Many Americans have become increasingly interested in – even slightly obsessed with – their health. We carefully watch what we eat and have become quite mindful of calorie consumption, avoiding artificial ingredients, and using natural herbal supplements. Corporations and manufacturers have followed this new trend by creating “all natural” products, labeling their products with calorie counts, boasting of “healthy” ingredients, and opening organic food stores. Physicians, too, have realized that an important part of medicine is keeping patients from getting sick, otherwise known as preventive care.
The concept of preventive care is simple: If we can keep people from getting ill by fine-tuning their health, we can increase their lifespan, reduce the personal and societal burdens of disease, alleviate suffering, and decrease healthcare costs. Preventive care includes regular checkups by your doctor. Lifestyle practices play a large role, as well. Eating a balanced diet, exercising regularly, not smoking, visiting the dentist regularly, having recommended screening tests (like a colonoscopy, where a small camera is used to look at the colon for signs of cancer), and getting immunized all fall under the umbrella term “preventive care.”
Yet, despite the many articles written and the increased emphasis on prevention, many people are still not getting proper preventive care. Although visiting a physician when one is healthy seems feasible, the reality remains that people are extremely time constrained, and scheduling such visits seems counterproductive in the short run. In this article, I hope to impart the importance of this topic and educate you and your family members in making the proper decisions, which will hopefully lead to long, happy, and healthy lives.
The Pitfalls of Pills
Our population is exploding, and we are living longer than ever before. This longevity may be attributed to better healthcare and increased education leading to healthier living. Unfortunately, strewn within the popular perceptions of healthy living are many areas prone to pitfalls. People often think they are doing something good for their bodies but may in actuality be causing harm. An example of this is the interest in herbal supplements and vitamins, which has skyrocketed in recent years. To understand why these supplements are potentially harmful, it is important to understand a concept that I believe carries a powerful message with it. Paracelsus, the father of toxicology, wrote, “There is poison in everything; only the dose makes a thing not a poison.” In other words, anything can be good or bad for you, depending on how much you take.
Let’s explain this concept with some examples of how supplements and vitamins may be harmful: Vitamin E is a very important vitamin for our bodies. Its main function is as an antioxidant, which means it helps keep cells from getting damaged. However, if Vitamin E is taken in high doses, it can cause life-threatening bleeding. Vitamin E deficiency, on the other hand, has also been associated with bleeding disorders and neurological deficits.
Another example is vitamin A, an important vitamin that plays a role in vision, immunity, cell functions, bone growth, and reproduction. Ingesting too much vitamin A can cause vision problems and birth defects, among other illnesses. Yet vitamin A deficiency can cause problems as well, such as vision problems and infections. It is important to understand that toxicity occurs at different doses for different supplements. For example, vitamin A toxicity will occur if greater than 25,000 IU is taken per day. However, vitamin E toxicity occurs at greater than 1,000 mg per day, which equals approximately 1200 IU.
Another complication of supplements is their effect on other drugs. For example, St. John’s wort, which is commonly taken for depression, can interact with many other medications. For instance, it may cause other medications (such as Xanax) to be broken down by the body faster. This can lead to the other medication being less efficacious or potentially toxic.
The biggest problem with supplements, however, may be the fact that there is little regulation by the FDA. This means that the pills one is putting into his or her body may contain something totally different than what is printed on the label. Unfortunately, this has been shown to be the case, recently, when New York Attorney General Eric Schneiderman and his office tested health supplements from four major retailers (GNC, Target, Walmart, and Walgreens) and found that the ingredients on the label did not match what was inside.
Additionally, some of the additives have not been researched long enough to determine their safety. I cannot stress enough the importance of proper research regarding correct dosage, side effects, and interactions of any supplement before it is allowed on the market. Unfortunately, the companies selling these supplements appear to be more interested in profits than safety and appropriate use. They prey on unknowledgeable customers who want to be healthy, and market the supplement by boasting of great, possibly false, health benefits.
This is not to say that all vitamins or supplements are bad. For some people, certain vitamins are imperative. Vitamins are great for growing children, pregnant women, and people with weak bones who require Vitamin D and calcium.
The message I would like you to take home is that, when it comes to taking supplements or vitamins, you should consult your healthcare provider to make sure they are proper for you.
How Medical Science Works
One challenging aspect of practicing preventive care is the fact that medical knowledge can be quite confusing and is constantly in flux. One research article may praise the positive health effects of a substance, and another article comes out disproving the first. It is important to understand that science is a complicated field, and research is rife with contradictions. This is because science, by definition, is constantly evolving as more is learned and understood. Something that may have been true years ago may not hold true today. However, the more scientists research, learn, and confirm or disprove their theories, the better they are at debunking common misconceptions.
To tackle these inconsistencies, doctors rely on “evidence-based medicine.” This is a form of medicine aimed at optimizing medical decision-making by focusing on evidence from well designed and conducted research. Think of it as a way of sifting all the good information out of the mediocre and bad information.
At this point, you might be thinking, if the recommendations are constantly changing and anything can be good or bad, what can I do to stay healthy? My answer – and the most important point I want you to take home from this article – is that everything should be done in moderation! The exception is smoking, which should be avoided at all costs. Smoking has been researched endlessly, and the consensus remains unanimous that even a little can be harmful. While on the topic, secondhand smoke has also been found to be even more harmful than smoking itself.
Why Some People Get Sick and Others Don’t
Why are some people affected by environmental insults like smoking worse than others? Disease, like the human body, is complicated. There are many different factors that accumulate to cause an illness. A well-accepted theory is that many diseases are a combination of nature and nurture. Nature describes the genes that are passed down from our parents, and nurture describes our environment’s effect on our health. Certain people are more susceptible and at higher risk for developing certain diseases because of their genetic makeup. Factor this susceptibility – to heart disease, say – with an environmental trigger like smoking (i.e., nurture), and the person can develop the disease. Every human being is different in the way his or her body reacts to environmental triggers.
This is not to say that smoking won’t harm people who do not have a genetic susceptibility. It is undeniable that smoking affects everyone, and although one won’t necessarily see all the manifestations of a full-blown disease, this doesn’t mean there is no damage. Smoking can cause many cancers, including oral, esophageal, lung, stomach, pancreas, colon, kidney, liver, bladder, cervix, and others. In addition, smoking causes heart disease, stroke, aortic aneurysm (a balloon-like-bulge in the aorta), chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, diabetes, osteoporosis, cataracts, and worsening of asthma symptoms. Smokers are also at higher risk for developing pneumonia, tuberculosis, and other airway infections.
A vital insight into why preventive care is so important is called the iceberg theory. An iceberg has only 10 percent of its mass protruding above the water, while the remaining 90 percent, its main mass, is underwater. To relate the iceberg theory to patient care, many things must go awry in order for the sickness to surface. However, by the time the “10 percent” surfaces, the damage (sometimes irreparable) has been done, because the bottom 90 percent is actually the root of the problem. Think of the bottom of the iceberg as being dependent on our lifestyle, genetics, environment, and other insults. By screening for diseases early, physicians can aggressively attack the illness before it fully surfaces. Why wait till there is a problem and the body’s natural defenses are overwhelmed? Earlier screening and earlier treatment can mean fewer problems down the line.
The Annual Physical: Relic of the Past?
A debate recently surfaced about the benefit of annual physical exams. Dr. Ezekiel J. Emanuel, a world-renowned physician, published an op-ed piece in the New York Times illustrating why he believes the annual physical exam is “worthless.” Dr. Emanuel argues that research shows that annual physical exams are unlikely to be beneficial. While Dr. Emanuel makes many valid points, each person needs to be evaluated on a case-by-case basis. The decision of whether appropriate follow-up through a yearly physical is right for a particular individual should be left to the discretion of the patient’s physician. Patients who have healthy habits, no concerning family history, and are generally in good health may not need as close a follow-up as others.
Certain populations, however, do require much closer follow-up. For example, it is very important that children (birth-18 years old) have regular yearly visits, and babies require even more frequent monitoring. The elderly, too, should be checked yearly or more often. Does it help to catch diabetes earlier? Does it help to aggressively tackle hypertension (high blood pressure) sooner? I believe the answer to these questions is a resounding yes. The way to do this is by having proper health care follow-up.
Consulting Dr. Internet
Public access to medical knowledge has increased over recent years. With the simple click of a button, any disease, be it common or rare, can easily be researched. Thanks to the internet, our lives have arguably become better and more efficient. As with all good things, however, there are negative consequences as well. It is just as easy for an ignorant or mistaken person to post fallacies online as it is for a knowledgeable one to do so. It is therefore incumbent on the reader to examine the veracity of any website or source of information when researching medical topics or seeking online advice. (See sidebar.) The internet has also caused a new phenomenon, in which people search their symptoms before going for professional help. This produces confusion and frustration for doctors and patients, because something as benign as a cough, for example, can be mistaken for lung cancer by someone doing an online search.
The Miracle of Vaccines and Antibiotics
Before closing this paper, I feel compelled to discuss vaccines and antibiotics. There is still, unfortunately, much discussion about vaccines causing autism or having negative health consequences. These concerns are at not valid at this point, and have not been proven. The paper that discovered “the autism association” was found to have been falsified and has been disproved over and over again.
It is important to understand that vaccines have helped us nearly eradicate deadly diseases like polio. If people stop vaccinating their children, these once eradicated diseases may come back. Take a look at California, where many parents have not vaccinated their children. A recent outbreak in an amusement park caused California to be the state with the highest number of measles cases in the U.S. as of May 2015. Additionally, in 2014, the U.S. saw the highest rise in measles cases in over 10 years. What do you think is more harmful: a debunked theory that autism can possibly happen after vaccinations or a life-threatening disease that your child can possibly contract? (Of course, as in any health situation, there may be exceptions, and individuals should follow the advice of their physician.)
Antibiotics, like vaccines, have the potential to save lives if used properly. It is imperative to understand how antibiotics work before requesting them for any mild illness. Antibiotics work to kill bacteria – never viruses. Bacteria, like humans, are complicated and very “intelligent,” constantly evolving and developing new ways to evade the antibiotics used to destroy them. Indeed, many bacteria are now super-resistant to antibiotics, immensely increasing the challenge of eradicating bacterial diseases. Bacteria have become resistant to antibiotics, in part, because of overuse and improper use. The overuse has happened because many patients who have a viral illness like a cold believe that the only way they can get better is if they take antibiotics. Physicians worried about the possibility of missing something deadly or in fear of a lawsuit tend to give antibiotics more willingly when pestered.
Another problem is that people often don’t take the antibiotics as directed. They forget to take a dose or stop taking the pills altogether before the end of the treatment regimen. This can be dangerous, because the bacteria that haven’t been killed off now have more strength to take over and become resistant. Another important thing to remember the next time you want to take antibiotics and your physician doesn’t agree is that rampant antibiotic use has also caused a disease called Clostridium difficile colitis. This potentially life-threatening infection of the large intestine has surfaced because antibiotics used to treat infections also kill off the normal intestinal flora. This allows the C. difficile bacteria to take over and wreak havoc.
To Life, to Life…
The body is very complex and is constantly regenerating itself, and we humans have the power to alter our destiny to some extent. If you get screened and catch something like diabetes early, you are helping control the damage before it is too late. Indeed, most of the common diseases can be prevented or controlled by catching them early and changing negative habits. A good example of this is coronary artery (heart) disease, which can be ameliorated by controlling its main causes: high cholesterol, high blood pressure, diabetes, and smoking.
So, use sunscreen when outdoors; vaccinate your loved ones; get screened for high cholesterol, hypertension, and diabetes; and go for a mammogram, colonoscopy, or any other recommended screenings at the proper age. Exercise more often, decrease your alcohol intake, eat a high-fiber diet rich in fruits and vegetables, and don’t smoke.
If we take preventive care more seriously, we will all hopefully lead happier, longer, and healthier lives. L’chaim!
Dr. Golfeyz is a second year internal medicine resident at Mount Sinai Beth Israel in NYC. He was born and raised in Baltimore and currently resides in Brooklyn, New York, with his wife and son.
The Internet: a Potent Tool
by Shmuel Golfeyz, M.D.
The internet has democratized medical information, giving patients a plethora of resources about various diseases and conditions. In this overload of information, however, some of it may be inaccurate or harmful. Remember these four points when going online:
- Accuracy: Does the website use reliable research? Don’t depend on one site. Check many sources and see if the results the same.
- Authority: Websites that end in .gov, .edu, or .org are usually the most reliable. These come from the U.S. government, university medical centers, and not-for-profit health or medical organizations. Also, look for the red and blue “HONcode” seal at the bottom of each page, which means the site is certified by the Health On the Net Foundation. (Government-sponsored health sites don’t have the seal.)
- Bias: Who’s paying? Is it a for-profit company, such as a drug or insurance company, which sells a product and may have a stake in providing you with inaccurate information? See “About Us” to find out who sponsors the site.
- Timeliness: Medical research constantly changes. The website’s information should be no more than three years old.
I recommend the following two websites for general medical information: www.medlineplus.gov and www.mayoclinic.org. In addition, www.consumerlabs.com is an impartial organization that evaluates supplements and provides both general and paid reports.