None Of The Above

I am sure you all remember the multiple choice tests where the last option was ‘none of the above.’ Well, I had my own ‘none of the above’ realization on a recent flight to Kauai to give a health talk.

I had an aisle seat, a long book (“Hemingway’s Boat”; worth a read but troubling) and was settled into my reading when a very nice lady to my left asked, “What do you do?” Tone of voice can convey more than my perfunctory answer, I was kind in my answer: “I’m a doc.”

“What kind of doc?” “I’m a drugs last not first kind of doc.” My short answers were because I wanted to read my book, but as she was sweet I kept answering. This discussion went on long enough that it does not reflect well on either of us and on reflection actually shows me in a worse light than her.

So her question after I said “…drugs last” was “are you a chiropractor?” “No, I’m an MD.”

Well to my little tidbits, each offered as I dove back into my book, she asked whether I was a ‘longevity doctor,’ or a ‘naturopathic doctor,’ or an ‘alternative doctor,’ or a ‘lifestyle doctor,’ or an “herbalist,” “holistic,” “integrative?” She actually asked whether or not I was several versions of a doctor I had never heard of; hard to do by the way.

I finally turned to her and said: “I’m a regular doctor, my card says ‘Health Management,’ but I just stress nutrition, exercise and spiritual discipline.” Well this too didn’t work.

I gave up and we talked for awhile, both she and her husband were very nice people, and as I knew from her repeated questions, she had her own health story to share and some ‘alternative’ paths in her medical past.

So it turns out the kind of doc I am is: “None of the above.” Which is part of my mission in life; let me explain.

The medical profession is an honorable one. When healing occurs in our lives it is a great gift. When one is allowed to practice one of the ‘healing arts’ it is a privilege almost without peer.

Yet, the fact that there are so many kinds of ‘docs’ is not a testament to the power of the healing arts it is, instead, a witness to how we, as physicians and the medical field as a whole, have lost our way; we have lost our credibility too. And frankly for good reason.

We hear everyday about the ‘epidemic of obesity’ and how our population is getting sicker and sicker;  well it is just not true. The average life expectancy in all of Africa is around 50-55 years and of India around 65 years. Anyone in the industrialized modern world has a life expectancy of plus or minus 80 years. Arguing about whether the Japanese or the Swiss or, pick your favorite, live the longest is a pretty silly statistical undertaking because we are talking about a year or two one way or the other and comparing genetic apples and oranges, as well as behavioral and cultural differences that are too complex to quantify and barely within our capacity to even conceptualize.  “The Vapors’,” “Turning Japanese” is just a song and not a real option. (Anyone remember that one?)

Helicobacter pylori was endemic in the United States in around 1900 and many people died of the stomach cancer associated with that infection. The incidence of Helicobacter pylori is now quite low here and as a result stomach cancer is much less common. Helicobacter pylori is currently endemic in China and as a predictable result they have a much higher incidence of stomach cancer. When that bacteria abates there as it did here the cancer mortality- oh, by the way the heart attacks and strokes associated with that infection too- will go down. How and why did it become less common here? Well the heroes of that story, besides the people who found and evaluated that particular bug, are plumbers and civil engineers.

Don’t forget smoking. That is down too.

So public health messages about how fat we are and how lazy we are constitute a bunch of lies. Well, sort of. People with a BMI- remember that one?- indicating ‘over weight’ live longer than those with an ‘ideal’ BMI. And the American College of Cardiology wants to take the credit for our longer lives which is silly on its face. The life expectancies have gone up in countries that have not tried to put Lipitor in the water and, a never-ending scandal and insult to my professional peers, people don’t take the medicines they are given anyway.

So somewhere around a mean life expectancy of 80 is what you get whether you are Japanese or Swedish and the differences are not trivial but they are not powerful either. Most of the former Soviet Union has a very high incidence of alcoholism, smoking and suicide; well that sure cuts down their average life expectancy and it is not because of too much borscht.

So what does a ‘plain old doc’ get to do if the plumbers have done it all already?

This gets to the nub of why I don’t want to encourage or participate in the fissioning of the medical profession; it illustrates why I claim to be ‘just a doc’ and want many more ‘just docs’ to be trained and in the field.  Conventional medicine is busy turning medical students into drug robots and alternative medicine, in whatever guise, is busy selling wishful thinking in the guise of ‘the wisdom of the ages.’ Well, the problem is not that they are both wrong but they are both right.

The family practitioner who hands out antibiotics and Lipitor all day gets to wear the hero’s mantel of the heart transplant surgeon and the integrative doc assumes the aura of an Oriental sage because he learned to hold a few Yoga poses and had an introductory course in Chinese herbs. There is something wrong here.

Getting to 80 is not the hard part. Getting to 80 and beyond without Alzheimer’s, or non-Alzheimer’s dementia, or bones so frail you can’t sit down too hard or you will break something is the hard part. And that takes precision, intention and measurement; that takes the help of a well-trained doc as familiar with how to do a deadlift as he is capable of understanding your personality so that he can help you fix poor sleep and depression. A well-trained doc that knows the full metabolic pathways, not so he can use the newest drug to upregulate some single point in a long chain of cause and effect but so that he can direct your behavior in such a way as to create positive adaptive change in that well understood chain of metabolic action. “Eat right and exercise” isn’t enough and yet that and ‘take one of these and call me in the morning’ is all they teach in medical school. This has to change. Your personal doc must not, that was ‘not,’ be under the delusion he is helping you when he repeats the latest ‘public health advisory.’ Low fat, no trans fat, walk every day, wear your seatbelt, lock up your guns; whatever.

You must measure, react and adapt to real data, your data, no one else’s data. Eat better? Yes. An apple will trump a croissant every time. Exercise? Yes. Walking will trump watching television everyday. Yet an apple and walking around the block is not enough to avoid dementia, osteoporosis, diabetes, low testosterone and poor sleep.

Help me build a new medical school. That is all I am asking for; not much, pitch in, help me.

Smile, Have Fun, God Speed,

Dr. Mike


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