Lessons from 007

In his 1961 book, “Thunderball”, Ian Fleming’s first chapter is titled “Take It Easy, Mr. Bond. “  James Bond has been living a very unhealthy lifestyle, is run down, and just wants to treat himself with aspirin so he can keep going.  M then replies:

“That’s just where you’re making a big mistake, James.  Taking medicine only suppresses these symptoms of yours.  Medicine doesn’t get to the root of the trouble.  It only conceals it.  The result is a more highly poisoned condition which may become chronic disease.  All drugs are harmful to the system.  They are contrary to nature.  The same applies to most of the food we eat—white bread with all the roughage removed, refined sugar with all the goodness machined out of it, pasteurized milk which has had most of the vitamins boiled away, everything overcooked and denaturized…there is no way to health except the natural way.”

Wow!  That is pretty astounding stuff, right?  The American health system, by and large, still does not embrace food as medicine.    Yet, back in 1961, the author of the James Bond novels had a great grasp of how to be healthy.  Ian Fleming was not a physician, he was a writer of action novels, but he got it.  Why are we so far behind?

There was an article published last year in the Journal of the American Medical Association (JAMA) titled, “The Paradox of Disease Prevention:  Celebrated in Principle, Resisted in Practice.”  It listed twelve obstacles to prevention.  I will highlight several of them. 

1.  Success is invisible:  There is really no way to document that an individual’s prevention efforts improved his or her health, because it is rather difficult to prove that they didn’t get something based on what they did (like eating a healthy diet, not smoking, exercising, etc.)
2. Lack of Drama:  There are no TV shows about preventative medicine.  If there were, they would probably not have much of a plot line.  Instead, we love shows about the emergency department or dramatic rescues.  We need to stop getting into health messes, rather than waiting for someone to save the day.
3. Long Delays Before Rewards Appear:  Delayed gratification is not a trait that is often valued in our society.  Our expectations typically revolve around the quick fix, often involving medication or surgery rather than lifestyle change.
4. Benefits Often Do Not Accrue to the Payer:  Insurance companies have a difficult time wanting to pay for programs that will not give them short term payout.  Likewise, hospitals can’t make any money if patients are healthy and no longer need to be admitted.
5. Changing or Inconsistent Advice:  We all hear in the news about changing preventative guidelines, such as with the age when mammography screening should be started.  The public wants hard and fast rules.  There is a ton of research about the benefits of good nutrition, but the food industry and government guidelines muddy the waters.
6. Persistent Behavior Change May Be Required:  In order to really benefit, people must adhere to healthy choices day after day.
7. Double Standard in Evaluation of Prevention as Compared with Treatment:  When studies compare a new medication treatment to non-treatment, the result is judged by whether the treatment made a difference in the outcome.  Prevention is looked at differently.  Prevention must be efficacious and cost-effective, but also produce net savings in resources.  This means that prevention is judged on different merits than treatment.
8. Commercial Conflicts of Interest:  This one seems rather obvious to me.  The American medical system is an industry.  Industries exist to make money.

The author goes on to discuss possible strategies to overcome these obstacles including:  paying for prevention, making prevention cheaper than free, involving employers, trying to reengineer ways to reduce need for individual action, using policy to make the right choices easier, and using the media to help reeducate the public.  I agree with these in principle, but I currently don’t have a lot of faith that our leaders will ever agree on enough points to make meaningful public health policy changes.

So, it is likely going to come down to people (like you) making informed decisions for their own health and wellness.  This is unlikely to ever be resolved from the top down.  If you are reading this on my website then you are likely already well on your way to thinking in a preventative manner.  Spread the word!  Share articles with friends.  Share recipes and insight.  Form health communities.  You know that there is value in prevention.  If you are making good choices, you will benefit.  This is not rocket science:  an author in 1961 knew that nutrition matters, I know it and base my practice on it, and you know it too.  Let’s apply what we know.  Poor nutrition drives chronic disease.  There is no reason to wait for the wonder drug to be developed.  You can prevent disease with the choices you make each day.  Health begins with your fork.