The Medicalization of America

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In his recent book, The Last Well Person, Dr. Hadler does a nice job of explaining why drugs and surgery offer little or no benefit for the treatment and prevention of diseases that result largely from unhealthy diets and lifestyles, aging and low socio-economic class. He makes it clear that the scientific evidence and cost-benefit analysis cannot justify much of what passes for standard medical practice.

My one criticism of Dr. Hadler’s excellent book is that he appears overly pessimistic about the potential of a healthy diet and exercise program to treat and prevent most of the diseases that kill Americans. I suspect Dr. Hadler’s pessimism is the result of projecting the relatively minor impact of drugs and other medical approaches to disease onto diet and lifestyle interventions.

For example, he believes treating hypertension (HTN) yields little benefit and costs a lot. He is correct that overall mortality is little impacted by taking anti-HTN drugs. With drug treatment of HTN, the reduction in cardiovascular disease (CVD) mortality drops by a modest 25% or so but the risk of death from all other causes increases slightly. People with HTN treated with drugs gain less than a year of life expectancy on average but often feel worse for many years due to the side effects and expense of the drugs. The medical treatment of HTN with various drugs offers little in the way of health or longevity.

Even the mildest form of HTN quadruples the risk of death from CVD and also increases mortality from all other causes by more than 25%. Someone with HTN is at least twice as likely to die each year as someone with optimal blood pressure. That translates into at least an 8-10 year reduction in life expectancy. That means even “mild” HTN can shorten one’s life as much as smoking cigarettes!

HTN can usually be largely reversed and almost always prevented by following a low-sodium DASH-style diet. The impact of a healthy diet on blood pressure would translate into an extra 8-10 years of life expectancy. That is a lot better than what anti-hypertensive drugs can do.

By James J. Kenney, PhD, RD, FACN

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