Why I dislike the current medical paradigm
A paradigm is a human being's mental model of the world, a map through which they navigate
their life. It may or may not conform to that of others but is often stereotypical of others i.e.
their map is often similar to those of others, but not the same.
A medical paradigm is a philosophy of medical science, a general conception of the nature of
scientific operation within which a particular scientific activity is undertaken. In other words,
it is about “how things are done around here” and within our national health service is confined to
medications (drugs), radiation, and surgery. That is the limit of the map through which NHS
professionals can navigate your illnesses and dis-eases. The current paradigm is narrow,
restrictive (to the bio-medical, silo, one condition at a time model) and ignores many approaches
(complimentary, metaphysical, functional, integrative, spiritual) that are also needed for healing.
It constantly emphasises the need for scientifically evidence based medicine. But how scientific is modern medicine? Not very.
But you never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. — R. Buckminster Fuller, American architect, systems theorist, author, designer and inventor
As a lover of acting, in particular playing in Shakespearean plays, I notice a silent drama and tragedy playing out before me on the stage of so-called “modern” health care …but hardly anyone is talking, let alone applauding. We have become so used to a seventy-year-old NHS that most of us are silent critics. Our medical and health paradigm – the bio medical model – is aged; it is not a health service. It is a disease management service. It fixes you up when you are breaking up or broken. But it is not holistic or integrative – you are not viewed as a whole person with intercommunicating cells, tissues, systems and organs, with education, thoughts and feelings, values and beliefs. You are viewed through your bits, symptom by symptom, even within the NHS departments and specialisms don’t talk one with the other. They treat you for one thing at a time. The paradigm is depressed – and is a suitable case for treatment. But we need to make our views known.
The current medical paradigm of the Scottish NHS is not geared to a holistic approach that deals with causes and is health-promoting. It is about illness management, about treating symptoms, and simply keeps us stuck in ill health and medical and pharmacology people in jobs.
We radically need a new paradigm, and not just a tinkering at the edges of the present one nor a ploughing of more and more money into a dying system. That is akin to trying to breathe life into a corpse.
There’s nothing wrong with making our current system more efficient and cost effective, and I don’t doubt that those managers who seldom see the real workings of the front-line in medicine or talk with patients are capable of contributing to that goal.
But this approach is a bit like rearranging the deck furniture on the Titanic. Giving more money to the Titanic, giving more crew, would not have saved it.
The present paradigm is not getting us any closer to reversing the rising tide of chronic disease—which is what more of our resources should be directed toward.
No matter how much we streamline, automate, or “app-ify” our “sickcare” system, it is still a sickcare system. It’s still focused on suppressing symptoms with drugs and managing disease after it occurs. It is not a system that helps create health.
We need to radically turn our attention to changing our diet, behavior, and lifestyle to prevent disease before it occurs and to use a Functional / Collaborative / Integrative / Holistic / Call It What You Will Medicine approach to reverse disease once it has set in.
We need a paradigm shift to one that promotes health and well-being as well as still treating those with signs and symptoms. In time, with better health and well-being we should witness fewer people with chronic diseases. But we also need to change the way we deal with signs and symptoms - to identifying and treating their cause, by treating not just the sign or symptom but by treating the patient and the root cause of their sign, symptom, illness or condition.
The cry for change - but one example
Our politicians at various levels seems blind and deaf to hearing ways in which the paradigm of health and social care needs to be radically changed, they seem reluctant to acknowledge the need for change, and are arrogantly determined to plough on regardless, with ever mounting costs, keeping people imprisoned in a system of disease and poverty management, and light years away from helping the public create better health and well-being. They shamefully misuse and abuse monies on a system that is not fit for purpose.
At a simple level, they continue to promote the current unhealthy paradigm of nutrition, yet give doctors around two hours over five years on nutritional training, and think this equips them to be experts in the field of something we do 2 -3 times a day, need to inform ourselves on our nutritional choices. Yet so much of our health and well-being depends on good nutrition. The health pyramid they offer us is ancient and out of date. Poor nutrition is killing people with diabetes, it certainly does nothing to help them reverse diabetes or lead healthier lives such are the issues around carbohydrates and sugar.
In October 2016, a number of prominent doctors, nutritionists,
sports scientists and health campaigners wrote a letter (opposite)
to the medical schools council, the general medical council and
the secretary of state for health calling for mandatory training
for medical students and practicing doctors in evidence based
lifestyle interventions to prevent and treat chronic diseases
including type 2 diabetes and heart disease…and the result is,
we shall plough on regardless when (a) these bodies could be
responsible for creating better health outcomes (no disease
management) and saving the health budgets a fortune.
Most of the increase in demand on the NHS which came into
prominence late 2016, early 2017, with horror stories of hospitals
unable to cope and patients (myself included) assigned to waiting
for hours in a corridor, is driven by - poor diet - low levels of
physical activity - smoking and - excess alcohol.
Now we as individuals can do something about the booze, the fags,
and whether we exercise, but when it comes to informed choices
on nutrition, we follow often what we are advised by those bodies
and official government agents. But they are giving us wrong advice
and doctors and nurses sigh with absolute disdain when they find
us informing ourselves through the internet. You cannot have it all
ways medical people.
For years, long before the internet, I was advised to “keep taking
the carbs” and other such nonsensical nutritional advice like
counting calories using formulas that needed a mathematics degree
to understand. You know, when it is mealtime, I just want to eat!
None of the advice did any good, but did significant harm. And is
now, in 2017 being totally discredited by eminent medical people
and their research.
So whilst we as the public must take responsibility for our health,
agents of the state and their representative, must also be more
responsible and better informed and less reliant on out of date dogma.
When one combines the foregoing with millions of people taking
medications of dubious benefit that come with many and huge side
effects, that are a major contributor to death and disability, it’s a
recipe for a public health disaster, monumental budgets, and gross
mismanagement of public funds; it is utterly irresponsible – yet this
is where we are today.
Around this time, early 2017, I saw a screening of the film, The Big
Fat Fix, by Dr Aseem Malhotra, and it is clear from that, that if
medical students and doctors were taught specifics of lifestyle
changes and nutrition to be used therapeutically, then we would
save the NHS billions in addition to improving the quality of lives,
and the health and well-being of millions of UK citizens. Add to
this how much more could also be done if we had a health system
that focussed not just on identifying symptoms and treating them,
but on treating causes of ill health and spending more time on a
paradigm of health creation. If people are healthy, they will need
less costly treatment interventions. But of course, the elephant in
the room, is that that would put lots of people, including those
in big pharma, out of business!
One of the prominent doctors, referred to earlier, and a signatory
of the also aforementioned letter, was Dr Rangan Chatterjee,
NHS GP and founding member of the Public Health
Collaboration, speaks eloquently on this topic and did so one
morning in January 2017 on BBC Breakfast. He also had
demonstrated on the BBC TV programme “Doctor in the House”,
that type 2 diabetes could be diagnosed and reversed within 30
days from simple lifestyle changes by recognising that at the heart
of this, it is important to understand that this is a condition of
“carbohydrate and insulin intolerance” but as a person with a
diagnosis of type 2 diabetes, this in my 20 years of living with said
diagnosis, has nevere been discussed. It has always been a question
of treating the symptom of high blood sugar through medication
I have witness also in my twenty years as a diabetic that there is a
disturbing lack of knowledge about basic nutrition and the impact
of exercise amongst the overwhelming majority of healthcare
professionals. This has more recently been confirmed by research
carried out by investment bank, Credit Suisse, which revealed that
54% and 40% of nutritionists still thought that cholesterol in food
raises blood cholesterol. Other research revealed that only one
third of doctors could identify an oily fish. Most recent research
carried out by Professor Chris Oliver’s team at Edinburgh
University revealed only 14% of medical students knew the Chief
Medical Officer’s physical activity guidelines!
Now tell me, who are the NHS staff, doctors and nurses, to lecture
me on nutrition and exercise?
This is not to condemn medical staff, this is about the system,
though they must share some responsibility if they expect patients
to take their share. I have heard it said that the majority of doctors
and students want to have the relevant training and be trained in
evidence based lifestyle interventions, as they believe it will benefit
patients. But I have met some, one of my diabetes nurses as an
example, who is extremely intolerant of this approach; she argues
with me about nutrition, exercise, cholesterol, statins – just about
everything. All she wants to do is get my blood sugar levels down
with meds and insulin! That madam, is not the issue nor the best
approach. There is also much evidence of the success many patients
now have in reversing diabetes through a low carbohydrate high
fat (which doesn’t mean loads of fat – it means naturally high
in fat) approach, on which I have also made significant strides
yet my diabetes consultant got angry at me for moving from
high carbs and low fat – yet the LCHF way was clearly working.
Areas such as unhealthy lifestyles will require greater emphasis in
medical training in the near future if the doctors of tomorrow are
to be fully trained to handle and help reverse the rising toll of disease
related to sedentary lifestyles, bad diet, alcohol and smoking.
In the training of doctors and appropriate specialist nurses,
priority must be given to nutrition and exercise.
Paradigms are, of their nature, persistent and hard to change.
Major advances in science-such, for instance, as the realisation of the
concept of the quantum or the significance of evolution in
medicine-involve painful paradigm shifts which some people,
notably the unawakened, find hard to make.
From personal experience, the experience of my clients, the
experience of family members who have suffered and died at the
hands of the NHS, I feel it is time to influence a change to a new
vision for a new paradigm.
Here is but one part of my story as to why I feel so passionate about
this need for change.
By November 2014 I was aware of numerous health issues and that
they were mounting. I know my body, I have studied lots about
health and healing, but I was struggling to find a way forward and
met with an NHS wall of “doctor knows best” and “we don’t have
time to listen to all your conditions.”
Two years on, in 2018, little has changed; I have given up on the NHS
and its reductionist, silo, ways of treating signs and not the patient.
My health is improving because of my own efforts. I attend for tests,
scans, and consultations but nothing is ever concluded. Prescriptions
are offered. Waiting lists are long. My healing is down to me.
Let the conditions and events speak for themselves: -
Anxiety – where once I was very much assertive and confident, I now find it difficult to cope for lots of reasons, key amongst which are the inefficient, non communicating systems within the NHS and often the battle to have someone listen.. My body is made of inter-communicating organs, cells, muscles, mind, body and spirt yet the NHS deals with everything in a separatist, reductions way. The two simply do not match. My lifestyle is never explored, my emotions are ignored.
Arteriosclerosis – time after time I would tell of the symptoms and nothing was done. I was shrugged off with, “It’ll be your diabetes!” "It's your age."Only after a few years did one consultant dare to mention the A word. But nothing was done! Yet recent research shows there is so much that can be done; it has never been discussed by any medical professional. I turned to functional medicine and made lifestyle changes.
Chronic fatigue syndrome – told by some GPs this does not exist, symptoms just ignored
Candidiasis – penile thrush, given cream and no discussion as to whether blood glucose controls are the problem.
Breathing difficulties on walking and climbing stairs – GP argued it was my heart. I claim it is not. But no, he is right, he says. “I am your doctor!” Talk about power and control. No patient centred approach here. Twelve weeks later saw a heart specialist and within ten minutes told it was not a heart issue but a lung issue. Then had to wait a further 8 weeks to see a lung specialist.
*Depression – increasingly concerned at the chronic side-effects of anti-depressants and lack of mobility. No attempt to get to the root of the depression - often a sign with multiple morbidity. But no one would listen when I tried to explain how having multiple conditions was affecting my mental health. I advised my doctor I was ceasing all AD medication. A classic example of treating the condition (depression) and not the patient. I turned to functional medicine and made lifestyle changes, focussing hugely on nutritional medicine.
*Diabetes Type 2 – my medical team see this as being all about blood counts and calorie counting and focusing on symptoms. Yet there is growing scientific literature that states by adopting specific dietary changes one can at the very least significantly reduce the need for medications and even send type 2 diabetes into remission. I adopted this approach, paid £250 for a specialist course, and my counts started to regulate except for when I got stressed. Neither the diabetes nurse or the consultant specialist were at all interested, in fact almost derided what I had done to bring about significant change.
Dupytrens contracture– a condition in which one or more fingers become permanently bent in a flexed position. It was well treated in the Borders NHS, but in NHS Forth Valley it was deemed not a priority. I was put on a waiting list, and taken off to give priority to a nasal procedure, apparently one cannot be on two lists at the same time. I waited for over eight months. The condition worsened. I needed physical intervention so there was nothing I could do to alleviate the situation.
Erectile dysfunction – apart from my GP in Spain, most GPs in Scotland would not discuss, simply said it was a side effect of depression medication and / or diabetes medication; so for 20+ years I have been denied any possibility of a sexually active lifestyle. No connection is made between that loss and depression. It was not only ignored but one GP would screw up his face as if in pain when discussing possible treatments.
Fibromyalgia – just gets ignored, no matter how I present the symptoms. My GP never referred me for pain management for this. I was referred for pain management when I had difficulty walking but the consultant at the clinic would not entertain discussion around fibromyalgia.
Gut flora, poor – but no one seems willing to discuss the connection between our intestinal flora and how seriously it affects our health. Are GPs even trained in this? In most Scottish universities the answer is no! We need more training for doctors on nutrition.
*Heart disease – no one ever told me I had heart disease. It came up during a consultation for something else. It was in my notes. Yet, in hindsight, I had beengiving GPs plenty of evidence there was a problem – shortness of breath, pains around the chest / heart area etc. I was only told when admitted for a stent procedure.
Immune system, weakened – immune system are words never discussed even when I try to raise it yet without a healthy immune system, how can my body hope to cope with stress and dis-ease? I suspect another topic in which doctors are inadequately trained.
Integrative health care – in 2016 in Glasgow there existed the Centre for Integrative Care, run by greater Glasgow and Clyde NHS Trust. According to their website, any patient in Scotland can seek a referral through any health practitioner. Yet I asked three times of a GP and two consultant and each declined. One said she did not know what it was, so speak to your GP. GP said he didn’t know and he didn’t have time to find out about it and emphasised he took it as an insult to his competence that I should ask for a referral! How blinded he is by his own arrogance and defensiveness? A second GP said , “I cant see what good that will do” then proceeded to admit he knew nothing about what the CIC did. How can he make the former judgement without first being informed. It is blatant defensiveness of their ignorance by GPs. I complained to the NHS CEO and I got my referral and have to say , the approach by the CIC has been the most informed, holistic, enabling experience I have ever had with the NHS. Wish that the rest of the NHS was like it. They not only consider the symptom but focus very much on the patient and their lifestyle trying to get to root causes.
Mental ill health – in 2015/6 my mental health went wildly out of kilter; I was dealing with the dying and death of my younger sister to lung cancer as well as coping with my overall health going wrong. I was given anti depressants, no discussion, a simple shrug of "oh, so your sister is dying.!" The approach to MH was appalling and people wondered why I get annoyed, angry, agitated. It is because of both the attitude of staff and the inefficiency of the system, the costs to me, financial and emotional and physical,which are many, and how it affects society at large.
Nasal problems –I have had these (difficulty in breathing through the nose) for eight years (since 2008), yet only in 2015 was a I taken seriously, but had to ask for a second opinion ( the first consultant was adamant there was nothing wrong and I was making it up) , to get my worse suspicions confirmed. I waited almost a year to get surgery which was another administrative fiasco, of inefficiency, poor communication between departments and with the patient. (See 23 - complaints - below.)
Obesity, overweight – dismissed and simply told to “eat less, walk more!” No discussion as to how I have struggled with weight, when it first became an issue, what its causes are, how I had tried to self-treat. Simply, patronisingly dismissed with the “eat less, walk more” mantra. The NHS staff are SO ill-informed when it comes to weight issues and with diabetes it I well-known that insulin adds to weight gain.
Pain throughout the body – always ignored. I even take diagrams to consultations to show where the pain is, what it feels like, how it shifts and moves, and it is totally ignored other than to try yet another pain killer. Something is causing the pain; there are different types - that caused by neuropathy, some by arthritic conditions, and some, I guess, by the Fibromyalgia. But no, one pill is meant to magically dull all that. Killing the pain (which the pills really don't do) is only suppressing it and is not treating what is causing it. Telling me that pain is difficult to deal with I could accept if doctors would really listen to me and go exploring the causes.
Rheumatoid arthritis – given a cream to rub on my fingers but the condition just worsens. No talk of diet or other approaches.
Sleep apnoea – I have had sleep problems for 8 years and yet, when raised, they are always ignored, occasionally given an anti-depressant which made me feel more like a zombie and killed any joy for life. Only when I had a lung scan in 2015 was it suggested SA was a problem; that is after 8 years. Now I get CPAP treatment which is proving useful.
Stressors, poor reaction - clearly stress has been a huge feature in my health but it has never once been discussed even though I have attempted many times to introduce it into the consultation. Of course, it is not a sign that can be seen so it goes undealt with.
Medical notes - many have been the timed when I have been sent to hospital for tests. I return to my GP and s/he looks on the screen and I get a generalised whizz through of what the test result says. But often I go for a consultation on a different issue and the GP refers back to notes from the hospital and reads out crucial information hitherto not divulged. As a matter of course, patients should get the reports that go to doctors. I know there are sensitivities but in the interests of transparency, and if you want the patient to be informed and take responsibility for their own health, they must be entrusted with full information from consultations as a matter of course.
Complaints - I have found making complaints ill-advised. All you get are long defensive retorts, justifying why the NHS did what it did, failing to take account of the patient's experience, covering their back, sometimes even with untruths, their replies are adversarial, often not dealing at all with the point the patient is making and, if you are a very bad boy, they put a note on your file (in red - I saw it once when a doctor had to leave her desk and left the page open on her screen) on the front page of the first screen any medical person looking at your notes will find. On mind it says, "Please consult complaints department before dealing with this patient." Forever damned and all because the stress I was under caused me to act over-assertively in an attempt to get my needs met - and which largely still go unmet.
Is it any wonder I get stressed and react poorly to NHS neglect? As a patient I am expected
to behave properly at all times. There are threatening signs in hospitals about behaviour of
patients to staff. Well what about a few posters about staff responsibilities to patients and
how their attitudes and ways can trigger the patient response? We have become a nation of
organisational blame and controlling people’s behaviour! And we put up with it.
Yet with some of the above conditions, the side effects of the medications, and the fact that when stressed my logical rational brain processes get flooded, I cannot always act as sanely as NHS staff would like. Yet, despite them being experts in the field of medicine, they seem to totally ignore this. Their understanding of and reaction to a patient in grief and stressed, is not in my experience good or helpful.
I dislike it when I get angry, I feel guilty when I speak out of turn, I have asked for help with this and did I get it? I got, after many years asking, six weeks of psychology which proved useless because we never dealt with the issues. The psychologist just focussed on taking notes. Another, using CBT (Cognitive Behavioural Therapy) got angry with me because I had some very fixed values. She could not understand that what was dear tome I valued whilst my beliefs I could consider changing.
I looked around and worked with a number of private counsellors and therapists, made some lifestyle and nutritional change's and felt that away from the NHS, I began to heal.
As a generalisation, I know, I have little time for the NHS; it has proven itself inefficient and uncaring. And let me not get started on how it dealt with my dying sister.
Politically, we as patients have our voices squashed. All we get is senior people seeking to defend what they are doing; they pretend things are patient centred when they are anything but. They talk of integration but it is simply bringing together the two strands ,medicine and social care, not integrating a whole variety of approaches of treatment possibilities, conventional and not, that could help someone heal in an era when there are more and more mystery illnesses that the NHS quite frankly has no knowledge nor expertise to deal with. It is time for some honesty that the system is unfit for purpose.
And tinkering with it will not improve it. We need a radical new vision.
The British-American author D. H. Lawrence said, "The world fears a new experience more than it fears anything. Because a new experience displaces so many old experiences." New ideas are not a problem. The world "can pigeon-hole any idea," Lawrence said, "but it can't pigeon-hole a real new experience." A true inner experience changes us, and human beings do not like to change. Neither does the NHS.
But change is on the way, like it or not.
For medical staff it means giving up their power, really listening to the patient, and being more open to different ways of treatment. Change is coming :-
In Switzerland, health insurance plans now cover homeopathy, herbal medicine, acupuncture, holistic care and traditional Chinese medicine. They are included in Switzerland's constitutional list of paid health services.
In Brazil, the government there is approving use of Medical Marijuana, including Real Scientific Hemp Oil (RSHO) to treat epilepsy, Parkinson's disease and chronic pain. In Britain, in October 2016, the Government decreed that only GPs could prescribe cannabidoil - yet GPs are notoriously anti the product and are not trained in its use. How are they equipped to prescribe let alone discuss?
The United States, which often flaunts its health-care system as the most scientifically advanced, is way behind, like the UK, when it comes to incorporating nature's vast medicine palette. Its overuse of antibiotics, as in the UK, is creating an evolution of superbugs that are both deadly and hard to eradicate.
In the UK we are blessed with a vast array of complimentary health approaches - many of these need to be integrated into the mainstream. Only then can we say we have truly integrative medicine. And if we start dealing with causes, real causes, we will begin to integrate functional medicine. What if doctors started working with patients' natural gut microbiomes to promote diversity and strength of the good bacteria in their guts? What if we worked with each individual's natural body chemistry and microbial co-hosts so that the body could protect itself and more readily adapt to its environment?
More and more in the UK we are embracing the idea that the medical model has to be about more than symptom identification and management and that we need to explore the cause of a person's condition and nurture them to wellness and health, not just manage their condition. This approach is more commonly being called Functional Medicine and is on the increase, though not yet mainstream in the NHS.
The NHS meantime, is stuck in a costly, outdated, ineffective paradigm, in part the result of a culture that is obsessed with maximising productivity at all costs, and one that ignores the fact that we are not just disembodied minds that can do cool stuff like develop apps and software—our bodies are what make us human.
For patients, a move forward will mean we need to take more responsibility for our lifestyles, our health and well being, for what we eat and how and how often we move. We need to radically change the way we do life, how we think, what we think, what and how we eat and move, and how we honour our spirit and soul.
With healthcare systems, including big pharma, corrupt and broken and doing more harm than good, the only way is up, there's only room for improvement, a need to bring a holistic approach and a paradigm of compassionate, individualised, patient centred care back to the forefront, where the over-riding question has to be, "Is what we are doing in the best interest of the patient and the patient's time?"
It's T-Factor time, time for a change to own responsibility, and time for radical healing, individually, politically, culturally, and organisationally.
The NHS is staffed mostly with well-intentioned, highly skilled professionals, but their talents and gifts are stifled by a medical model, a system, that no longer serves. In hospitals how can we truly expect a doctor to do a 12 hour shift, and more, and be fully functional and competent. It is ironic that the way the NHS treats its own staff is a demonstration of how poorly it poorly it does not realise that it is in the business of health. How can we be asked to consult and discuss with GPs subjects in which they have no or little training and in which the patient is more likely to be better informed? Why does everything have to be filtered through your GP?
Although one might expect that the over-riding objective of any national health policy is to ensure the best possible health for the public, the reality is very different.
In practice, we have been badly let down by politicians and senior health professionals who whether by accident or design allow themselves to be manipulated by other forces and seem incapable of exerting any kind of authority to ensure that the highest standards of public health are achieved.
We desperately need a cultural mindset shift, a change in the worldview of health, in how we approach & manage chronic disease & end of life care and, too, the focus, or lack of it, we give to the creation of health. The fact that this requires gargantuan effort and radical re-thinking should be no excuse for not doing so.
I write not only as a patient with multiple medical conditions, I write too as someone who has worked within the charitable sector of the health service.
Dear Katie and Niall,
We write to you as a group of doctors, nutritionists, sports scientists and health campaigners. We ask you as a matter of urgency, to support the introduction of evidence based lifestyle education, including basic training in nutrition and the impact of physical activity on health and chronic disease into all medical curricula. This should also extend into continuing medical education (CME) for current doctors. We also believe such training would benefit other healthcare professionals, such as nurses.
The NHS is in crisis and much, if not most, of the increase in demand can be directly attributed to unhealthy lifestyles, such as poor diet, smoking, low levels of physical activity and excess alcohol. These factors now fuel the majority of global deaths and diseases, according to the Lancet (1). Taking just one example, the combined cost to the NHS and to the economy due to lost productivity of Type II diabetes, an almost entirely preventable and potentially reversible condition, is close to £20 billion and without significant action is projected to double in less than twenty years (2). The Royal College of General Practitioners’ clinical expert in diabetes Dr David Unwin, has just from simple diet advice for his pre-diabetic and type II diabetes patients saved £45,000 on diabetes medications alone, compared to the average expenditure in his clinical commissioning group (3). This extrapolated across all GP surgeries across the UK, could potentially save the NHS £423 million a year on diabetes medications. In addition there are the considerable savings from attenuating side effects through reducing the need for medication. NHS GP Dr Rangan Chatterjee also showed in his “Doctor in the House” documentary last year, that type 2 diabetes can be diagnosed and reversed within 30 days, a reversal that has proved sustainable.
But there is a lack of knowledge and understanding of the basic evidence for the impact of nutrition and physical activity on health amongst the overwhelming majority of doctors. This has its roots in the lack of early formal training.
A global survey carried out by investment bank Credit Suisse worryingly reveals a substantial level of misinformation that exists amongst doctors, with 92% believing that fat consumption could lead to cardiovascular issues. 54% of doctors and 40% of nutritionists incorrectly thought that eating cholesterol rich foods raises blood cholesterol (4).
There is a paucity of data on the extent to which basic knowledge of nutrition is taught and understood by doctors in particular. The most recent evidence comes from the USA, which shows that the majority of medical schools provide less than the recommended minimum of 25 hours of nutritional training, and less than half of all schools reported teaching any nutrition at all in the clinical years (5). Perhaps as a consequence of this, most practising doctors express self acknowledged poor understanding of nutrition, with data suggesting that 78% of physicians were willing to undergo further training and considered this would benefit patients, whilst demonstrating that over half of physicians spent less than three minutes discussing diet and lifestyle with patients. Furthermore, only a third of doctors could identify an oily fish, and under half were able to confirm that low fat diets had not been shown in randomised controlled trials to reduce the risk of cardiovascular disease(6).
This week the British Journal of Sports Medicine has published a leading editorial “Tomorrow’s Doctors Want More Teaching and Training on Physical Activity for Health” by Prof Chris Oliver and team from the Physical Activity Research Centre, University of Edinburgh. In a medical student survey In Edinburgh only 14.9% knew the recommended Chief Medical Officer Physical Activity guidelines for adults. Fewer than 10% reported that they felt adequately trained to give physical activity advice, and over 90% reported that they would like more formal training on it (7).
The documentary film co-produced by cardiologist Dr Aseem Malhotra “The Big Fat Fix”, which premieres to students and staff of Edinburgh University on Thursday October 20th hosted by Professor Chris Oliver, offers a specific prescription of lifestyle interventions, including dietary changes, the importance of regular movement, and managing stress (8). Scientific evidence reveals that these interventions are more powerful than any medication in the prevention and treatment of heart disease and come with few side effects.
Furthermore, the current model of healthcare must change. Prescribed medications in the population, which have dramatically increased in recent years, contribute to significant morbidity and mortality with estimates that up to a quarter of hospital admissions in the elderly are a result of adverse drug reactions. Furthermore, as the population ages, demands for healthcare will increase substantially if those later years are accompanied by chronic disease. A Lancet analysis found that, if rising life expectancy in the European Union means years of good health, then health expenditure caused by an ageing population, is only expected to increase by 0.7% of gross domestic product by 2060.
An over medicated population is considered such a serious concern to the nation’s health that last year the Academy of Medical Royal Colleges (which represents the views of the majority of the UK’s 220,000 doctors) launched a “Choosing Wisely” campaign; an initiative to wind back the harms of “too much medicine” (9). Shortly after this publication the medical director of NHS England, Sir Bruce Keogh, told the Telegraph newspaper that 1 in 7 operations and medical treatments in the NHS were unnecessary and should not have been carried out on patients. (10)
We commend and welcome the Secretary of State for Health, Jeremy Hunt’s ambition to reduce 30,000 premature deaths in the United Kingdom by 2020, but achieving this target and reducing demand on the healthcare system, improving quality of care and improving population health will also require a cultural shift within the medical profession to prescribing fewer drugs and deploying more lifestyle interventions. This cannot happen without equipping doctors with the necessary skills to confidently and genuinely ‘make every contact count’ as recommended by the Academy of Medical Royal Colleges’ “Measuring up” obesity report of February 2013 (11). It is also instructive to note that 50% of the NHS 1.4 million employees are also overweight or obese (12).
NHS England’s Five Year Forward View specifically talks of the pivotal importance of addressing the burden of chronic illness, and the urgent need to address public health issues that relate to preventable morbidity and mortality, and yet our health professionals are not being trained to meet this challenge. (13)
We ask you to support our calls for mandatory training for all medical students and practising doctors in evidence based nutrition education and physical activity. The future of a sustainable NHS will depend on putting lifestyle medicine at its forefront
First Aid not enough
Dr Aseem Malhotra
Calls for Change
“The present convergence of crises–
–in money, energy, education, health, water, soil, climate, politics, the environment, and more––is a birth crisis, expelling us from the old world into a new.”
While studying the history of medicine and practising for over twenty years, Dr. Victoria Sweet discovered approaches to healing that today would be considered inefficient--but put into practice, are just the opposite. One such lesson was from 12th century abbess Hildegard of Bingen, who felt that "the body is more like a plant than a machine . . . the difference being that someone has to fix a broken machine but a plant can heal itself." The trick is to allow for and encourage the veriditas or life force to work its magic--which sometimes involves removing obstacles to it, or personal attention from the doctor, which is seldom allowed today.
The Efficiency of Inefficiency
If you remain unconvinced that we need a new health paradigm, Mike Adams, Health Ranger, and Dr. Suzanne Humphries talk about CDC science fraud, vaccine safety, immunization science and other interesting topics. See particularly minutes 15.29 +