Achieving Wellness, Whatever That Is

New York Times
June 24, 2008

Worried Sick
A Prescription for Health in an Overtreated America. By Nortin M. Hadler, M.D., University of North Carolina Press. 376 pages. $28.

Medical Myths That Can Kill You And the 101 Truths That Will Save, Extend and Improve Your Life. By Nancy L. Snyderman. M.D. Crown Publishers. 273 Pages. $24.95.

There are so few good belly laughs in health care these days. What a pity I am likely to be the only person on the planet to enjoy the guffaw-laden, if slightly unnerving, experience of reading Dr. Nancy Snyderman and Dr. Nortin Hadler’s new books in tandem, taking careful notes.

Both are practicing physicians who have made second careers interpreting medical principles for a lay audience. Both consider themselves experts not only in illness but also in wellness, that shimmering grail of our time. Both have combed through all the latest studies and are now pleased to provide you, the average healthy adult, with guidelines for staying well.

Both muster science, statistics and a judicious smattering of personal experience to present, with no small fanfare, completely, utterly, diametrically opposite advice.

Dr. Snyderman, a surgeon and longtime broadcast journalist who is the chief medical editor of NBC News, delivers no surprises. Her mission is to assure readers that enough attention to the principles of modern medical science will bring you a longer, healthier life.

With chirpy, can-do optimism she recapitulates the standard wisdom. Watch your diet, exercise, lose weight, stop smoking, be screened regularly for a variety of dire illnesses, rein in cholesterol and blood sugar, stay in touch with your doctor and be sure to check out those aches and pains pronto, just in case. So speaks the medical establishment.

Everyone, perhaps, but Dr. Hadler, a rheumatologist and professor of medicine at the University of North Carolina who is a longtime debunker of much the establishment holds dear. Dr. Hadler may not actually keep a skull on his desk, but he might as well. We are all going to die, he reminds us. Holding every dire illness at bay forever is simply not an option. The real goal is to reach a venerable age — say 85 — more or less intact. And the statistics tell Dr. Hadler that ignoring most of the advice Dr. Snyderman offers is the way to do it.

The statistics are the key here, and readers will need stamina to traverse the thicket of numbers and analyses Dr. Hadler provides. Reviewing the data behind many of the widely endorsed medical truths of our day, he concludes that most come up too short on benefit and too high on risk to justify widespread credence.

Dr. Hadler sees no evidence that mild high blood pressure or mildly elevated blood sugar pose much of a risk to longevity — certainly not enough to warrant the aggressive drug treatment often offered for them. The same goes for the extra 20 pounds that make you overweight but not obese, and the modest elevations in serum cholesterol that, these days, spell a statin drug for life for many healthy people.

He deplores the careful attention we pay to the state of our coronary arteries. Angioplasties, stents, coronary artery bypass grafts — all these procedures, he writes, “should be consigned to the annals of good ideas that proved bad.”

As for the screening that purportedly keeps us safe from cancer, mammography and the blood test for prostate cancer are, in his view, blunt cudgels that can harm as much as help. Nor does he want any part of routine colonoscopies: “Let my polyps go.”

I had a good time imagining these two authorities chatting at a cocktail party. Dr. S. would be nibbling salmon, tuna or trout and sipping her single daily alcoholic beverage. Dr. H. would be eating and drinking whatever he pleased (“You are not what you eat”) .

She would describe her daily multivitamin regimen. He would discuss the “enormous North American vitamin scam.” She would declare that “having ourselves checked on a regular basis is a vital step we must take.” He would reply that an annual physical exam is “entirely useless.” She would tell the story of the time she felt “bone weary and pooped” for a few days and so had a C.T. angiogram of her coronary arteries. He would have an apoplectic fit.

Yet, these two books do raise serious questions. Dr. Hadler articulates one of them. What exactly does it mean to be well? Is it complete freedom from pain, creaky joints, dyspepsia and sleepless nights? Or is it instead, as he suggests, the ability to cope with all these common physical problems without transforming oneself from person to patient?

What are the cumulative psychic and economic tolls (on a person, and on a nation) of conflating discomfort and disease?

Hold on, Dr. Snyderman might counter. If even one life is saved by the standard medical rigmarole — and that life could be yours — is it not all worthwhile in the end?

By now, it should be obvious why no one but me is likely to be reading both these books. You, reader, have undoubtedly already decided which author is a sage and which one a lunatic, which advice is sound, worthy of reading and re-reading, and which is simply misguided.

And that is the final thought-provoking lesson. Our health beliefs are so deeply ingrained that data, admonitions, guidelines and oceans of ink on reams of paper will seldom dissuade us from believing what we want to be true.