HEALTH: A doctor's Rx: Don't smoke, don't drink and drive, be lucky

A doctor's Rx: Don't smoke, don't drink and drive, be lucky

Bill McClellan
ST. LOUIS POST-DISPATCH

I had dinner with a doctor not long ago and the subject of health care came up. "People are missing the point," he said. "The problem isn't about getting more health care to more people. The problem is too much health care."

Too much health care?

"Yes," he said, "You want to be healthy? Good luck."

Good luck?

"Yes, it's mostly luck. Genetics. The best advice I can give a patient is, 'Don't smoke and don't drink and drive.' Other than that, the secret to a long life is being lucky."

He went on to say that a person ought to eat well and get exercise, but those things can only do so much. Doctors can do very little. We're overrated, he said. GET MORE
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It's natural to get sick sometimes, he said. Almost always, you're going to get better, and that's with or without a doctor. There are only a few instances in which you won't naturally recover, and in many of those instances, a doctor can't help you anyway, he said.

I can tell you that no doctor would go to a doctor's office for the flu, he said. Stay home. You'll recover, he said.

But thousands of people die from the flu every year, I said.

Of course, people die from illnesses, he said. That's nature. That has nothing to do with health care. Frankly, many of the people who die from illnesses die in hospitals, he said. Dangerous places, those hospitals, he said.

It is his contention that we have made them dangerous places by providing too much health care. Somebody gets a bug and goes to the doctor and the doctor prescribes antibiotics. If you don't take anything, maybe you get better in four days. If you take the antibiotics, maybe you get better in two days. But these two days come with a very high price.

We overuse antibiotics and pretty soon the bug develops an immunity to the drugs. These superbugs are a real problem, the doctor said, and not surprisingly, they're often found in hospitals.

We also overtest, he said. That drives health care costs way up.

Oh sure. Defense medicine. That's because of the lawyers. Fear of lawsuits, right?

That plays a very small part in this, he said. I'm not trying to stand up for lawyers, he said, but the overtesting is almost a conspiracy between the patients and the doctors.

He told me about a woman who brought her teenage daughter to see him about a problem. "She needs an MRI," the mother said. The doctor said he thought an MRI was unnecessary, and told that to the mother. "I had the very same symptoms last year, and I had an MRI," the mother said.

"And what did it show?" the doctor asked. "Nothing," said the mother. But still, she was insistent about the MRI. "So I ordered an MRI," the doctor told me.

Why not? Patients expect tests. They want tests. They see doctors as gatekeepers. If your doctor won't open the gate, then you should find one who will. That's the theory. And the doctors? Hey, more tests mean more money. More procedures mean more money.

"Take two aspirin and go to bed," might be the best advice, but you can't pay the overhead if you give that advice too often.

We spend by far the most money on health care and we are no healthier than people in other industrialized countries, the doctor said. There is no correlation between money spent and longevity, he said.

He told me about two recent reports — one in this country and the other in Europe — that indicated screening for prostate cancer is ineffective. That is, there was no reduction in deaths from prostate cancer between men who had been screened and men who had not been screened. In fact, screening would seem to be less than neutral since screening results in thousands of men undergoing unnecessary treatment.

(I later looked up news accounts of the studies. An interesting sidelight was this — most men over 50 in this country are tested for prostate cancer and most men in Europe are not. "The mentality of Europeans is different," said the lead author of the European study.)

I should add that my friend was not dismissing all tests. Of course, he acknowledged, there are certain thing medicine can do, and there are times when doctors can help.

He specifically mentioned mammograms and colonoscopies as being effective in detecting cancers early, when they are most treatable. And most men over 50 should probably be taking something for cholesterol, he said.

Other than that, don't smoke, don't drink and drive and try to stay away from hospitals and doctors' offices. Too many sick people in those places, the doctor said. Too much chance of catching something.