Many of you probably know that my day job is that of Emergency Medicine physician. I work in several busy emergency departments, and see a wide variety of patients. All of my patients have at least one thing in common: they have something wrong with them. No one comes to the emergency room when they feel great, except for the staff members. In addition, most of them are scared that what is wrong may be serious. Most people will not come to the emergency room unless they think what they have is serious. The fact of the matter is that the majority of patients that I see don't have an actual emergency, but that is irrelevant. It is the perception of an emergency that drives them in to see me.
The fact that I find most interesting in my job is that the things people worry about the most are usually the least deadly. Every year, during the winter months, I see hundreds of people in the ER for colds, coughs, bronchitis, the flu, and upper respiratory infections. I know why they come in for these problems: a cold or the flu will make you feel pretty crappy. That being said, all of these diseases are self- limited. What that means is they will go away on their own no matter what you do, and there is no medicine that we have which will make them better in any way. What I do with these patients is put them on medicine which will cover up their symptoms (almost all of which can be bought over the counter) until the disease goes away.
Now, it is true that infectious diseases used to be very deadly. In fact, Sir William Osler, one of the patriarchs of modern medicine, called pneumonia "captain of the men of death." In the days before vaccines and antibiotics, infectious diseases were the leading cause of death in all age groups. To illustrate this, here is a list of the leading causes of death in New Jersey in 1900 vs 2000:
Leading Causes of Death, New Jersey, 1900 and 2000
Rank 1900 2000
1 Acute lung diseases 1. Diseases of the heart
2 Consumption 2. Malignant neoplasms
3 Diarrheal diseases of children 3. Cerebrovascular diseases
4 Adult brain and spinal diseases 4. Chronic lower respiratory diseases
5 Diseases of heart and circulation 5. Diabetes mellitus
6 Deaths under one month of age 6. Unintentional injuries
7 Contagious diseases (not TB) 7. Influenza & pneumonia
8 Renal and cystic diseases 8. Septicemia
9 Brain and nervous diseases of children 9. Nephritis, nephrotic syndrome, & nephrosis
10 Violent deaths 10. Alzheimer's
11 Digestive and intestinal diseases 11. HIV disease
12 Cancer 12. Chronic liver disease & cirrhosis
13 Puerperal 13. Pneumonitis due to solids & liquids
14 Acute rheumatism 14. Suicide
Here is what I find interesting about this list: in the year 1900, You have to go down to #5 on the list to find the first cause of death that is not an infection. The first four are: acute lung diseases (pneumonia), consumption (TB), Diarrheal diseases of children (almost all are bacteria or viruses), and Adult brain and spinal diseases (such as meningitis and polio). Finally, with #5, you get to a non infectious cause of death: heart disease. In the list from 2000, you have to go down to #8 to find a cause of death which IS from an infection: Septicemia (systemic blood bacterial infection, commonly called blood poisoning).
That's great, Jake, you may be saying, but what does this mean? I'll tell you. Infectious diseases are random. If you are exposed, you can be infected and get sick. Though lifestyle choices can make you more or less likely to get sick, they only play a limited role. The modern death list is filled with what I like to call "diseases of lifestyle." Though there are some environmental factors at play, diseases such as heart disease, cancer, cerebrovascular disease (stroke), and chronic lower respiratory diseases (such as emphysema), are largely based upon the choices we make. Having a heart attack or stroke is mainly based on what you choose to eat and whether or not you choose to exercise. The vast majority of cancers are either diet or tobacco related, and emphysema and other lower respiratory diseases are almost exclusively smoking related.
Thus, in the modern world, whether you get sick or not, and how well you heal is based largely upon the choices you make. Modern medicine has come up with many fancy drugs, and many fancy procedures, but other than antibiotics for infections, heart catheterizations for heart attacks, and emergency surgery for conditions such as appendicitis, these medicines and procedures don't really cure anything. Drugs for high blood pressure don't cure high blood pressure, and patients are placed on a treadmill of ever escalating doses as their body adapts to the medicine. Drugs for cholesterol are far less effective than proper diet and regular exercise in treating cholesterol problems. Drugs for heart disease and emphysema do nothing to reverse these diseases, only slow their progression somewhat.
Somehow we as doctors have failed in our education of patients, and this information does not reach people. I say this because I have a stream of people through the doors of my ER wanting me to rescue them from their self limited infections and the end consequences of their poor lifestyle choices, but relatively few are ever interested in how they can prevent these diseases in the first place. In America today, we want to go to the doctor, get a prescription pill, and continue to eat however we want, and neglect our responsibility to exercise.
The main reason I write this blog is to try and bring home this point. Proper nutrition and exercise are far better medicines than anything the drug companies can mix up in a lab. If you fuel your body properly, and exercise every day or nearly every day, you can avoid most of the diseases on the list above.
In the end, it all comes down to choices.
M. Jacob Ott, M.D.
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