A 105 year old doctor advocates a better path to improved health and wellness
In July of this year Dr. Shigeaki Hinohara died. His obituary was given to me recently by one of my patients, which is why I am writing about it now. There was a telling quote in the obituary: “In the 1970s, he reclassified strokes and heart disorders — commonly perceived as inevitable adult diseases that required treatment — to lifestyle ailments that were often preventable. Dr. Hinohara insisted that patients be treated as individuals — that a doctor needed to understand the patient as a whole as thoroughly as the illness.” How radical and unlike anything practiced in this country!
Dr. Hinohara died at age 105 after an eventful life. He worked until the end and believe you should never stop working. He ate a healthy diet and continually exercised. He believed in happiness and fun. Although he did advocate for the importance of annual medical visits, he eschewed medicines, tests, and procedures. He wasn’t even on a statin, if you can imagine that! At the end of his life he insisted on a palliative approach. Many in Japan credit this longevity expert, who practiced what he preached, to extending the average lifespan of his native country. He did this thorough life style, not through calling for more specialized, intense medical care as we have adapted as gospel in this country. Our country is spending hundreds of billions more in health care dollars than we did a decade ago, and our lifespans are getting shorter. How does that make sense?
Well over 100 years ago a prominent physician named William Osler understood all of this. His quotes are telling, and I will relay three now:
The good physician treats the disease; the great physician treats the patient who has the disease.
Listen to your patient, he will tell you the diagnosis.
The person who takes medicine must recover twice, once from the disease and once from the medicine.
William Osler understood how to be a good doctor, way back in the “dark” days of medical practice! Today he is revered at his institution, Johns Hopkins, as a saint. And yet nothing about what the man said or did survives at Hopkins or in any bastion of American health care. Rather, at the end of his life, his ideas were negated by a new saint, Abraham Flexner, who wrote a report for the Carnegie Foundation that closed many medical schools, consolidated power in the hands of a few, and advocated a scientific approach to health care. Flexner believed in the German school of thought, whereby those doctors who learned enough science could, by virtue of that alone, heal their patients. Listening to patients, getting to know them, treating them like individuals; all of that was debunked. In his last years Osler fought against Flexner’s approach, one that replaced practicing doctors with scientists in places like Johns Hopkins. But his battle was futile, and his words, as grand and thought provoking as they may be, are lost. I am currently writing a book about these two men and how they influenced the dysfunctional medical world in which we now live and work.
Dr Hinohara did understand Osler. He knew that lifestyle is so much more important than the drugs, tests, and procedures that are being pushed on us by alleged “experts” who treat us like algorithms and do not actually understand the gospel they are preaching. (Fewer than 10% of doctors grasp the risks and benefits of the medical interventions they inflict on patients according to many studies that are quoted in my book and other blog posts). They get paid well for that approach; changing lifestyle (as one doctor told me after a talk I gave) is just too tough. But that’s what works!
Two interesting studies came out recently. One showed us that even in patients with chest pain, placing stents in blocked arteries work no better than placebo stents. Wow! We already knew that stents do not extend life or prevent heart attacks in patients with blockages who have no symptoms; in fact, they cause 20/1000 people who receive them to have severe complications such as major bleeds and strokes while conferring no benefit. Now we know they do not even help chest pain. And yet the prophets of stenting—the cardiologists who tell my patients they are saving their lives with a stent—continue to be paid very, very well to put them into patients, and the system pays hospitals and stent-makers just as well, at a cost of $35,000 per stent! It seems to matter not at all that lifestyle does actually help: diet, exercise, quitting smoking. Of 1000 smokers who quit at age 50, 200 will live substantially longer, there are no side effects, and it is free. No medical intervention comes close to quitting smoking in helping people live longer and better. Why aren’t doctors who convince their patients to quit smoking paid substantially more than those who put in worthless and potentially harmful stents? Dr. Hainhara must be turning over in his fresh grave!
We are also learning more about diet. We know that diets high in fruits and vegetables, whole grains, oils, and nuts extend life. Even diets high in fats help us! A new study is one of many showing this counter-intuitive fact. Simple carbohydrates are the devil. And yet doctors are still measuring their patients’ cholesterol and telling them not to eat fat. They spend no time talking about diet. Rather, they just put their patients on statins. Most people on statins do not live longer or better; of the places in the world where people live the longest (so called blue zones), virtually no one is on a statin. To cardiologists, this is sacrilege!
The great myth perpetrated by doctors and the medical establishment that we can make you better if we do a lot of stuff and give you a lot of stuff is pervasive across all of health care. We continue to flood patients with dementia drugs at a price tag of $3 billion a year even though studies clearly demonstrate their lack of efficacy compared to placebo. Studies also show that exercise and diet help curb and prevent dementia, but those are neither paid for by insurance or advocated with any seriousness by doctors. (It’s certainly easier to do an MRI and give a worthless drug than to attempt to change life style!). Bone density tests and treatments are similarly ineffective, and yet doctors are considered negligent if they do not prescribe them. We are told to push blood pressure very low, treat diabetes aggressively, and put all people with atrial fibrillation on blood thinners. None of these actually help people any more than they could harm them, but we are led to believe they are both necessary and life-saving. The media perpetuates the myth. So too do ads on TV. So too do protocols that force doctors to treat patients without regard to their individual situations or considerations. Poor Osler would be appalled!
As Dr. Osler did over 100 years ago, Dr. Hinohara died preaching health interventions (changing lifestyle rather than focusing on drugs/tests/procedures) that are effective, inexpensive, and easy to achieve. If followed, they would solve our entire health care mess. But the forces that profit from our current system will resist this at every turn. It is up to us to be sensible and to reject the false prophets who purport to be experts but who are really just very well-paid snake oil salesmen.