Ignoring Health Risks Bears A Deadly Cost

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Andy Towle/Roundup - atowle@payson.com

Smoking remains the leading preventable cause of death in America, claiming half a million lives annually. That’s the equivalent of crashing three fully loaded jumbo jets every day. Yet, studies show that doctors make little sustained effort to convince patients to give up smoking. By contrast, 70 percent of smokers say a doctor’s advice would deter them.

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Andy Towle/Roundup - atowle@payson.com

Phil Brawner walks at a brisk pace while doing his cardiovascular workout at the Payson Athletic Club.

Let’s say you liked me — loved me even. But I smoked. Then you found out I had lung cancer and three months to live. Would that make you quit smoking yourself?

You don’t smoke? Well, let’s say you loved me and I was fat, never exercised and then I had a heart attack. Would you start an exercise program?

Maybe. But alas — you don’t love me.

I’m just a newspaper writer — trying to figure out some gimmick to make you change your life to avoid an early, debilitating, painful death. Two out of three Americans will die of preventable diseases — mostly cancers and heart attacks related to smoking, bad diets, and sitting around all day internalizing stress. Granted, even if you exercise like crazy, never even look at a cigarette, eat a vegetarian diet, take aspirin and vitamin E, load up on dietary fibers, control blood pressure and cholesterol and get all the recommended vaccinations and screening tests — you’re still going to drop dead eventually. But probably not until you live a full life span, meet your great-grandchildren, and skip that final decade of mounting health problems and disability that stems from decades of burying your head in the sand.

A series of interviews with health experts has yielded the sage advice, clever tips and grim warnings that follow. Most of our diseases are self inflicted. Smoking kills nearly 500,000, alcohol about 100,000, and diseases related to poor diet and lack of exercise another 400,000 every year. Injuries — most of which are preventable — cost more than $100 billion annually, cancer more than $70 billion, and cardiovascular disease more than $135 billion.

Prevention is the key

Our insistence on killing ourselves off early raises a couple of vital questions.

• First — if prevention works, why does the medical system do such a lousy job of helping people stay healthy?

• Second — if the studies have conclusively proven that our lifestyle is killing us, how come we don’t change?

Take cigarette smoking.

It’s the leading preventable cause of death in America — roughly one in every five deaths. That’s the equivalent of crashing three fully-loaded jumbo jets into the ground every morning. Smoking kills more people than alcohol, murder, suicide, auto accidents, AIDS and illegal drugs combined.

But this is not news. I bet even the tobacco company executives know this — when they squint into the mirror. So why do 26 percent of Americans still light up every day? How could it be that smoking rates among teenagers are actually increasing, especially among girls?

Why does the U.S. government subsidize tobacco farmers and lobby to increase cigarette exports? And why do so few doctors make any sustained effort to help patients quit smoking although 70 percent of smokers say that the advice of their doctor would be influential?

“I think that when medical historians look back on this period, one of the things that will stand out is the incredible inability of our society to come to terms with what tobacco is doing to us,” said Dr. Carlos Campbell at the Arizona Prevention Center at the University of Arizona Health Sciences Center. At most medical schools, prevention gets about two afternoons a week during the second year of training, said Campbell.

Moreover, it’s notoriously hard to convince people to stop smoking, lose weight or exercise. In addition, many of the insurance plans offer no way to pay doctors for that half hour conversation about smoking, diet and exercise.

And yet, studies show that companies which encourage employees to eat properly, exercise and quit smoking can cut medical bills by 20 percent.

In addition, it’s hard for even doctors to keep up with the steps they can take to prevent disease. Consider ulcers, which afflict 4.5 million Americans and trigger about 40,000 surgeries every year. Most people think that ulcers are the toll they pay for stress. Not true. Mostly, they stem from a recurrent bacterial infection.

Scottsdale-based PCS Health Systems prescription drug management company did a study on how many doctors were prescribing antibiotics for ulcers.

The results were disquieting.

Only 2 or 3 percent of the patients were getting the recommended antibiotics, which means that perhaps 90 percent of the current costs and surgeries were unnecessary.

All of which means, it’s up to you.

It’s your life

And that makes sense. It’s your life. It’s your kids and your spouse who will have to figure out what to do without you. You’re the one who is going to spend the last decade of your life stuck in a nursing home, hooked up to an oxygen tank, or checking in and out of hospitals.

You can’t rely on the doctors and the hospitals to make you do what’s good for you. Granted, they can help, and they’re mostly eager to serve as your allies. But it’s your problem.

Which brings us to the second essential question: Why don’t we do what’s good for us? Why are we getting fatter, more inert, and more stressed?

Here’s a clue: People aren’t rational.

“At one time, we thought that if we educated people — gave them a body of knowledge — that it would influence behavior,” said Dr. Richard Papenfuss, associate professor of health education at the University of Arizona. “I think that was too big of a leap. It’s really hard for adults to change behaviors.

So there it is.

We’re killing ourselves — acting from a bundled blend of ignorance and need. However, we can save ourselves — although many doctors aren’t convinced the facts will sway you.

Maybe not. But try this: As you read this story, pretend we’re talking about someone you love — dying very slowly because of habits they won’t change. Actually — come to think of it — you won’t even be pretending.

HEART DISEASE

Heads up, kids: This is the big one.

List the five people you like best in the world. Odds are, heart disease or stroke will kill two of them.

Heart attacks kill about 500,000 Americans annually, and strokes chalk up an additional 140,000. We spend more than $151 billion annually treating the 60 million Americans who suffer from cardiovascular disease, which includes heart attacks, high blood pressure, high cholesterol levels, clogged coronary arteries and stroke.

But maybe two-thirds of that toll could be prevented if people changed their lives — by getting even modest exercise, decreasing dietary fat and increasing dietary fruits and vegetables. If those changes don’t reduce risk factors, then a variety of drugs can be used to lower cholesterol and blood pressure levels.

Our desperate scramble to cope with heart disease illustrates how the medical system shortchanges prevention, but lavishes futile billions on a desperate effort to patch all the holes in the hull in the middle of a typhoon. Experts say heart disease death rates have dropped by nearly 50 percent in recent decades, but that’s largely because of lifestyle changes rather than the billions lavished on new techniques.

In this medical shell game, we’re dazzled by lasers, stents, treadmill tests, tiny cameras and sophisticated imaging systems, while neglecting diet, exercise and smoking which cause most of the problems.

What’s more, the complexity of a problem like heart disease digs all sorts of bear traps for the unwary. For instance, few experts would argue that people with heart disease ought to be screened for high cholesterol and high blood pressure and put on drugs to reduce high levels if diet and exercise changes don’t work.

But what about the millions of Americans with high blood pressure or high cholesterol who haven’t developed heart disease? Studies suggest that mass screening costs a bundle for each life saved.

If you want to avoid the No. 1 killer of Americans, you can improve your odds considerably by not smoking and then improving your other risk factors, including:

GET OFF YOUR BUTT

Nearly 60 percent of Arizonans get almost no exercise at all. That increases their risk of a heart attack substantially. Suppose this worries you enough that you start walking briskly about 20 to 30 minutes a day — just enough to be a little breathless, and develop a faint sheen of perspiration. Your odds of a heart attack just dropped 44 percent. Not only that, your odds of developing diabetes, depression, colon cancer and lung cancer just dropped significantly. But remember — this should be a lifetime habit. The benefits of exercise fade after you stop.

EAT RIGHT

Cut the fat out of your diet, reduce salt intake if you’ve got high blood pressure, and watch your cholesterol levels. Ideally, less than 20 percent of your daily calories should come from fat, and you should be close to your ideal weight on various life insurance weight tables. You should be scarfing down three to five servings of fruits and vegetables a day. This will reduce your risk of heart disease, not to mention diabetes and colon cancer. Substitute “good” oils like olive oil for “bad” oils like the saturated fats that remain solid at room temperature.

MONITOR BLOOD CHOLESTEROL

If you have heart disease, you should be working aggressively with your doctor to lower cholesterol levels — especially the ratio between the “good” high density lipoproteins (HDL) and the “bad” low-density lipoproteins (LDL).

Total cholesterol readings should be below 240, and HDL levels should be above 35 mg/dl. Diet and exercise are the first line of defense, then people with high levels and other risk factors should consider cholesterol-lowering drugs.

It’s less clear what you should do if you have high cholesterol levels and no other risk factors. Diet changes and exercise can lower cholesterol levels by 5 to 15 percent. But there’s only weak evidence cholesterol-lowering drugs reduce mortality or heart attacks for people without other risk factors.

That’s why it’s important to work with your doctor to evaluate all the overlapping risk factors, including high blood pressure, a lack of exercise, an abnormal treadmill test, obesity, age or a family history of heart disease.

MONITOR HIGH BLOOD PRESSURE

This is another one of those confusing risk factors. Clearly, people with high blood pressure above 140/90 should try lowering their blood pressure by losing weight and getting exercise, which often cuts blood pressure by 5 or 10 percent.

And clearly people with heart disease ought to try medications to lower their blood pressure if diet and exercise changes don’t do the trick. If you don’t like the side effects of one drug, fiddle with the other possibilities. Again, it’s less clear what to do about otherwise healthy people with high blood pressure. Clearly, losing weight and exercising would help. But it’s unclear when otherwise low-risk individuals should resort to blood-pressure-lowering drugs. Again, find a doctor you can work with, and use a variety of tools to lower your risk.

Prevention Checklist

• Exercise at least 20 to 30 minutes a day — even if it’s 10 minutes at a time.

• Stay within 20 percent of your ideal body weight.

• Keep total cholesterol below 240.

• Keep blood pressure below 140/90.

• Consider periodic exercise stress tests once you’re older than 40.

• Reduce cholesterol in your diet.

• Reduce calories from fat to below 20 percent of your daily intake.

• Reduce saturated fats in your diet.

• Take an aspirin a day, unless you have contraindications.

If anyone has adopted the gospel of prevention, it’s got to be pediatricians.

And most pediatricians do their best: They measure growth and development, they administer vaccines that remain the most cost-effective prevention strategy in medicine’s armory, they involve the whole families and they check eyesight and hearing.

They tend carefully to every little tree-like symptom.

Only problem is — the forest is dying.

If present trends continue — about two-thirds of our kids will die as a result of smoking, poor diet, a lack of exercise, and a short list of common but preventable diseases — like heart disease, stroke, diabetes, AIDS, accidents and many forms of cancer. The studies documenting this truth have been stacking up for decades. But frustrated experts say that it’s extraordinarily difficult to change the habits of adults and stress that the best way to prevent disease is to teach kids good health habits.

This we know.

But kids get less healthy every year. They exercise less and smoke more. They weigh more, have unprotected sex more often, face more violence in their lives — and have less health insurance. They take less physical education in school and rarely learn much about the risks of sex, cigarettes, fatty foods, and a lack of exercise.

In short, we know a lot about how to keep our kids healthy, but keep it a secret from them until after their first heart attack. In the meantime, food producers and cigarette makers pump billions of dollars into advertising and packaging to promote foods, drugs and habits that will con kids into embracing unhealthy habits for the rest of their lives.

Meanwhile, pediatricians continue to employ prevention strategies to keep their pint-sized patients in the pink.

“The key thing is making sure that a child’s immunizations are current,” said Dr. Charles Basye, a Phoenix pediatrician, including measles, mumps, rubella, diphtheria, pertussis, polio, a form of meningitis and tetanus. The effectiveness and safety of these vaccines is well established. For instance, every dollar spent on giving measles shots saves $14 in other medical costs.

Dealing effectively with asthma is another major concern, since it affects 15 million Americans — 60 percent of them children. The incidence of asthma jumped by 42 percent between 1982 and 1992. The treatment of asthma racks up $6.2 billion in medical costs annually.

It accounts for more than half of all emergency room visits by children. But about 90 percent of the asthma-related deaths and hospital visits could be avoided with correct management.

One drug company study found that only 40 percent of asthma patients get the right medications. In addition, many asthma sufferers are among the 50 million Americans with no medical insurance who get no preventive care to keep their asthma from turning into a perhaps fatal emergency room visit.

Averting accidents is also a key prevention strategy for pediatricians. That includes child-proofing toddler’s homes by covering up electrical outlets, putting child-proof latches on cabinets, keeping medications, poisons and chemicals safely out of reach, and removing other potential hazards.

Baby seats and routine seat belt use is not only sensible, but required by law. And doctors say that you can avoid many childhood injuries by insisting that your children wear helmets and other protective gear when using bikes, skates or skateboards.

Parents and doctors should also make sure that they try to educate children about the risks of smoking. Parents and doctors should also monitor children for things like depression, a treatable disability that is on the rise among teenagers.

Prevention Checklist for children

• Get the full array of recommended vaccinations.

• Ensure regular well-baby checkups.

• Use baby seats.

• Use seat belts.

• Use helmets and wrist supports in biking and skating.

• Child-proof toddler’s homes.

• Install and maintain pool fencing.

• Get mental health checkups.

annual mammograms for women between the ages of 50 and 70. But debate still rages about whether mammograms are cost effective for women younger than 50, because the density of their breast tissue makes mammograms much less accurate.

Prostate cancer is the other big question mark. Doctors find 317,000 new cases annually, and report 41,000 deaths — mostly in men over 50. Evidence suggests that virtually every man will develop prostate cancer if he lives long enough, but it’s usually so slow growing that most men with prostate cancer will die of something else even if they’re completely untreated. That means age is the main risk factor, plus a family history.

But most of the debate currently revolves around the perils and benefits of early detection of prostate cancer — thanks to the development of a simple blood test that detects certain proteins produced by prostate cancer cells. Many men who have avoided the standard, annual digital rectal exam recommended after the age of 40 are willing to take the new prostate antigen test. However, the blood test is plagued by both false positives and false negatives.

Moreover, the improved tests have detected many prostate cancers at a very early stage. But early detection raises some thorny problems. Although most prostate cancers are so slow growing, some types grow aggressively and require quick treatment. But in many other cases of prostate cancers, the side effects of treatment are actually worse than the effects of the cancer.

Unfortunately, doctors can’t easily distinguish between fast-growing cancers which should be treated immediately and the slow-growing type.

EXERCISE

Exercise remains perhaps the best prevention for a host of diseases. Unfortunately, 60 percent of the American population remains largely sedentary. Among those older than 65, 90 percent get no exercise — although this group would reap the biggest immediate benefit from even light exercise.

If everyone engaged in even moderate exercise, heart attacks and strokes would drop by one-third. Exercise also reduces the risk of lung cancer, colon cancer, diabetes, bone thinning and depression — a malady that affects one in six people in the course of a lifetime and costs the health care system $44 billion annually.

The biggest health benefit comes from going from completely sedentary to 20 to 30 minutes a day of even moderate or light exercise — like walking until you’re slightly winded, or just starting to sweat.

So get started — but start slowly — recognizing that you’re in for the long haul. Most people who start exercise programs stop within a couple of weeks — often because they started out so vigorously that it was painful and unpleasant. Over-doing can be dangerous — since sedentary men who undertake overly vigorous exercise suffer an initial increase in the risk of a sudden, fatal heart attack. However, that risk is quickly overwhelmed by the longer-term benefits of exercise. Even seasoned athletes are more likely to suffer a heart attack during vigorous exercise, even though their overall rate of a heart attack drops sharply.

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