David L. Katz, MD, MPH

Us and Now

In the face of any pressing need, those so confronted may feel intimidated or overwhelmed.  But we are all invited to examine the options imposed by such urgency, and ask ourselves: if not us, whom?  If not now, when?  Dealing with crises is never easy - but ignoring them is never right.

This is a time of crisis for health on many fronts.  A projection made by the CDC some years ago that as many as one in three Americans would by diabetic by mid-century has thus far been fully substantiated by the ominous year-to-year trends.  The obesity numbers may have plateaued, but rates of severe obesity are rising steeply.  We may no longer be able to gauge progression of the obesity epidemic by asking how many are obese; we may need to start asking: How obese are the many?  The answer, increasingly, is severely so.

Mortality rates from cardiovascular disease, stroke, and cancer have been declining for some time.  But this is more thanks to advances in treatment than the avoidance of such conditions and their risk factors altogether.  And as we dodge certain bullets, we wind up right in the paths of others.  Projections regarding Alzheimer's rates in an aging population are quite staggering.

Compounding the burdens of rampant chronic disease are the dual challenges of cost, and distrust.  We have "medical" responses to much of what ails us, but these come with a very high price tag, and the inevitable risk of side effects and complications - which in turn push the costs higher still.  A recent report highlights the frequency of unintended harms resulting from the treatment of illness and injury in the Medicare population.

Distrust of the medical establishment is a product of many currents in modern society, among them universal access to on-line information (much of it wrong); the rapid conversion of almost every scientific study into hyperbolic headlines; erosion of the doctor-patient relationship; a general disregard for "expertise"; and a veneration of nature at a time when its virtues seem to be receding from us.  A tendency to over-medicalize, as in the case of behavioral problems among young children, exacerbates these themes.