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April
2004
A Full Partnership
for the Future
Ten years ago, the Journal
of the American Medical Association published a landmark study
finding that almost half of the deaths
in America were caused by a behavior that was preventable — smoking,
overeating and drinking to name the top three. Last month, a follow-up
study reported that nothing has changed — except for the
fact that obesity and poor physical fitness are about to catch
up to tobacco as the most preventable cause of death in the United
States.
A second study, in Health
Affairs, reinforces the bleak future. The rates of death and
disability among older Americans have fallen
steadily over the past few decades, but this healthy trend could
disappear if the nation’s obesity epidemic persists. Researchers
predict an 18 percent to 22 percent increase in the prevalence
of 50- to 69-year-olds who have difficulty bathing, dressing or
walking across a room by the year 2020 if Americans continue their
weight-gaining ways.
And in recent days, the New
York Times reported that evidence
about what prevents heart attacks has been misunderstood and misapplied
for years. Common prevention techniques, including quitting smoking
and use of cholesterol-lowering drugs, may be more effective than
opening clogged arteries with stents or angioplasty.
Last month, I asked in this space if biomedicine alone is up to
the task of dealing with not only the obesity epidemic but a future
of an aging America facing chronic diseases, fiscal constraints
and disparities based on racial and ethnic status. There are no
certain answers, but in light of what we are learning about the
health challenges ahead, only a full partnership with health behavior
research will bring medical advances to a public demanding better
health.
The problem,
as I see it, is that evidence-based health care will require
an understanding of how the actions of individuals influence
their health. In the meantime, however, investments in health science
remain focused on the medical management of disease.
NIH Director Elias Zerhouni,
in a recent talk at the Research!America annual meeting, said
that with the rapidly rising price of high-tech
interventions, “Only a revolutionary understanding of disease
process can put a brake on those costs.” A heart transplant
is many times the cost of preventing a heart attack, he said, and
the solution may be both prevention and “molecular pre-emption
of disease.”
Dr. Zerhouni's description of the future is correct, but where
we may differ is on emphasis. As the head of a biomedical behemoth,
he is seeking to weight the research portfolio with molecules.
I believe his focus is promising but ought to be balanced with
research into understanding how individual actions can make use
of this knowledge to prevent and manage disease.
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