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The purpose of this blog is to stimulate thought and discussion about important issues in healthcare. Opinions expressed are those of the author and do not necessarily express the views of CMDA. We encourage you to join the conversation on our website and share your experience, insight and expertise. CMDA has a rigorous and representative process in formulating official positions, which are largely limited to bioethical areas.

Keeping the Main Thing the Main Thing

October 12, 2017

by Robert E. Cranston, MD, MA (Ethics)

Throughout much of the world today, a great number of people die primarily due to malnutrition and lack of potable water. Infectious diseases, many due to lack of reliable immunization, are still a leading cause of death worldwide, particularly in low-income countries. There are countless complex reasons for these realities, and most of them cannot be easily solved. Nonetheless, lots of people are dying due to a lack of basic necessities.

Meanwhile, here in Western society, much ado is made of the latest fad diets, nutritional supplements, organic food, bottled water and “natural” foods of all sorts. “Processed” has become a dirty word, along with “chemicals”—though, of course, everything is composed of chemical substances and most of what we eat is processed in some way. While some of these issues may matter some, in general they miss the point.

Some of this is due, perhaps, to social media and the immediate widespread dissemination of “fake news.” Some authority figures and celebrities claim carcinogens are lurking everywhere and thus account for the tremendous upswing in cancer in all its forms around the U.S. and the world. In fact, the rate of cancer is not a discrete definable number. What types of cancer? What populations? Are we referring to prevalence or incidence?

Despite common wisdom, U. S. cancer mortality trends have decreased markedly in the last 15 years. The overall death rate from cancer fell by 13 percent between 2004 and 2013. Part of the appearance of the increase in cancer is due to the growing number of cancer survivors, the aging of the population in general and the alarming rise in obesity—a risk for cancers of many types.

Nonetheless, cancer in general is still the number two cause of death in the developed world, close behind heart disease. The top 10 causes of death in the U.S., after heart disease and cancer, are Chronic Obstructive Pulmonary Disease (COPD), accidents, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, chronic renal disease and suicide. Some of these conditions are not preventable, so a more pertinent question is, what are the addressable risk factors for morbidity and premature death in general?

When we remove genetic predisposition and communicable diseases (though now with a growing number of anti-immunizers we are seeing mini-epidemics of some of these), we come up with a short list of preventable causes of illness and premature death. These include: smoking, alcohol abuse, drug and opioid abuse, obesity, insufficient physical activity, poor sleep patterns and poor stress management. Many of these are overlapping in impact. High fat, high caloric foods contribute to hypertension, diabetes and obesity, which in turn are risk factors for heart disease, stroke and dementia. Obesity is a risk factor for diabetes and hypertension, which in turn are risk factors for stroke, heart disease and dementia. Poor sleep is frequently caused or exacerbated by sleep apnea, which is frequently precipitated by obesity, which may lead to increased risk of stroke and heart disease. High use of social media may be a factor in increasing stress due to its isolating effect and fake news impact, and it is a factor in our increasingly sedentary life-styles.

If you have patients who are concerned about their health (unfortunately many are not), there is a short list of important, uncontroversial things anyone can do to improve their chances of living longer, better lives.

  1. Don’t smoke tobacco, marijuana or other substitutes. If you already smoke, stop. Don’t use tobacco in any form. There are no redeeming health advantages of tobacco use.
  2. Drink alcohol, if at all, only in limited quantities. Even binge drinking, as opposed to daily consumption, can be injurious to your health. While some cardiologists tout alcohol in moderation as a health aid, the social damage created by people with alcohol control issues is an enormous public health problem. If you don’t take the first sip, you will never become an alcoholic.
  3. Exercise often. Walking is an available option for most of your patients. If this is not an option, swimming, biking, weight training, organized sports or other programs have proven benefit. One can argue about frequency and composition of workouts, but frequent sustained exercise has been proven many times over to be beneficial for many aspects of health.
  4. Watch your dietary intake. While there is much debate as to the ideal diet, there is little disagreement that large numbers of people don’t eat enough fruits and vegetables. For many, salt and sugar intake may contribute to health problems. For a growing number of Americans, total caloric intake is too high. This leads us to our next point.
  5. Watch your weight. Work with your physician or dietitian and strive for a healthy weight. While Body Mass Index can be criticized as a benchmark, it is still a helpful tool in determining your ideal weight. BMI of 18-25 is considered optimal, but body type, genetics, conditioning and other factors may dictate different targets for different people. Consult your physician. The main issue with most Americans’ diets is not whether it is vegan, vegetarian, non-GMO or organic but how much is eaten.
  6. Take the medications your physician has recommended for your medical concerns, and work with him or her to decrease opioid use as much as possible. Opioids have become a major cause of mortality in the U.S., and there are non-opioid and even non-pharmaceutical interventions that may greatly ameliorate pain. Be responsible.
  7. Get some sleep. Turn off the TV and stop working late at night. People often state that they cannot find time for sleep, but we make time for what we value. Limit caffeine consumption after mid-day. While there is some discussion about the risks and benefits of moderate caffeine consumption, caffeine use after mid-day is a contributing factor to sleeping problems for many people.
  8. Manage your stress levels. A supportive social network, which may include regular church attendance, prayer, meditation, reading of Scripture and spiritual books can go a long way toward helping us manage our stress. Alternatively, ask your spouse or close friends if they think you need help by a professional for your stress management. We don’t always recognize the signs of stress in ourselves.
  9. Wash your hands. The number one prevention for communicable disease is frequent hand washing or gelling.

We are to be gentle with all, and tolerant with those who hold strong beliefs about health and dietary management techniques they espouse—assuming they are not dangerous—but we can focus on the important things ourselves and direct our patients to appropriate resources to guide them into healthy living. We need to keep the main thing the main thing.

Robert E. Cranston, MD, MA (Ethics)

Robert E. Cranston, MD, MA (Ethics)

Robert E. Cranston, MD, MA (Ethics), MSHA, FAAN, CPE, is a board certified neurologist, with additional training and experience in palliative medicine, executive coaching and medical leadership. He is completing his 30th year serving at Carle Health, (formerly Carle Foundation Hospital) in Urbana, Illinois, as an attending neurologist, and (Past Chair—14 years) of the Carle Ethics Committee. He is a clinical professor of medicine (neurology) at Carle Illinois College of Medicine in Urbana-Champaign and is on the clinical faculty of University of Illinois, Urbana-Champaign. He is a member of the CMDA Ethics Committee. He and his wife Tammy are grateful for their five grown children, their daughters- and sons-in-law and their 11 grandchildren.