Monotherapy vs. Program Therapy
*Disclaimer - This was written during the middle of the COVID-19 Pandemic, but the ideas still apply as we approach cold and flu season.
The last 100 years have seen the discoveries of amazing cures to diseases that have attacked our bodies throughout the centuries. Most of us are aware that vaccines have saved us from numerous diseases that caused great suffering for our ancestors. One of the most famous vaccines is the polio vaccine developed by Jonas Salk in 1955. Now, most of us have never even met someone who suffered from polio. This is an example of monotherapy. One shot and you are no longer at risk for that disease. Another monotherapy is antibiotics. If our ancestors suffered a bacterial infection, there was no resistance besides our body's immune response. If the bacteria overwhelmed our immune response, death followed. In 1928, Alexander Fleming discovered penicillin and the course of medical history was changed. Countless lives have been saved by the discovery of penicillin and many other antibiotics. Now we have become accustomed to waiting for a pill or a shot to cure all our diseases. We hope for a pill to not just manage type 2 diabetes but to cure it. We want a pill to safely alter our metabolism to cure our obesity. We want something to not just decrease the inflammation of arthritis but to cure it. We need a cure for cancer, for dementia, and any other disease which could affect us or our loved ones. When we are young, we think the cure may arrive long before we are old enough to get the disease. I remember as a teenager being confident that male pattern baldness would be cured long before my hair started thinning. Even today, when I perform a total knee replacement I think to myself that we need to come up with something better. On the one hand, this surgery is already a tremendous advancement in orthopedic medicine that replaces a worn out joint and restores quality of life. On the other hand, we are cutting out the joint and replacing it with metals, alloys, and plastic. It is a big improvement for a joint with bone on bone arthritis, but it is not the joint you grew up with. Gel (artificial joint fluid) injections help some people temporarily, but I often wonder, “why can’t someone invent some kind of sterile marshmallow that works forever and in every joint?”. We are all waiting for a cure. We wear pink to support breast cancer. We go to events to raise awareness for dementia. We run the 5k for heart disease. Scientists are working everyday and everyday we are closer to another cure. When I was a medical student HIV was a death sentence. Every medical student assessed their own risk when choosing a field. Needle sticks and surgical injuries could mean a prolonged illness and a death at too young an age. Universal precautions were emphasized to treat every patient like they may be infected. Now we consider HIV highly treatable and even cured in many cases. It is really an amazing advancement.
As a society we have become accustomed to finding a cure. We are even confident that the cure to our future ailment will be found. We just hope it is not too late to save us or our loved ones. The truth is that we already have the cures to dramatically cut down the number of cases of most common diseases. We have a cure for 80% of the cases of heart disease, Type 2 diabetes, and stroke. We have a cure for 40% of cancers. However, the cure is not a pill or a shot or even a surgery. It is not a monotherapy. It is not one thing. It is a program therapy and that program is simple. Stay away from tobacco, eat a healthy diet, and exercise. Do this and your odds of staying healthy and living a drastically healthier life are greatly improved. You will also save tons of money on your own personal health care. If we as a country do this we can drastically reduce the health care spending on preventable diseases. This means more resources can be spent on the truly unlucky and the “black swans”. The only way we as a group or an individual will be successful is if we change our habits.
“We are what we repeatedly do. Excellence, then, is not an act, but a habit.”
-Aristotle
Our habits are killing way too many of us prematurely. We are taken down by middle age while we watch healthier individuals continue to remain active. We are too sick to enjoy the retirement we dreamed of. We end up in a nursing home so we are not a burden on our families. It happens slowly so in many ways it sneaks up on us. Just enough people are lucky and avoid chronic but preventable diseases that we hope we fall into the lucky group instead of taking action to avoid our unhealthy habits. We start the day pouring so much sugary creamer into our coffee that we turn it into a dessert. We eat processed carbs with more refined sugar in the form of bagels, donuts, cereals, toast, and pancakes for breakfast . We can’t avoid the sugary treats at the office or the fast foods and carry out foods at lunch. We snack on chips and candy. Even when we exercise we have become convinced we need a sugary sports drink to recover. Every social event and celebration is filled with more junk food. We have become surrounded by so much temptation to destroy our health and continue bad habits that improvements can often be an uphill battle. Can we even do it?
The answer is yes. There are examples everywhere. People eat healthy and exercise daily proving it can be done, but it would certainly be nice to have some help along the way. There is no better time than now to get started. As I write this, we are in the middle of the 2020 global Covid-19 pandemic. No one seems to know if we are at the end, the middle, or just the end of the beginning. There is a heated debate about our goals. Are we trying to flatten the curve so we have enough hospital beds at all times, or are we trying to prevent people from getting the disease entirely? Are more people going to die from the viral infection or from the problems that may come from a pending economic depression related to the government shut downs? What you believe tends to follow who you read or listen to. We know predictions have been wrong. The models have missed the targets. Politicians blame each other. Many of us are waiting for the cure, the vaccine, the monotherapy. There is one thing the data shows for sure though. Very few people have been admitted to the hospitals who were metabolically healthy, normal weight, and without risk factors. 94% of the deaths are in those with underlying chronic disease related to excess body weight.
“Covid 19 has pulled back the curtain on how unhealthy we are as a nation. The major driver in our poor health, which increases the risk of hospitalization and a death from Covid-19 is the nation's diet- rich in starch, sugar, and processed foods and low in unprocessed food, vegetables, fruits, whole grains, beans, good fats, seafood, nuts, and seeds.”
-Mark Hyman
How is the virus and our diet linked? Our diets are causing obesity and chronic disease which result in increased inflammation and immune suppression to viral illness. Once we are infected many of us no longer have the immune response capable of fighting the infection. Our bodies are already at a high level of inflammation and the virus takes it even higher. Our lungs are overwhelmed despite the best efforts of doctors and nurses and we become another statistic. Our elderly, especially those living in nursing homes, are our highest risk group. The sad truth is many of these people would have never been infected if they were living independently at home.
Our politicians, journalists, and talking heads argue about who is to blame. They argue for more testing, but a test will not save you. They argue for more ventilators and more protective gear. These are real issues and we can be proud of all the people and corporations who responded by creating more hospital beds, more ventilators, and more protective gear rapidly but the true body armor in the fight against Covid-19 is our own metabolic health. Only the unlucky and the “Black Swans” are dying without preventable risk factors. For most of us the cure for Covid-19 is right in front of us. It is not a monotherapy; it is a program therapy. The same program that eliminates most chronic diseases will cure this virus. The program is no tobacco, eat plants, lean meats and nuts, drink water, and exercise.
We have proven we are willing to take action to save lives. We have completely shut down all non-essential businesses. Other businesses quickly transitioned to making the equipment we need to fight the disease. Our politicians have passed a huge stimulus to pay furloughed workers and help businesses pay their payrolls even when they can no longer be open. We wear masks in public and avoid seeing our friends and family members. Our children are missing school, sports, graduations, and normal social events when their risk of becoming sick is close to zero. When and if this passes will we just go back to normal? Shouldn’t we change our habits so we greatly reduce our risk of dying from not only Covid-19 but the regular flu that comes every year and the preventable diseases that take all too many of us? 647,000 people a year die from heart disease.147,000 from stroke, 606,000 from cancer. Changing our habits would drastically reduce these numbers as well as help protect us from future pandemics.
“Knowledge is Power”
-Schoolhouse Rock
The first step is we need education. Everyone needs to understand the difference between preventable diseases related to our lifestyle and non preventable diseases. We spend time learning the basics of science throughout our education. It may be even more important to teach how our nutrition and lack of exercise relate to preventable diseases than anything else we are taught in science class. This will need government support to be done in our public school system. The legwork to add this to the curriculum is easy. Courage will be required to stand up to the special interest who will lobby on behalf of the processed food industry. People before profit. I am certainly not trying to put any company out of business. If we educate our population to make better food choices the companies will offer better food choices. Once schools educate our children it will be much easier for doctors to educate their patients. Patients will understand that many chronic diseases can be prevented by their efforts.
Transferring government subsidies from producers who make processed refined foods to producers of fruits and vegetables needs to be a bipartisan effort. Politicians who support the producers of food toxins need to be published. They know they can not tell the people they are fat and unhealthy and win votes so they need support in trying to make healthy options more affordable. Politicians need to crave the accolades they receive from being supportive of healthy lifestyles. We also have areas where healthy food is not even an option. Our urban population frequently relies on cheap highly processed foods to survive. There are no grocery stores around for miles. The poor do not have cars to travel to the suburbs. It will require government spending to make these foods available. I have always been someone who wanted to limit all government spending but I would rather spend money making healthy food choices available now than spending more on medicare and medicaid down the road. Didn’t we just spend billions of dollars on a huge financial stimulus package because too many people were at risk for dying from Covid-19? Make healthy food cheap and available and we will save money in the long run. Change Habits, Change lives. Get with the Program.