestyle medicine both for the prevention and TREATMENT of chronic disease. That report is called the ACPM Lifestyle Initiative, and I encourage you to read it. It concluded there is strong evidence that a lifestyle-based approach to chronic disease often works better than medication or surgery and saves money.
Taken collectively, the evidence is actually overwhelming. Lifestyle intervention is often more effective in reducing cardiovascular disease, hypertension, heart failure, stroke, cancer, diabetes and all cause mortality than almost any other medical intervention.(iii) This data in conjunction with a number of extraordinary recent research papers that call into question the very foundations of our current approach--treating risk factors such as high blood pressure, high cholesterol, or high blood sugar to prevent heart disease and diabetes--forces us to rethink our whole approach to medicine. These studies showed that lowering blood pressure, blood sugar, and cholesterol in pre-diabetics with medication didn't reduce the risk of heart attacks or death and created unnecessary side effects.(iv),(v),(vi),(vii)
We're targeting the wrong things--we need to treat the cause, not the effects. High blood pressure, high cholesterol, and high blood sugar are NOT the cause of heart disease or diabetes. The real culprit is what we eat, how much we exercise, stress, and environmental toxins. Our lifestyle and environment influences the fundamental biological mechanisms that lead to disease: Changes in gene expression, which modulate inflammation, oxidative stress, and metabolic dysfunction. Treating risk factors is like blowing away the smoke while the fire rages on. Lifestyle medicine puts out the fire.
Unfortunately, insurance doesn't usually pay for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. It should be the foundation of our health care system, but doctors ignore it because doctors do what they get paid to do. They get paid to dispense medication and perform surgery. They also need to be paid to develop and conduct practice-based and community programs in sustainable lifestyle change such as those pioneered by Dr. Dean Ornish.
The new health care bill provides for community based wellness initiatives like these, and that's a step in the right direction. The National Council on Prevention, Health Promotion, and Public Health has begun to develop policies that will create a healthier nation. But what's missing is insurance and Medicare reimbursement for treatments known to be effective for heart disease and diabetes--lifestyle-based therapies that are critical not just for prevention but also for the treatment and reversal of these modern epidemics. By not offering reimbursement for these treatments we have, in effect, begun the Tuskegee experiment of the 21st century.
The future of medical care must be to transform general lifestyle guidance--the mandates to eat a healthy diet and get regular exercise that many physicians try to provide to their patients--into individually-tailored lifestyle prescriptions for both the prevention and treatment of chronic diseases. The only way this is going to happen is if doctors are paid to do it. Lifestyle is often the best medicine when applied correctly, and it is the only thing that will end our modern Tuskegee experiment.
To your good health,
Mark Hyman, MD
(i) BARI 2D Study Group, Frye R.L., August P., Brooks M.M. et al. 2009. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 360(24): 2503-15.
(ii) Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators, Newman M.F., Kirchner J.L., Phillips-Bute B.,et al. 2001, Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 344(6): 395-402.
(iv) The ACCORD Study Group. 2010. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 362(17): 1575-1585.
(v) The NAVIGATOR Study Group. 2010. Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med. 362(16): 1463-1476.
(vi) The NAVIGATOR Study Group. 2010. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med. 362(16): 1477-1490.
(vii) Ray K.K., Seshasai S.R., Wijesuriya S, et al. 2009. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: A meta-analysis of randomized controlled trials. Lancet. 373(9677): 1765-72.
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
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