Why ObamaCare is Not Enough: It’s the Health Care Costs, Stupid!

by

In the run-up to the presidential election, the political debate is heating up around ObamaCare.  This week the Supreme Court upheld ObamaCare and the individual mandate, but the single biggest question is hauntingly absent from the campaign discourse.

How do we stop and turn back the tsunami of chronic disease, in particular, diabesity – the continuum of obesity, pre-diabetes, and diabetes that is the major driver of 21st century suffering and costs?

Diabesity is the hidden cause of most heart disease, hypertension, high cholesterol, stroke, dementia, many cancers (breast, colon, prostate, pancreas, liver, and kidney), and even depression. Yet is it almost never treated directly because there is no good drug for it.

Over the next 20 years $47 trillion will be spent around the world to address chronic diseases caused by diabesity.

How our next president addresses this will determine whether or not we bequeath a bankrupt, desperately sick nation to our children; the first generation of Americans who will live sicker and die younger than their parents.

The good news is while we cannot solve problems like war or natural disasters, we can solve diabesity. We haven’t been able to win the war in Afghanistan, but we can win this war on chronic disease.

Diabesity is nearly 100% preventable, treatable, and very often curable.  As Donald Rumsfeld said, this is a “known, known.” The science is clear, the strategies well documented (if little applied.)  Democrats, Republicans, Libertarians, and Tea Partiers alike all have the potential to get sick and must face this problem square on.

Diabesity affects one in two Americans, yet is not diagnosed in 90% of those who have it. In fact, there are no national screening recommendations for pre-diabetes or for persons at high risk for diabetes. The implications of this medical blind spot are staggering – the single biggest cause of chronic disease is overlooked and not treated 90% of the time.

Twenty-five percent of those over sixty-five, one in five African-Americans, and one in ten across the whole population have diabetes.  One in three children born today will have diabetes in their lifetime.

And pre-diabetes affects up to 150 million Americans. Diabetes alone accounts for one in three Medicare dollars spent. Diabetics cost health plans five times more than non-diabetics ($20,000 versus $4,000.)  By 2014, when sixteen million more citizens are eligible for Medicaid, the burden of costs will be even greater.

Seventy percent of the federal budget is for Medicare, Medicaid, and Social Security. By 2042, 100% of the federal budget will be required to pay for Medicare and Medicaid, leaving nothing for defense, transportation, education, agriculture, environment, or any of the government’s other basic services.

This is unsustainable. We need a collective, bipartisan national campaign with the passion and vision of President Kennedy’s call to action, of “putting on a man on the moon by the end of this decade.”

The insurance reform at the heart of the Affordable Care Act allows for better access to medical care, including medication and surgery. It laudably promotes improved efficiencies, reduction in medical errors, better care coordination, and implementation of best practices.

But what if we are coordinating the wrong kind of care? What if our best practices are the wrong practices? 

Our toxic industrial diet, our sedentary lifestyle, chronic stress, and environmental toxins cause diabesity and its attendant downstream ills (often mislabeled as something else such as hypertension, cancer, heart disease, and dementia.)

Drugs and surgery are feeble, ineffective, costly, and often harmful treatments for lifestyle-induced illness. They are misguided efforts at best, dangerous at worst.  Mounting evidence proves that the solution to lifestyle and diet-driven obesity-related illnesses won’t be found at the bottom of a prescription bottle; they will be found at the end of our fork.

Prescription medication for lifestyle disease has failed to bend the obesity, disease and cost curves.  Statins have been recently found to increase the risk of diabetes in women by 48%.

And factoring in the increased risk of diabetes when statins are used to prevent first heart attacks, there is no net benefit, and significant potential harm from statin use in the over 20 million Americans who take them.

Avandia, for example, the number one blockbuster drug for type-2 diabetes, has caused nearly 200,000 deaths from heart attacks since it was introduced in 1999.   The large ACCORD trial found in over 10,000 diabetics that intensive blood sugar- lowering with medication and insulin actually led to more heart attacks and deaths.

This is Pharmageddon.

A recent study found that over 75% of stent placements for heart disease don’t help at all to reduce heart attacks and deaths, are harmful, and unnecessarily increase health care expenditures. Yet the number of angioplasties and stent placements performed has increased, not decreased.

We don’t have “evidence-based” medicine. We have “reimbursement-based” medicine. Doctors do what they get paid to do, not what the science shows they should do.

That’s the bad news. The good news is that there is an extensively studied, scientifically validated set of strategies that work better, faster, and cheaper than medication and surgery and can be implemented at scale with little cost by lay people in local communities and in medical practices.

Intensive lifestyle therapy, not wellness counseling or prevention, but lifestyle treatment of existing chronic disease focusing on pre-diabetes, diabetes, and heart disease has been proven to work better than medication or surgery.

Currently this is not implemented in our health care delivery system or in community-based programs in any meaningful way.  But it can and should be.

Intensive lifestyle treatments – simple, proven behavioral change strategies, peer and online support, appropriate financial incentives, and partnerships within communities can be used to address the social, behavioral, and biomedical roots of diabesity.

While individual mandate and insurance reform are the main focus of the debate surrounding ObamaCare, little known but potentially transformative provisions of the Affordable Care Act provide the seeds of change for our entire health care system.

These provisions, the National Diabetes Prevention Program (section 10501), Prevention and Public Health Fund (section 4002), creation of community health teams (section 3502), and incentives for states to prevent chronic illness among Medicaid beneficiaries (section 4108), could stem the tide of chronic disease.

There is no lack of pilot programs, demonstration projects, and examples of the success of intensive, community-based lifestyle programs to improve health care outcomes and reduce costs.  Current provisions for payment and innovation within the health reform bill set the stage for expansion of these programs.

The Diabetes Prevention Program showed that a structured lifestyle-change program could reduce the progression to diabetes by 58%, working better than any other known treatment.

The study published in 2002 in the New England Journal of Medicine, was based on outdated and contraindicated nutritional advice from the old Food Pyramid recommending a low-fat diet for diabetes prevention.

The study was performed when bread and pasta was king, and our government encouraged us to eat 8-10 servings a day of bread and cereals, which are now known to directly drive the risk of diabetes. And yet still, it was more effective than any medication.

This model has been scaled in communities and organizations across America, including a partnership with the Center for Disease Control, YMCA of America, and United Health Group using lay health coaches to implement the program.

While the dietary recommendations are still less than ideal, these programs are working.  Imagine what a program based on 21st century nutritional science could do. And these programs have been conservatively documented to save billions.

Over the last few years a number of examples of the power of community-based peer-support models have emerged. At Saddleback Church, Rick Warren, Dr. Mehmet Oz, Dr. Daniel Amen, and I enrolled more than 15,000 congregants in a lifestyle change program delivered with online support in small peer-support groups.

The church lost 250,000 pounds in one year, and many reversed diabetes, reduced or eliminated medication, and avoided hospitalization.  We changed the culture of the church, and changed what was served at bible breakfasts, at work, and at home.

Participants learned to create health together — to shop, cook, eat, exercise, and play together. We didn’t treat disease.  We didn’t create a weight-loss program.

We taught people self-care and how to care for one another, and together they created a miracle – something health care or health care reform has not been able to achieve.

Innovative community-based models also can change our default choices for how we live, move, eat, and play.  If the things that create health are easy to access and things that create disease are hard to get to, extraordinary change occurs.

In Albert Lea, Minnesota, a pilot project was designed to create healthy choices and limit bad ones. Kids who weren’t allowed to eat in hallways and classrooms, for example, lost 10% of their weight.

In Thailand, one community garden is irrigated by an old bike hooked up to a generator run by patients with diabetes. They get exercise and grow healthy food at the same time.

This model has been replicated across the world – including Peers for Progress that created pilot programs to treat diabetes in Cameroon, Uganda, Thailand, and South Africa based on peer support.

The peer support group models were more effective than conventional medical intervention for improving the health of diabetics and healthcare costs decreased tenfold.

Health, it seems, happens outside the clinic, where people live, work, play, and pray. We need to rethink how we treat chronic disease.  It is not only better medical management, which often just barely, if at all, staves off complications and death, but with high-science, low-cost, and high-touch innovations.

A comprehensive integrated strategy can solve this problem. Start with revised screening guidelines to identify the 90% of pre-diabetics and the 25% of diabetics never diagnosed.

Build new practice models and reimbursement for group visits to deliver lifestyle medicine in more effective and cost efficient ways.  Support and scale proven community based peer-supported models of lifestyle change.

Over 20% of Americans are out of work.  Train a new army of 1 million community health workers, like the barefoot doctors of China, who can support their peers in creating health. Set a national goal for America of losing 1 billion pounds a year.

Retool medical education to train future doctors in lifestyle and food treatment. Support private-public partnerships to create community environments that foster a healthier lifestyle.

Fully fund programs that work (lifestyle change), and stop paying for what doesn’t work (most angioplasties and stents and statin use.) Implement little-known provisions from the Affordable Care Act that can effect change.

Prioritize the work of the newly formed National Council on Prevention, Health Promotion and Public Health Council, an inter-agency council focused on creating a healthy America outside of the clinic and hospital.  Fund these programs, test them, implement them, measure them, and then let the good ones flourish.

We can’t win the war in Afghanistan, and we have been losing the war on cancer, but this is one war we can win.  We just need to mobilize.

To your good health,

Mark Hyman, MD

 

 

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58 Responses to Why ObamaCare is Not Enough: It’s the Health Care Costs, Stupid!

  1. Cindy June 29, 2012 at 1:38 pm #

    Amen!

  2. Michele Eby, The Vital Life June 29, 2012 at 2:00 pm #

    Keep it up! This is important stuff.
    We can not bow to the pressures of big-bus and government “ideals.”

    Eat right – eat whole foods, eat locally (as possible), eat with joy; move daily; and serve in your community.

  3. Patti Bailey June 29, 2012 at 2:18 pm #

    I have been battling with health issues since the age of 8. I have been on and off diets , cleanses, detoxification plans. I have seen Doctors, homeopathies, counselors and the like. I even was in a group that encouraged improved coronary health, I am embarrassed to say I helped teach the class. My health did not improve much and I was discouraged.Than I found your book The blood sugar solution. I was nearly on the right path in all my endeavors. For me nearly was like not at all. Many doctors teach a part of it but I found that you teach the whole of it. Holistic health. I now must do the work. Stay on a plan that friends and family find foreign spend money on supplements and abstain from former ways. It is not a magic pill or super easy. It is work and accountability. If I fail, I fail myself and my health systems around me. If I succeed everyones wins. Many American’s want an easy way out.Some smoke, drink and eat poorly knowing it is harming them. How can we get people to care?Sadly the reason I care isn’t because I am such a good person, it was because I wanted out of my suffering so badly I chose the inconvenience of good health over the inconvenience of poor health. Michelle Obama tries to get the health message out, yet some scoff at her. What does health have to do with politics? I now know the answer. It has a lot to do with it. Thank you for sharing what you know and caring as you do. Thank you for helping me and many others. Hopefully it will get less foreign and more natural the way it was meant to be.

  4. Jackie June 29, 2012 at 2:55 pm #

    I don’t have a lot of confidence that the government will do a great job implementing these Diabetes Prevention Programs that you say are included in Obamacare. When has any gov. program been run efficiently and within its budget? Perhaps if we had a dynamic Surgeon General who made diabetes prevention his primary mission, much like C. Everett Koop did with smoking prevention & AIDS prevention, then people will take notice. Warning labels on white bread and pasta would be an eye opener! You would make a great Surgeon General, Dr. Hyman!

    • Margaret June 30, 2012 at 12:56 pm #

      For future reference; that title is offensive and so I have no interest in reading the article.

      • Wizard Prang July 3, 2012 at 11:39 am #

        “Didn’t like the title, won’t read the article”

        At what, precisely, were you offended?

      • Beverly July 15, 2012 at 10:42 pm #

        smacks of a bad case of “contempt prior to investigation” – it’s a good article even if you didn’t like the name!

    • John L. Herr June 30, 2012 at 4:55 pm #

      Your comments are absolutely correct. The problem is getting people to implement a program that is essentially naturopathic- no drugs and no surgery, but with diet , supplements and exercise. What is needed is Naturopathic Physicians and Board Certified Naturopathic Doctors to be able to practice in all of the states. Unfortunately Naturopathic Physicians are trying to corner the naturopathic market and still trying to gain licensing permission to prescribe drugs and do minor invasive surgery procedures. That is not naturopathic medicine. Also more Nurse Practioners are needed to fill the void that will be created and the number of Physicians (MD’s and DO’s) are reduced. Chiropractic Doctors are also promoting more naturopathic methods and this will help to alleviate the shortages somewhat. I am 71 and by lowering my pH levels by eating allot of raw fruit and vegetables as well as taking your suggested supplements my average blood sugar level is now reduced to 120. My current goal it to get it down too 110 and ultimately down too 80. I take no medication and do it all with diet, supplements and exercise. My lowest A1c number was 6.1 and I am working to getting it too 5.5. It can be done.

  5. Mike Montez June 29, 2012 at 4:07 pm #

    Dr. Hyman for Surgeon General!!!

  6. Karen Vertanen June 29, 2012 at 7:02 pm #

    One of my doctors has written the above website. http://truecostofhealthcare.org He makes a lot of sense.

  7. Ola June 29, 2012 at 7:40 pm #

    One area where change should be immediately implemented is in school lunches. Unfortunately, the corporations maintain a firm grip on what lower middle class put into their mouths (the pizza sauce and tater tots that are supposed to be vegetables, etc.).

    And how is a youngster supposed to be educated on what she should eat, if even the formal institution of school gives her such a meager example of food? All the vending machines should also be eliminated.

    I think community programming is a fantastic idea. I wonder how it could be pushed into government further. Could it work somehow along First Lady Michelle Obama’s Let’s Move program?

  8. maggie June 29, 2012 at 7:56 pm #

    Geez! I have high cholesterol 225 total …52 yr old woman. My doctor gave me simvastatin 5mg. I have never had a heart attack, and never took drugs in my life. Now a week into this medicine i feel better, but after getting on these many websites and reading all about the dangers of statins, the poison drugs, and this and that, and then my doctor says i need it, people say i dont need drugs, but instead to take alternatives…then the websites say this and that, people tell me this, and that…..geez.. its all making me LOCA!!!..i am confused and just dont know what to do now. Im just going to the church and ask the preacher to lay his hands on me and pray to be healed…..cuz everyone else plus the drugs, and the internet has me confused…

  9. Shirl June 30, 2012 at 10:25 am #

    I’m happy to know that Diabetes Prevention Programs are included in the Affordable Care Act. I’m surprised they got this included, as every time Michelle Obama talks about eating more veggies, she’s accused of promoting the “Nanny State”. Since I worked for the government, I did experience government programs being run efficiently, even though we were always hobbled by budget cuts and lack of personnel. At the same time, I would see the rise of private, for profit companies take over much of our work with much less efficiency and so much wasted taxpayer money going to the pockets of a few executives instead of the people they were supposed to serve. So whenever I hear the mime about so-called inefficient government programs as opposed to the so-called efficiency of the private sector, I know that the profiteers have succeeded in convincing the American people to “shrink government to the point of being able to drown it in a bathtub” so that the few can make more money at the expense of the many.

    • JL July 3, 2012 at 8:25 am #

      I commented earlier and have to comment again. I mentioned my age, 64, and when I was a kid there were no fat children in my school. Besides walking to school, and eating fresh foods, our parents packed our lunches. A lunch sack included a sandwich and a piece of fruit. What happened when the government starting feeding children, they got fat. The government mucks up everything it touches, and all with a huge price tag. People were far better off without government assistance. It is hard to call this a “free country” anymore.

      I feel sorry for kids that must eat the garbage that schools dish out.

      • Jeanne July 5, 2012 at 6:35 pm #

        JL – I’m 66 and my school did have lunch, so obviously people did not get fat just from school lunch, as you claim. The private food industry is much more to blame. Schools used to provide a meat, a starch and a vegetable, but kids stopped eating that. They wanted the pizzas, mac and cheeze, and hamburgers that they were used to eating. While the government isn’t perfect, neither are private entities. There are places for both and thoughtful, civil discussion can lead to improving both. And that is what concerned citizens need to engage in. Statements like “the government mucks up everything it touches’ are unfounded and unhelpful.

    • Beverly July 15, 2012 at 10:46 pm #

      there are greedy ones in government too – I’ve seen them everywhere, but none so greedy as these corporate CEO’s! I’m terrified that with Obamacare the American public will get seriously ripped off by these giant corporations – the way we do with housing and banking! And I am not buying health insurance. period. If I have to choose between a roof over my head and eating or health insurance – guess what trumps?! A lot of very low income people are in the same situation.

  10. Arlene Jones June 30, 2012 at 12:57 pm #

    Dr. Hyman,

    Did you just call President Obama stupid?! I hope not. He is the most intelligent President I’ve witnessed in my lifetime of 58 years. I expected more of you. Take me off your email list. Thank you.

    • Wizard Prang July 3, 2012 at 11:46 am #

      er… no he didn’t.

      Variations on this meme (“It’s the economy/spirituality/structure/tribes, stupid” ) are found all over the internet.

      With so many dead or dying of diabesity, it is amazing to me how many people are getting offended by the use of the word “stupid” in what is obviously a non-offensive manner.

  11. tamarque June 30, 2012 at 1:03 pm #

    I agree with most of what you say in this article. ACA was never about health care, nor was it about saving costs. What it is about is controlling all monies spent on health care, ensuring they all go to big pharma and big insurance corps. That is how it is structured and that is why it is done so.

    However, your article loses power by misinformation. The bulk of the federal budget goes to the war machine and its offshoots. Considering the abomination that goes for health care, there is no need to exaggerate in describing the health cost crisis. What is important is that people know that our money is being spent by the military/industrial/prison complex maintaining wars at home and abroad. These wars are all at the expense of social programs that promote health and peace and co-existence.

    I do like the idea of community based organized focus on changing lifestyles to healthier ones. The price is certainly right and the communal value is one to be supported. I would like to see this tried in non-religious organizations as many of us do not participate in those institutions which is our democratic right.

    • Beverly July 15, 2012 at 10:51 pm #

      you are so right! if people added up all the billions spent in different government categories on these wars, they’d be furious that we can not have government-funded, single payor health services for all Americans. I believe more of our tax dollars are now being spent to give health care to Afghanistanis these days than to our own citizens as well! Very sad state of affairs.

  12. Louise June 30, 2012 at 1:11 pm #

    ” Implement little-known provisions from the Affordable Care Act that can effect change”–that is the key dear Doctor. Please give us the information that you reference here–I know I will be glad to do anything that DOES NOT involve regular western medicine.

    My problem with Obama Care is that it has NOTHING to do with health–it is finance based business, it is about insurance–there is nothing about HEALTH in it, it is about money. Medicine it is not. I have no wish to be part of the system that makes everyone into a cash cow. I avoid establishment doctors, eat no industrial food, take no pharmaceuticals, work a very physical job, enjoy life–I am a female, 57 years young and believe that we need NOT be riddled with cancers, diabetes or be fat, sick and at the mercy of finance based “medicine”. I wonder if they will begin to put people like me in jail for not paying for Sick Care. I will buy their Sick Care product, I do not want it, I do not use it, it is money down the toilet to me. Is there conscientious objector status for the new US Sick Care Program???

    Carry on your excellent work–we must preach long and hard to get to the masses–will they awaken and take their health into their own hands–hopefully not too late. When you realize you are a cash cow being milked with treatment and decide to become again a human who can learn to be healthy with little effort–your life changes for the better. You will get some flack from those who are part of the machine, but the momentum is building.

    You are a voice of reason in the wilderness. Thank you and keep it up.

    • Beverly July 15, 2012 at 10:56 pm #

      great idea – we need a ‘conscience objector” movement among the theoretical consumers of our country’s greedy insurance companies!!! I am NOT buying health care. I am 60 years young and healthy although I have gained too much weight since I stopped smoking 7 years ago. Can our health care system help me with that? No. I’m on my own – unless I get very, very sick. Hopefully, I’ll get control of my weight before that happens. But I would rather go to jail than be forced to pay into insurance corporations pocketbooks. (I worked for awhile for lawyers who did workers compensation and personal injury for consumers – and I believe the insurance industry is as crooked, or more so, than the banking industry. I want no part of it!)

  13. Marianne June 30, 2012 at 1:15 pm #

    This is a great article! Something needs to be done NOW! We know what to do! It is not difficult! I am taking the Plant-Based Nutrition Course from eCornell and the T. Colin Campbell Foundation, and besides Dr. Hyman, the research of Dr. Campbell (The China Study), Dr. Esselstyn (Prevent and Reverse Heart Disease), Dr. Barnard (Physicians Committee for Responsible Medicine) and others have shown the way to disease-free health, lowered insurance and health-care costs, and a vibrant and energetic old age. We know what to do….guys, the answers are hiding in plain sight! We are consuming a vast array of unhealthy, even deadly, foods-hamburgers with cheese, steaks, donuts, pizza, ice cream, etc. We eat the Standard American Diet, the answer to the cause of so much disease in this country and elsewhere we have exported this diet. It is too much saturated fat and cholesterol found in animal-based foods and not enough fiber and antioxidants found in plant-based foods. I applaud Dr. Hyman for his wonderful contribution to the health of this nation. I have given The Blood Sugar Solution to people and recommended it to all of my clients. I am a psychologist and have loved all of his books and writings! I also promote Functional Medicine to friends, clients, and family. I have almost healed a severely arthritic hip without cortisone injections and joint replacement surgery by using prolotherapy and wonderful nutrition. It can be done without the big guns of allopathic medicine! I have joined the crusade!

  14. Michele June 30, 2012 at 1:26 pm #

    I do not support mandates and strenuously object to buy healthcare I dont believe in and insurance that does not cover all healthcare. I think the Affordable HC Act is intended to regulate insurance companies and uses the only powers available at the federal level to address an issue tied directly to the American people. I will end up paying the tax because I wont buy health insurance and use alternative and preventative treatments outside the western medical model. The model does more harm than good. Presently the Affordable HC Act does not address my immediate concerns but it does address the most pressing introduced in the political arena. Either we take care of ourself or take responsibility foe our health we cannot expect the government to do it for us. HC costs are high because the more you use it the higher it rises….like oil prices…. it is not based upon a standard economic model od supply and demand. The Affordable HC Act is a baby step no doubt but it has legs. Medicine, insurance and Americans must now change how to think about healthcare as a collective and systemic model rather than on an ndividual basis.

    • Beverly July 15, 2012 at 11:01 pm #

      I am not giving my money to health insurance corporations either. I’m tempted to vote republican with hopes they can do away with this poor mandate – that I fear will hurt more Americans than it helps. Sure, people who can afford insurance already can keep their kids on longer – and really sick people are better off – but what about us quite healthy, need a doctor only once a decade people?! And us low income people who live hand-to-mouth, you know, the “working poor”?! We are 50% of the population I believe – and we can not afford to give our money to insurance corporations who are well known to avoid payments at all costs! They’ll find every loophole available to them – and get our money – and laugh all the way to the bank. i will not play!

  15. Dr. Hyman,
    You are my go-to resource for my clients and your books are highly recommended. I have found that the saliva antigens of all blood type O’s are not able to produce the digestive enzymes to digest wheat. Furthermore only a subset of antigens in blood type AB’s are able to digest the products from the wheat germ, highly touted as healthy for everyone.

    I have also studied a Haplo Map of migration patterns of humans populating the planet that was created by using linguistic origins and DNA carbon dating.

    From my study of the various color coded and labeled migration patterns in the various time frames, I focused on one clan that originated from 35,000 years ago emerging from the Middle East. What was striking to me was the fact the this clan migrated in two directions. One group went east across Europe and Asia and crossed the Bering Straight to become both North and South American Indians.

    The second group went west and populated the Scandinavian region and part of them diverged to Scotland and Ireland.

    I noted the my ancestry of Franco-American also contained a double gene from both parents that came from the French and Indian wartime. That left me with two gluten intolerance genes that, among other effects, blew out my thyroid by the age of twelve.

    But the big “ah ha” was the other two regions of the world that came from the same original clan. Namely the Scotch-Irish.

    I’ve since queried all my clients as to their genetic ancestry and everyone who has had at least one of these three ancestors have had a wheat belly and several of the genetically activated diseases that gluten activates through the inflammatory cytokine proteins that switch on the “epigene” switches.

    To date, no one has made the connection of ancestral genetic markers but it’s a tremendous shortcut for identifying at-risk candidates for people who test negative for celiac disease but nontheless have one or two markers for the six intolerance genes.

    I hope to get the word out about my discovery so everyone can benefit and prevent the dominoes of aging inflammation from falling, just because the refrain is “It runs in my family”. This proves it doesn’t have to. If everyone in the country who was intolerant to gluten eliminated it we’d cut the health care costs in half.

    Elizabeth Lowe

  16. Cheryl June 30, 2012 at 1:42 pm #

    The ACA or Obama Care was never intended to control health care costs or provide health care to Americans, it was intended to set the stage to control every aspect of our lives. We can’t be so roped into their message as to believe that they care about us. Patients need to learn the proper health care practices and be well informed and learn to work with their doctor to keep a life of wellness. The government should not be in the business of telling patients and doctors how to keep their lives free of disease. The age of a patient should have no bearing on the treatment of a patient. If you are living a life style that is not conducive to good health you should learn how to modify it and not let the government tell you which doctor, which medicine, what food and drink you are authorized to have.

  17. Dr Pieter Dahler, DDS, MD ND (hon) PhD June 30, 2012 at 2:09 pm #

    We, collectively, in the Western world have made it too easy to be sick. Our school education from way before we were conceived is faulty in not teaching us the true basics of good health maintenance. Our kids have not been brought up in an environment that mimics the true needs of our bodies and minds. Where I have spent the most part of my professional life (40 years) with the indigenous and isolated tribes of Latin America, my team and I have observed NO diseases of modernity. Hard work to cultivate the land, crops and animals provides the natives with exactly what their bodies need. It costs nothing to be and stay healthy there. All we give them is seeds and information to improve their environments to be able to sustain their lives with a balanced food and water intake.
    We never brought in artifical foods to them. Those that decided to test the waters of modernity come back riddles with health and mental problems. How much more proof does one need that going back to the basic (Paleo?!) approaches toward maintaining health and sanity are found in one’s ongoing, and thus becoming natural in habit, intention to be and stay healthy. Diabesity is unheard of in the jungles, deserts and canyons. We only administer medical attention for injuries incurred from accidents. Dental health is generally superior after one generation of our first arrival. Suggesting again that such scourges of medernity are reversable epigenetically. Yes, we have made it way too easy to be sick and miserable in the Western cultures. The problem is that most of us do not know why we are sick because our parents, schools and doctors are oblivious to the causations. The current doctor crowd tends to live years shorter than most of us. The doctors and volunteers by the thousands I have the honor to work with in the indigenous “trenches”, are approaching their 90s and 100s in fantastic health and still love to give their time and energy…without monetary compensation…mostly with love and sincerity.

  18. Judy June 30, 2012 at 2:24 pm #

    It seems to me we’re creating a nation of people dependent on the insurance and doctors to bail them out of
    health problems they cfould have avoided if they’d taken care of themselves. I see more people running to the
    doctor for treatment with drugs, etc and less learning about how to prevent the diseases they get. And once
    hooked will they ever get off? We’re making it too easy for people to live unhealthy lifestyles.

  19. Carrie June 30, 2012 at 3:05 pm #

    Why are you calling it “ObamaCare”? The word was coined by critics to denigrate the plan and the President. Why would you use this term?

  20. Simply Healthy June 30, 2012 at 4:34 pm #

    Dr. Hyman, as a holistic health coach, this article really resonates with me. As a small business owner, operating my practice, I find it difficult to reach the masses who often cannot afford the services I offer to support the lifestyle change you speak of.

    Are you, or anyone else reading this, aware of specific grants or opportunities, maybe through National Council on Prevention, Health Promotion and Public Health Council, that would open doors for more people?

    I think helping small businesses, such as mine, within their communities would provide a unique connection with support in small groups, much like you experienced at Saddleback.

  21. wayne waly June 30, 2012 at 5:09 pm #

    Most of the people I know don’t do facebook or twitter and don’t want to !!!
    E-mail ONLY

  22. Low Orbit June 30, 2012 at 5:28 pm #

    The Health Care bill controversy was never about health care even though all the beeding hearts and those people who “really care” have been playied to the max to get it passed. The real issue was about absolute control of your life with the intent of bankrupting America to fund universal health care. Controlled by un-accountable gate keepers, you cannot usurp 20 % of the National ecomomy (in the least) when the country is already bankrupt and expect life to continue as it has been. No one but a moron would want the health care system to fail or people to suffer but somehow the gullible swallowed the sales pitch that ditching the entire ecomomy, welfare, social security, a balanced budget, and everything else for worse health care or no health care, is a good thing. Not only will health care be only a token of its former self but you will have given up your freedom and your money to the government, for nothing. Way to go America. It never ceases to amaze me how ignorant we are. Health care as it is, is not the problem. Out of control spending by the government is. They have bankrupted us all and now they seek to mortgage our furture and the lives of our children so that they can continue their evil ways. Don’t be a fool. Don’t be part of the problem.

  23. Profile photo of Michelle
    Michelle June 30, 2012 at 6:59 pm #

    Thank you, Dy Hyman for speaking to the REAL reasons for our exploding health care costs. The real problem, as I see it are:
    1 – The crappy, industrialized foods that are extremely low in nutrition;
    2 – Our contaminated grain supplies,
    3 – Genetically modified foods (GMO) that our bodies don’t even recognize as food!
    4 – All of the insecticides and unnatural toxins that our foods are grown in
    5 – Our complete lack of nutritional information. (Did you know that there are about 20 different “guidelines” produced by the federal government and FDA? And almost all of them contradict the others?)
    6 – Our addiction to “give me a pill to fix my problem,” rather than changing our life-styles
    7 – Our unwillingness or inability to stop unhealthy stresses (jobs, relationships, social pressures, etc.)

    All of these components are at the root of our health-care crises! Over 90% of our health problems can be addresses by changes in our food choices and stress reduction. And NONE of those issues are being addressed by any health-care system!

    It’s time to learn about how our bodies really work. It’s time to take personal responsibility for what we put into our mouths. It’s time to question our doctors and health care professionals about what REALLY works! And it’s time to say no to big pharma, big agriculture, GMO foods and big chemical companies who are destroying our land and water.

    But it really comes down to personal education and personal responsibility. We vote with our pocketbooks. Plant a home garden (you can do this even if you live in an apartment), Learn about what damage chemicals do to our bodies and avoid them! We don’t have to be victims. We have choices. We just need to know what to do.

  24. cristina condur June 30, 2012 at 8:10 pm #

    It is a step in the right direction, if we want to get something accomplished we need to start with small steps, in today’s political environment all we hear is criticism and negativity. We need to start some place and now is the time, ObamaCare may have flaws, but it is a step in the right direction. Be supportive !!

  25. Everett Senter June 30, 2012 at 8:15 pm #

    Please create a petition for me to sign that says in some fashion exactly what you are saying in this article and not only will I sign it, but I will contribute to the cause of its broad dissemination. I am serious about this. I did post this on my FaceBook status and gave it a tweet. But we need a petition and you have far more potential readership than I. Help us to do this. I support you in that.

  26. John V. Bach, Esq. June 30, 2012 at 10:37 pm #

    Unfortunately Obamacare is about Obama and his “score card” and not improving the quality of care. It will be, to start and at a minimum, a $2.5 Trillion bill. It is not about containing cost, if it were we would have seen specifically provisions containing malpractice suits and more importantly awards. Why didn’t we see that? Because Obama gets great financial support from the Trial attorneys. Government running and determining who gets what and how much and under what circumstances care is going to be available to its citizens is going to reduce our care to Euro/Canadian socialized medicine.

    Do you really believe Obama and the Federal Government is going to foster creative solutions or care? There is a reason the rest of the world seeks our Doctors and Hospital, it was perceived as the best, and often the most creative in quality of care. How long is it going take for the Bureaucrats running this monstrosity to choke all creativity in care, or even exploration into alternative solutions? Obama has shown himself unable to comprehend the workings of our Economy, the relationship of taxes and choking off growth and jobs, and we expect him to understand, comprehend, or even care about the value of our current Healthcare system to its beneficiaries, or even care beyond his need for a :”legacy” about the intricacies and special relationship between our Doctors and their patients? We could have tweaked our current system to meet the uninsured; those with pre-existing conditions, and the under 27 year old living with parents…it was proposed and ignored. The baby was thrown out with the washwater, because it wasn’t his, it wasn’t Socialized Medicine, his goal. After all, he personally knows better, he doesn’t need input or counsel on these issues. He has told us so many times, over and over. For now we are stuck with it, I certainly hope we don’t die with it.

  27. Mayte G. Bastida June 30, 2012 at 11:45 pm #

    Dr. Hyman, you are into something GREAT!!!…I support you 1000000%….we need to join forces with thouse that have the same vision. I am from Spain living in USA. I have two organitations: “SuperNova Spain” “Holistic Care Center”….One of my biggest pourpose is to “transform” cultural mentality from the past to a healthier present with a higher most positive future. I am preparing some programs taking things from my culture and traying to transform it with a higher healthier energy. Food is one of the tools taking to spread the message. It is hard though. Many peopleare so “attach” to traditions even if they are not good any more. Too much emotional involvement. Romanticism, sentimentalism, convenience, etc.

    I “dreamed” with a new “Universal Humanistic Government” where the “people” is empowered with knowdledge and personal responsibilities for their choices, and the “leaders” of this people would lead with “comprenhesive integrative strategies” according to different global needs.

    There is an organization HEALING TOUCH which supports another recently organization HOPE that is advocating for the integration of the “unconventional” health care treatments in the Obama’s Health Care Plan Maybe you should check with them, and create an organization that calls to all of those that wants to support the same vision. If we (the people) voice for that, we can make, create….the difference.

    You have my support and hope I can meet you one day with my cultural program and make of this an example around the world for all the cultures. This is not just an American Issue. The health issue is world wide. “POWER TO THE PEOPLE, FOR THE PEOPLE, BY THE PEOPLE” that are in alignment with the Highest Best intentions for the best of all.

    Sincerely,

    Mayte

  28. Yorke Rodda July 1, 2012 at 3:23 am #

    Thank you Dr Mark and your team. It is a beautiful cold but sunny winter day in Pretoria, South Africa and I am so grateful for the work you are doing. South Africa may seem a long way from US and very different but we face very similar challenges. The medical and pharmaceutical sectors tend to be the false kings, prophets and priests of our society as is yours. We can change this and with the help of our creator I believe we can reclaim our position in the created order and take care of our health by living right.
    In a local state hospital we hope to start a life-style intervention project that we will monitor and do research alongside the implementation. We will be learning from you and your work and I hope we will be able to link in with the Daniel Plan of Rick Warren’s Church. I heard about the Daniel Plan from this web site.
    Bless you and thank you!
    Yorke

  29. AK July 1, 2012 at 9:21 am #

    “We don’t have “evidence-based” medicine. We have “reimbursement-based” medicine. Doctors do what they get paid to do, not what the science shows they should do.”

    This pretty much sums up why health care costs keep going up. Yes, Americans don’t take care of themselves. But we also have a health care system that takes advantage of that. Why tell a patient to eat right and exercise? There’s no money in that. But convince them they need the latest drug or procedure and you can make a killing. Doctors claim they order unnecessary tests and procedures to protect themselves from lawsuits. That may be true, but they also make more money that way. But imagine if we had a system where payment was based on outcomes, not services provided. Unfortunately, we won’t have that system as long as health care is for-profit. There’s just too much financial incentive to prescribe drugs, order tests, and perform procedures. Other countries have healthcare provided by the government. We Anericans complain about our tax burden and we don’t even get free health care. It shows how skewed our priorities are. Billions in subsidies for Big Oil, but not for public health care? Single payer would solve everything. No longer would people not be able to access health care. No longer would costs be insanely high. And no longer would we making people sicker by giving them drugs they don’t need.

  30. Phil Faris July 1, 2012 at 11:36 am #

    Changing the face of health care is one of the greatest leadership challenges we face today. Moving from our sick care model to a wellness model has one big hurdle…Money. To understand our current situation you need to follow the money. Sick care is BIG Business and much of what you outline would threaten the profits of those currently in power. These are the people who are currently “educating” the public and regulating the health care area. What you describe requires something that is in short supply in the US… common sense and personal responsibility. Because the consequences of our lifestyle are cumulative and not immediate most people don’t feel the need to change until changing is a major challenge. Because there are no immediate negative consequences at the point of consumption (eating Twinkies or drinking that 16 oz big gulp) people do it and think about changing tomorrow.
    As you have pointed out the information and models for change are there. What is lacking are the business models that can drive the engine for making positive change. As innovative and wellness minded business leaders discover how to profit more from wellness than sickness positive change will accelerate. Until then the key is to do everything possible to empower individuals with the information they need to make better lifestyle choices and encourage them to take responsibility for there own heath. For this I am thankful for people like you who are committed to providing that information and support. Keep up the good work.

  31. Laura, RD July 1, 2012 at 7:11 pm #

    Prevention needs to be the focus! This includes access to nutrition professionals that is covered by insurance, which is currently very much lacking in most states.

  32. Ed Duffy July 1, 2012 at 9:28 pm #

    Dr. Hyman can you please show me the reference to this statement
    I quote you ”

    A recent study found that over 75% of stent placements for heart disease don’t help at all to reduce heart attacks and deaths, are harmful, and unnecessarily increase health care expenditures”

    I can’t find the study. Thank you very much. ED

    • Profile photo of Dr. Hyman Nutrition Staff
      Dr. Hyman Nutrition Staff July 2, 2012 at 5:46 pm #

      Hi Ed,

      Dr Hyman quated the above from JAMA.

    • Marianne July 3, 2012 at 7:44 am #

      Ed,

      Also, check out Dr. Caldwell Esselstyn’s book Prevent and Reverse Heart Disease. He did the research at The Cleveland Clinic for over twenty years. His program has helped hundreds of people with severe heart disease without stents or surgery. Acccording to Dr. Neal Barnard, “This powerful program will make you virtually heart-attack-proof. On the basis of decades of research, Dr. Caldwell Esselstyn has shown not only how to prevent heart disease but also how to reverse it-even for people who have been affected for many years.” This program also works for diabetes, cancer, auto-immune diseases etc. It is very inexpensive, there are no side effects, and it affords the person a better quality of life.

  33. JL July 2, 2012 at 11:26 am #

    I am 64 years old. When I was a kid, there was not one fat child in my whole school. We did not have meals out of boxes, bags or cans, and we walked to school, the movies, anywhere we needed to go. We did not have air-conditioning, so people lost weight in the summertime. I believe our modern comforts have taken a toll on the health of America.

    Agree with the poster who said we need a Surgeon General, Dr. Hyman perhaps, who would really make a difference.

    I am totally against Obamacare. The government is not able to run anything without run-away costs. By the way, the Government needs to go on a diet. Why would we spend more money, when we owe trillions. This country is headed for a huge financial collapse.

  34. Sherry July 2, 2012 at 5:36 pm #

    Thank you, Dr. Hyman, for a great article and for your Blood Sugar Solution book, which is a great read. I have found a Functional Medicine dr. and continue to learn from him and you.

    Functional Medicine was begun by a group of M.D.’s who saw the need for change in our current system. I have a 142 page document shared by a pharmacist friend outlining their recommendations. We spend more money on healthcare in this country (USA) and have lower longevity rates and higher infant mortality rates. Most drs. only know how to diagnose, prescribe a pharmaceutical, or do surgery. Many patients have adverse effects to the drugs and become more ill. Look for a FM dr., people! It’s a whole new world. http://www.acam.org or http://www.functionalmedicine.org.

    I have to disagree with one writer who said single payer would solve everything. It would not address the quality or
    cost of healthcare, but would only mandate that everyone have it. It will help poor people who have no insurance now, but are they really being helped in our current system, which is very broken?

    My personal opinion is based on personal experience. I worked in the healthcare industry for 21 years. I have not forgotten the day the newest dr. in the practice approached my desk with an enormous smile on his face. He had just finished a meeting with a drug representative. He had a teenage daughter and two young sons, and he had been given a free, all-expenses paid vacation to Disneyworld for his family. His actual words were ‘this is just the beginning of what’s to come!’. I will spare you my thoughts about this man and his approach to practicing medicine. This is the definition of the pharmaceutical companies being in bed with the drs. Another friend’s daughter was a drug rep. She was so proud of her daughter for this achievement because she was going to be traveling all over the world for seminars. Another friend worked for a well-known pharmaceutical company for FIVE years. She has a pension, and lifetime health coverage, which is better than her husband’s who is still working. They also get a free yearly membership to the health club of their choice. Think about this! This is a mega-wealthy industry. Five years as a secretary begets lifetime health coverage???

    Can we win a war against the pharmaceutical industry and their lobbyists? Perhaps eating and living well is the first step. Then we won’t think we need a drug to become well. There is no healing in a pill. Pharmaceuticals only mimic symptoms. Our bodies heal themselves given the right food and lifestyle.

    Dr. Hyman, continue to help us know how to fight this uphill battle. Hopefully, one day our children and grandchildren will have natural healthcare clinicians who want them to be well.

    • Marianne July 3, 2012 at 8:06 am #

      Sherry, excellent post! It is so sad what has happened to the medical profession in this country, if not the world. I agree about Functional Medicine and have also found a naturopathic doctor that I love. She does the same things as Dr. Hyman. I have also found a way to improve the health of this country, and that is what we eat! Americans eat way too many animal-based foods, including milk and dairy, and not enough plant-based foods. Did you know that giving some babies milk increases their risk for Type 1 diabetes? Animal-based foods are very high in saturated fat and cholesterol, sodium, and have absolutely no fiber or antioxidants. Even skinless chicken breasts which are said to be “healthy” are very high in sodium, fat, and cholesterol! I strongly recommend checking out the DVD “Forks Over Knives” as plant-based eating will help people avoid the major diseases of our times and significantly reduce the heathcare burden in this country. I also recommend Dr. Michael Klaper’s “Foods that Kill” on YouTube. It is powerful information.

      • Herbalist July 4, 2012 at 12:32 pm #

        Marianne!!!! please update your reading. Cholesteral is NOT the problem. FATS are not the problem. MEAT is not the problem. SALT is not the problem. There are NO healthy vegetarians. DAIR is not the problem. EGGS are not the problem.

        PROCESSED “foods” are the problem. If you eat meat from grass fed animals. There is nothing more excellent than truly fresh eggs. If you procure RAW dairy and BALANCE your intake of all things, you will find health. Pasteurized dairy products are responsible for many health problems. Yes, giving dead liquid milk products to anyone will create problems, but live dairy is a real food that is healing and nutritious. Humans have been doing so for centuries and it works. It is the greed of large industry that destroyed the real dairy industry and still they are working the make YOU believe their lies.

        The misinformation of the past fourty years is still wrong and loading up on plant food is not the be-all end-all that too many try to make us believe. We are not rabbits. Humans are Omnivores.

        BALANCE is what we need and humans need protein. There is no protein in plants. Clean up the food chain, eat real local organic food, avoid industrial “food” and pharmaceuticals like the plague. I am living, vital proof. UNBALANCE is what will kill us.

        • Marianne July 17, 2012 at 6:29 pm #

          Herbalist, thanks for replying to my post! That is great that you read it! I agree with you that processed foods are killing us. Pesticides, hormones, antibiotics and GMOs are killing us. Literally!!! Big Ag and Big Pharma are killing us. However, my information is hot off the press so to speak as I just finished a course today in Plant-Based Nutrition from eCornell and the T. Colin Campbell Foundation. There are many excellent doctors out there who are promoting a whole-foods, plant-based way of eating to prevent and reduce the diseases of affluence like cancer, heart disease, obesity, and diabetes, to name a few. Dr. T. Colin Campbell, Dr. Caldwell Esselstyn, Dr. Neal Barnard, Dr. John McDougall, Dr. Joel Fuhrman and many others are reversing heart disease and diabetes with a whole-foods, plant-based diet. The Standard American Diet is killing people. We are consuming way too much animal protein, and plants do provide adequate and nutritious sources of nutrients, including protein. Elite athletes like Brendan Brazier and others like the Venus and Serena Williams twins in tennis are building muscle and are powerful athletes on a plant-based diet. The problem with dairy is the casein which has been shown to cause cancer. Cow’s milk comes from pregnant cows that are loaded with all sorts of hormones. Cow’s milk is good for baby cows because of the growth hormones that fattens up the baby cows. The high incidence of breast and prostate cancer in countries with high consumption of dairy is unequivocal. The high incidence of osteoporosis in countries with a high consumption of dairy is amazing. Fat is the problem. Please read Dr. Esselstyn’s great book, Prevent and Reverse Heart Disease and see what happens to the endothelial cells and nitric oxide with even a small amout of dietary fat.

          People who eat a whole-foods, plant-based diet are more likely to be healthy, given their other lifestyle habits are supportive of health. There are many healthy vegans out there, maybe not vegetarians as they consume fish and dairy products, and many vegans eat a lot of procesed junk food which makes their health status compromised. See Dr. John McDougall’s artticle, The Fat Vegan.

          Unfortunately, I think YOU might be working under a lot of misinformation, so I wish you luck with your health.

  35. Gigi July 8, 2012 at 11:43 pm #

    The high levels of sodium (MILK!!!!) and high fructose corn syrup (EVERYTHING!!!) in general food products served to children in daycares and schools MUST STOP! Convenient lunch packets, juice paks and the rest of “individual servings” are toxic in the amount of calories, preservatives and sodium for starters. Organic vegetables and fruits, juices (no fillers) and organic meats,etc. should be the only foods considered for ANY GOVERNMENT PROGRAMS.
    Are you listening, Michelle Obama???

  36. Astrid Campos July 9, 2012 at 4:07 pm #

    If everyone above already has a very good idea of how to create better health, why do we need any level of government involvement? Remembering that government agencies have the responsibility for determining what chemical additives are safe to add to our food supply or ingested as medicine and the atrocious results, especially in the last 35 years, why would you continue to put your faith here? Dr Hyman et al, conducted a private community based experimental program with great results. Many of the other programs and organizations mentioned above are also private, non governmental organizations that have seen a need and worked to fill it. We are all agents of change, and can do so much more effectively and cost efficiently than a single behemoth agency giving one size fits all solutions to a large and diverse population. So duplicate that, replicate that effort. but don’t pass the buck on to the government. In my opinion, government involvement in medicine and healthcare is what has started and perpetuated this mess.

  37. Seraina McCarty July 15, 2012 at 2:00 pm #

    Dr. Hyman,
    Thank you for all that you continue to do for health in our world.
    I think one area that we need to address in moving towards health conciousness is
    to start organic gardening, farming programs in all our prisons.
    I would create future jobs for the prisoners on their releases, it would supply good
    organic food for the people in the prisons, and we all know what that can do to change
    the conciousness of the eater and the grower, We could have pilot programs where
    the prisoners grow food for the communites, for Women and infant children programs,
    and for people who have been dropped off of welfare and food assistance programs.
    These types of programs have been started all over the world with great success.
    But not so much in America. We all know that we are not going to be able to continue
    to support the present prison system as we know it, we all know that there will be
    food shortages coming (with all the crazy weather patterns) Lets start some programs
    that head us in the right direction, and not just tax us for health (insurance). the only
    health insurance that we will ever have, is to eat and grow healthy fresh ripe raw organic
    food.

  38. vel July 16, 2012 at 11:04 pm #

    Hi Dr. Hyman, I read your article on Isabel, a cute 10yr old girl from texas, she had an Autoimmune Disease, I was very moved by the result and outcome of the didease, someone had emailed me the article, I haven’t left the website as yet,
    I have a 16yr old son who was diagnose with systemic sclerosis, rheumathoid arthritis and Autoimmune Disease, about 4months ago, my son has been hopitalize for 3months with shortness of Breath, he first had the swelling of his hands and his big toe, and he was also loosing weight, i took him see a rheumatologist and she prescribed prednizone steriod, my son then developed breadthing problem, we end up in the emergency room, since then he has gotten a list of medicine, but the shortness of breadth the doctor are scratching their heads, he looks very normal but if he takes steps he is short of breadth, so i push him around in a wheel, he was a normal 16yr old love and played soccer, i want to be able to do that again, or at least to be able to walk without getting out of breadth, he also uses an oxygen with a portable tank if he has to walk, when i read the article on Isabel, I believe there is hope for my son, he was given the hi dose of steriod through intravinous1000mg,, for the past 3 saturdays, plus he gets the pills daily 45mg, their are other drugs they want to try which i objected after reading about it the name is Rituximab, and other harmful drugs whhen reading about them. i really believe my son condition would get better if he has Funtional Medicine, because i believe in the Children Hospital where I am, these doctors may not be able to tell me about Funtional Medicine even if they know it can help, because they have to go with Hospital policy, if i can get any information, I will highly appreciate it, thank you.

  39. kristym August 25, 2012 at 12:55 pm #

    Can you tell me WHERE I can see the “report” you state in total? I cannot find any reports online that state this:

    A recent study found that over 75% of stent placements for heart disease don’t help at all to reduce heart attacks and deaths, are harmful, and unnecessarily increase health care expenditures. Yet the number of angioplasties and stent placements performed has increased, not decreased.

  40. Diabetologist February 21, 2013 at 10:45 pm #

    The vast majority of overweight people are not type 2 diabetics, since the development of this condition requires a genetic predisposition lacking most people. There is now increasing evidence of a strong autoimmune component to the development of type 2 diabetes, making it more like type 1 than previously suspected. Any diabetologist will tell you that many of the type 2 patients he or she treats will be quite thin on diagnosis, so in them obesity is not even a factor. Historical records indicate that in earlier periods in the 19th and 20 centuries in Europe and the United States, people consumed more calories than they do today, yet still, type 2 diabetes was far less common, so factors other than weight are clearly at play.

    And finally, we have all the type 1 diabetics for whom weight and lifestyle are completely irrelevant to the development of their condition.

    So the article obviously requires considerable qualification. It is quite ironic generally to see that now that we know the vital importance of genetic predisposition in the etiology of much chronic illness, the focus is more than ever on prevention, even though no one can pick his or her parents!

    But it is so much easier for doctors with no answers just to blame their patients through the ‘all disease is preventable’ mantra, or for governments and insurers to use the same strategy to exuse denial of coverage for chronic diseases..

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