Steven Blair on “magic bullets” vs. lifestyle change

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The U.S. government plans to spend $1 billion on a new NIH centre on “Advancing Translation Sciences.” Great news, right? Not according to James Hebert and Steven Blair of USC, who have a new commentary just posted online at the British Journal of Sports Medicine:

This plan typifies the search for a ‘magic bullet’, in pill form, that will cure all diseases and health problems…

[L]arge drug companies have spent ~US$400 billion on drug research over the past 15 years. We should examine the effectiveness of this huge expenditure in terms of public health benefits… What happens in a society in which people are told that pills are available to put them to sleep, wake them up, stimulate them, calm them down and control appetite and body weight? We argue that the answer is in the growing number of people with mental disorders including depression and anxiety, sleep disorders, deteriorating nutritional status and increasing rates of obesity unprecedented in human history. The pills that have been developed, advertised on television and demanded by a desperate populace have been spectacular in their inability to address the major and growing public health problems of the USA.

Instead, Hebert and Blair want to see more emphasis on lifestyle change. They cite some interesting data from studies comparing lifestyle and pharmaceutical interventions. For example, a study found that just three or four sessions with a dietician produced the same reduction in total and LDL cholesterol as taking statins. And two randomized trials found that “lifestyle interventions” were twice as effective as drugs in preventing high-risk individuals from developing diabetes. The authors are “puzzled and concerned” that results like these haven’t received more publicity and follow-up.

So what’s the solution? They suggest an NIH “National Institute for Improving Healthy Lifestyles” instead of the translational medicine institute. Would this make a difference? It seems to me that if we knew how to get people to change their lifestyles, we’d already be doing it. But perhaps they’re right: with enough resources — and $1 billion would be a pretty good start! — maybe lifestyle change wouldn’t look quite so daunting.

We understand that while changes in diet and physical activity are conceptually easy, they are diabolically difficult to do in practice. The promise of even easier solutions to cure the consequences of years of sloth needs to be debunked.

That, I think, is the key point. We need to stop promising that getting healthy will be easy, and emphasize instead that it’s worthwhile. To borrow a thought from physics, it’s like that Einstein quote: “Everything should be made as simple as possible, but not simpler.”