President's Desk, October 2014
David L. Katz, MD, MPH
We Know Enough; We Do Too Little
In my prior column here, I made the case that lifestyle medicine can be an utterly transformative force; but only if we do enough. Studies of what lifestyle medicine CAN’T do, based on assessments of too little, too late, are not meaningful.
I am writing this on the eve of our annual meeting in San Diego, and suspect you will see it afterwards. That timing is good to revisit the theme of enough. This time, I want to make the case that we know enough- but must do a far better job of using what we know.
At conferences around the country, in print, on air, and in cyberspace, I routinely encounter- as you, no doubt, do- seemingly endless theories and epiphanies about health promotion and disease prevention, competing with endless, alternative theories and epiphanies. There are authors of books about health (and diet in particular) that refute everything in all the other books that in turn refute everything in that one. There are claims, counter-claims, and contentions about this food and that; this nutrient and that; this supplement and that.
Believe it or not, when the parsing and peddling, back-pedaling and back-stabbing are all done – it’s a fact established and reaffirmed over a span of decades that we know enough(1-4)! What we know about health promotion, disease prevention, sustainable weight control, and lifestyle as medicineIS ENOUGH to prevent 80% of all chronic disease and premature death. We already know enough, and have known enough for literal decades, to add years to life routinely; and add life to those years.
No one refutes this; the evidence is too strong, too consistent, too often replicated. The iconoclasts don’t refute it. The renegade geniuses don’t refute it. Those with competing theories to sell don’t refute it.
They simply ignore it, and pretend that the focus should be on what we don’t know; what can be made (to seem, at least) controversial. They ignore it, and pass on to the one particular thing they want you to believe, buy, or berate.
They ignore it.
Let’s not ignore it. Please don’t let anyone else ignore it. Please don’t look on passively at a culture fiddling while Rome burns. And please, don’t add your own fiddle to that orchestra.
This isn’t a column; it’s a campaign. I am calling it the let’s #UseWhatWeKnow campaign. I am asking you to share, tweet, pin, and email that moniker- and help me agitate a movement.
Imagine letting a building burn to the ground while debating the best particular kind of fire hose (e.g., length; caliber; materials; etc.); the best kind of water (e.g., soft; hard; etc.); and the best way to handle and direct the spray. Imagine, far worse, that there are people in the building while the debate rages along with the fire. Imagine our collective horror at discovering that the bickering and parsing lasted until there was nothing but ash and body bags.
This, folks, is our culture. We are bickering over what may even be legitimately debatable at times, but doing so while failing to use all that we already know- and letting preventable chronic diseases reduce lives to ash and cinder. It is a tragedy; it is a travesty. We could put an end to it any time we decide to #UseWhatWeKnow.
Admittedly, if we #UseWhatWeKnow, we could only save about 80% of such buildings. We could only save 8 out of every 10 people in such buildings. But right now, the hyperbolic claims compete for our attention as the flames take them all.
Let the parsing continue, for that competition is healthy if it helps us do something about the residual 20% of all chronic disease we don’t already know how to prevent. But let us not squander what we do know while working to learn what we don’t. Let us not subordinate the tried and true to the new and titillating. Let us not ignore what we know and count the cost in years lost from life, life lost from years. Let us recall that we all have skin in this game- our own, and that of the people we love. The next time one of these metaphorical buildings catches fire, one of us, or one of them, could well be in it.
Knowing more is always good. But we know enough to do an astonishing amount of good; good we would all see and feel.
Please help spread the word. Please help put out the fires. Please- let’s #UseWhatWeKnow.