President's Desk, June 2014
David L. Katz, MD, MPH

Us and Now



In the face of any pressing need, those so confronted may feel intimidated or overwhelmed. But we are all invited to examine the options imposed by such urgency, and ask ourselves: if not us, whom? If not now, when? Dealing with crises is never easy—but ignoring them is never right.

This is a time of crisis for health on many fronts. A projection made by the CDC some years ago that as many as one in three Americans would by diabetic by mid-century has thus far been fully substantiated by the ominous year-to-year trends. The obesity numbers may have plateaued, but rates of severe obesity are rising steeply. We may no longer be able to gauge progression of the obesity epidemic by asking how many are obese; we may need to start asking: How obese are the many? The answer, increasingly, is severely so.

Mortality rates from cardiovascular disease, stroke, and cancer have been declining for some time. But this is more thanks to advances in treatment than the avoidance of such conditions and their risk factors altogether. And as we dodge certain bullets, we wind up right in the paths of others. Projections regarding Alzheimer’s rates in an aging population are quite staggering.

Compounding the burdens of rampant chronic disease are the dual challenges of cost, and distrust. We have “medical” responses to much of what ails us, but these come with a very high price tag, and the inevitable risk of side effects and complications—which in turn push the costs higher still. A recent reporthighlights the frequency of unintended harms resulting from the treatment of illness and injury in the Medicare population.

Distrust of the medical establishment is a product of many currents in modern society, among them universal access to on-line information (much of it wrong); the rapid conversion of almost every scientific study into hyperbolic headlines; erosion of the doctor-patient relationship; a general disregard for “expertise”; and a veneration of nature at a time when its virtues seem to be receding from us. A tendency to over-medicalize, as in the case of behavioral problems among young children, exacerbates these themes.

The consequences of such distrust include increasing reliance on disreputable sources of information, and the increasingly frequent rejection of time-honored practices. Neglect of vaccines has brought measles outbreaks at rates not seen in decades. In the area of chronic disease, nearly daily reversals in dietary guidance for health promotion and weight loss, and an endless parade of competing fad diet claims, is associated with widespread failure to use the reliable information long at our disposal.

Without question, the time to confront such challenges as these is now. And since lifestyle as medicine is the best response to them, the burden—and the opportunity—fall particularly to us. We cannot allow one in three of our children to become diabetic. The answer to that and related crises is: us and now.

But in this as in all things, the conversion from passion to pragmatism and progress requires resources. And there, our news is all good.

In the very short interval since I took over the Presidency, we have engaged Susan Benigas as our Executive Director. I will say less than I should about Susan’s extraordinary energy, efficiency, insight, and devotion only to avoid embarrassing her. She is a force of nature, and an exceptional asset for ACLM.

Our remarkable growth and success over the past year—to the credit of those running the show before I came along—has made us an ever more important ally to larger, more established organizations such as the American College of Preventive Medicine. We are currently exploring in detail how each of these organizations may best support the other.

Finally, we have new sources of financial support, details to follow. For now, suffice to say that ACLM has supporters who believe in our flight plan, with the means to put the wind beneath our wings.

We are young, but we represent the future of both sustainable health and healthcare. We are not the only ones to recognize that we are the right answer to many of the vexing questions of modern medicine—and the resources are pouring in accordingly. Us and now should be the answers; and every day we have new reasons to believe they will be.