Taking Responsibility for Our Health


Many of you have written to me stressing the importance of maximizing one’s health by engaging in appropriate lifestyle behaviors. I agree that this is a vitally important theme, and thus offer the following excerpt from The Myths of Modern Medicine for your consideration:

“I’m Just the Patient; I’m Not Part of the Problem”

Sarah Matthews had always struggled with her weight. Her life was a series of disappointing attempts to control her insatiable appetite. It came at a hefty price—to her self-esteem, her relationships, and ultimately to her health.

Though her physician had long counseled her to lose weight and begin to exercise, Sarah continued her habit of consuming more than four thousand calories a day. Her weight at age forty-two had swelled to more than 280 pounds, and her joints were showing the wear of carrying such a big burden.

But it was more than Sarah’s joints that were beginning to fail. Her annual physical revealed that she was perilously close to becoming a full-blown diabetic. Her blood pressure hovered at 160/100, which is very high, and the slightest exertion made her short of breath. At this pace, Sarah’s life would be dramatically shortened. As a diabetic, she would run the risk of blindness, loss of limbs, and eventually death. If her blood pressure remained high, coronary-artery disease would naturally follow—potentially precipitating a stroke or heart attack. Furthermore, recently published research suggested that the earlier one becomes obese, the greater the probability of developing atherosclerosis.

This time, her physician was unflinching in his strongly worded advice: “Lose the weight now. There are no more tomorrows.” Sarah broke down in tears. It was not a lack of desire to lose weight; she simply didn’t know how to win the battle against her lifelong demon. Fortunately, her physician had a dedicated nurse educator, who not only started Sarah on the path to recovery but enlisted the help of a counselor, a nutritionist, and an exercise coach.

Frightened by the prospect of a grim future, Sarah became compliant. Though it took more than a year, she successfully shed just shy of one hundred pounds through daily diet and exercise. Her lab values responded in tandem with her changes in lifestyle. After eighteen long, difficult months, Sarah was able to stop taking her medications. What appeared to be the beginning of a lifelong path of advancing chronic illness had been stopped in its tracks.

Taking Personal Responsibility for Our Behavior

The message emblazoned in every chapter of this book has been that our health-care system has gross deficiencies that can seriously affect your care. Numerous strategies have been outlined about how to increase the probability of receiving the “right” care for you and your family. Yet the best strategy of all is to simply not need care in the first place.

That means taking exquisitely good care of ourselves—a lesson that Sarah is learning late in life. Sarah was not merely the patient. She was also the problem. It was her eating behavior—not some random disease or virus—that was causing her to develop debilitating, chronic conditions. Had she maintained her current trajectory, these conditions could have robbed her of joy, health, and ultimately her life. In the process, Sarah would have required an increasing onslaught of medications and other interventions, all of which would have brought their own associated risks and contributed to feeding the national health-care bill.

Granted, not all of us seem to suffer the ill effects of an unhealthy lifestyle. Some people get away with murder when it comes to their bodies. My mother was such a person. Finding the best restaurants and bakeries was a lifelong passion for her, though she somehow stayed slim. Her idea of strenuous exercise was a full day of shopping. Her habits finally caught up with her at the age of sixty-five, though, when her severely blocked arteries necessitated quadruple-bypass surgery. Having her chest brutally cracked open slowed her down for a short time, but before long she was back to her diet of candy, cookies, fried chicken, and steaks.

My mother’s diet contributed to her development of cardiovascular disease (including a heart attack), transient-ischemic events (TIAs—or “mini-strokes”), and insulin-dependent diabetes. Despite her multiple comorbidities, she lived another twenty-two years and seemed to enjoy almost every minute.

There are always exceptions, but poor lifestyle choices eventually catch up with most of us, taking a major toll on our health and well-being. Whether it is smoking, overindulging in food or alcohol, or foolishly taking chances with drugs, promiscuous sexual behavior, or the need for speed when behind the wheel of an automobile, our choices often determine our fates.

Proof can be found in the data collected by the Centers for Disease Control, who keep close tabs on our nation’s health. The CDC’s website contains some startling illustrations of the impact of lifestyle choices on the health of the population:

  • Seven out of ten deaths among Americans each year are from chronic diseases. Heart disease, cancer, and stroke account for more than 50 percent of all deaths each year.
  • In 2005, 133 million Americans—almost one out of every two adults—had at least one chronic illness.
  • Obesity has become a major health concern. One in every three adults is obese, and almost one in five youths between the ages of six and nineteen is obese.
  • Diabetes continues to be the leading cause of kidney failure, nontraumatic lower-extremity amputations, and blindness among adults age twenty to seventy-four.
  • Excessive alcohol consumption is the third leading preventable cause of death in the United States behind diet, physical activity, and tobacco.[i]

The bottom line is that we are a chronically ill nation and our illnesses are not merely debilitating but also costly—resulting in hundreds of billions of dollars spent unnecessarily on health-care expenditures every year. And the situation is deteriorating!

It doesn’t have to be this way. We have the power to change our nation’s prognosis. Many of the chronic diseases we experience are either preventable or can be delayed until the latter stages of our life. This simple yet profound message was preached for more than thirty years by Dr. James Fries. The question is, Do we have the will to change?

Compression of Morbidity: A Fancy Term for a Simple Goal

The July 17, 1980, issue of the New England Journal of Medicine featured a landmark article by Jim Fries, MD, professor of medicine at Stanford University. The article became one of the most frequently cited scientific references in the emerging field of wellness. Fries focused on the impact of chronic disease, which he described as “responsible for more than 80 percent of all deaths and for an even higher fraction of cases of total disability. Arteriosclerosis (including coronary-artery disease and stroke), arthritis, adult-onset diabetes, chronic obstructive-pulmonary disease (including emphysema), cancer, and cirrhosis represent the overwhelming majority of our health problems. They are widespread conditions that originate in early life and develop insidiously; the probability of their occurrence increases with age.”[ii]

Fries’s contribution did not lie in describing the inescapable spiral of chronic disease into disability and death. Rather, it was his challenging theory of the “compression of morbidity” that suggested the progression of disease and infirmity could be forestalled. “Disability and lowered quality of life due to the most prevalent chronic diseases are thus inescapably linked with eventual mortality,” he wrote. “These chronic diseases are approached most effectively with a strategy of ‘postponement’ rather than cure. If the rate of progression is decreased, then the date of passage through the clinical threshold is postponed; if sufficiently postponed, the symptomatic threshold may not be crossed during a lifetime, and the disease is ‘prevented.’”[iii]

Fries is stating that, while we cannot escape the human condition, by taking care of ourselves we can stay vital, active, and healthy until the very twilight of our lives. In Fries’s mind, that would be living the good life. He even went so far as to point to behavior changes that would compress morbidity, saying that “some chronic illnesses definitely can be postponed; elimination of cigarette smoking greatly delays the date of onset of symptoms of emphysema and reduces the probability of lung cancer. Treatment of hypertension retards development of certain complications in the arteries. In other illnesses, circumstantial evidence of similar effects of postponement is strong, but proof is difficult: that arteriosclerosis is retarded by weight reduction or exercise is suggested by associative data but has not yet been proven.”[iv]

I was fortunate enough to meet Jim Fries when he was part of a panel assembled by my mentor, Martin Seligman, at the University of Pennsylvania. Seligman, who was working under a Robert Wood Johnson Foundation grant, had assembled some of the brightest minds in preventative medicine to define the emerging field of positive health, including Dr. Fries. Fries obviously lives by the tenets he preaches, for he appeared to be in great physical condition.

In the intervening three-plus decades since Fries published this article, our knowledge on wellness and prevention has expanded greatly. Thousands of researchers have built on Fries’s foundational research, and the accumulated knowledge provides us with powerful but disheartening information on the degree to which our population is managing their lifestyle behaviors to affect wellness:

  • More than one-third of all adults do not meet recommendations for aerobic physical activity based on the 2008 Physical Activity Guidelines for Americans, and 23 percent report no leisure-time physical activity at all in the preceding month.
  • More than forty-three million American adults smoke. Lung cancer is the leading cause of cancer death, and cigarette smoking causes almost all cases.
  • Excessive alcohol consumption contributes to over fifty-four different diseases and injuries.[v]

If you are wondering how that compares to other people in other nations, “in terms of individual behaviors, Americans are less likely to smoke and may drink less heavily than their counterparts in peer countries, but they consume the most calories per capita, abuse more prescription and illicit drugs, are less likely to fasten seatbelts, have more traffic accidents involving alcohol, and own more firearms than their peers in other countries.”[vi] As we saw in the opening chapter of this book, our nation pays dearly for its behavior as evidenced by our poor population health status relative to every other industrialized nations.

Regardless of one’s nationality, the trick is not in knowing merely what to modify but how to modify our behaviors so that we live longer, happier, healthier lives.


If you would like to learn more, please consider reading: The Myths of Modern Medicine: The Alarming Truth About American Health Care, John Leifer, 2014 (Rowman & Littlefield).



[i] Centers for Disease Control and Prevention, “Chronic Diseases and Health Promotion,” last modified August 13, 2012,http://www.cdc.gov/chronicdisease/overview/index.htm.


[ii] James F. Fries, “Aging, Natural Death, and the Compression of Morbidity,” New England Journal of Medicine 303 (July 7,1980):doi:10.1056/NEJM198007173030304.


[iii] Ibid., 248.


[iv] Ibid.


[v] Centers for Disease Control and Prevention, “Chronic Diseases and Health Promotion.”


[vi] Institute of Medicine of the National Academies, U.S. Health in International Perspective: Shorter Lives, Poorer Health (Washington, D.C.: National Academies Press, 2012),


A Panacea for the Ills of Health Care

iStock_000026356944LargeWhat if I told you that there was a panacea to our nation’s health care crisis? Would you burst into laughter, stop reading, or simply conclude that I could not possibly understand the complexity of issues underlying our health system’s dysfunction?  After all, everyone knows that there are no silver bullets in real life.

Yet, that’s exactly what I am going to propose – there is a panacea, we are simply choosing not embrace it. Before describing the cure, let’s define the illness.

In the most basic of terms, the U.S. spends far more than any other nation on health care services, yet “enjoys” some of the worst health outcomes. We live shorter lives, have ridiculously high rates of infant mortality, and succumb to a plethora of chronic, yet preventable diseases. Here are a few, quick stats:

“In 2005, nearly half of all adults – 133 million – had at least one chronic illness. In 2009-2010, more than one third (35.7%) of U.S. adults were obese, and 8.3% had diabetes. In 2005-2008, over 30 percent had high blood pressure.”

“Health care spending represented 17.9% of our gross domestic product (GDP) in 2010, and is expected to reach 20 percent by 2020. Three quarters of these costs go to treat chronic diseases, which in many cases are preventable.”

“According to the IOM’s 2012 report…an estimated 80 percent of cases of heart disease and of type-2 diabetes, and 40 percent of cases of cancer, could be prevented by implementing public health interventions that increase physical activity and healthy eating and help reduce tobacco-use and excessive alcohol use.”

We Stand to Save as much as $1.1 trillion annually:

According to a research published by the American Public Health Association, “By investing in prevention and treatment of the most common chronic diseases, the U.S. could decrease treatment costs by $218 billion per year and reduce the economic impact of disease by $1.1 trillion annually.”

Jim Fries’ Contribution:

These are not stunning, new revelations. The July 17, 1980, issue of the New England Journal of Medicine featured a landmark article by Jim Fries, a professor of medicine at Stanford University. The article became one of the most frequently cited scientific references in the emerging field of wellness. Fries focused on the impact of chronic disease, which he described as follows: “Chronic illness now is responsible for more than 80 percent of all deaths and for an even higher fraction of cases of total disability.”

The power of Fries’ article, however, lies in his conclusion: “Disability and lowered quality of life due to the most prevalent chronic diseases are thus inescapably linked with eventual mortality. These chronic diseases are approached most effectively with a strategy of “postponement” rather than cure. If the rate of progression is decreased, then the date of passage through the clinical threshold is postponed; if sufficiently postponed, the symptomatic threshold may not be crossed during a lifetime, and the disease is “prevented.

Fries is stating that, while we cannot escape the human condition, by taking care of ourselves, we can stay vital, active, and healthy until the very twilight of our life. We can “compress morbidity” – thus reducing the disease burden, costs, and impact on our quality of life.

A Pittance of an Investment in Wellness:

So what level of investment are we making in prevention/wellness? “In 2009, U.S. public health pending amounted to $76.2 billion – only 3.1 percent of the nation’s overall healthcare expenditures of $2.5 trillion.” Granted, the Affordable Care Act (ACA) provides additional funding for prevention/public health initiatives– but a few more billion dollars, though significant, pales by comparison to our burgeoning health care tab that now exceeds $2.8 trillion.

Perhaps even more significantly, ACA may have stifled many embryonic efforts by providers to implement more robust wellness offerings. Like deer in headlights, most providers are responding to ACA by trying to eviscerate costs – not expand wellness programs for which there is little to no direct reimbursement.

Hospitals and the Wellness Sham:

Furthermore, while hospitals and health systems may preach wellness, few offer comprehensive services designed to improve your health and well-being. Rather, they pay lip-service to this essential component of health care – viewing wellness more as a marketing opportunity than a true effort to do everything in their power to minimize unnecessary and costly utilization of their medical services.

There’s no surprise here, since the dominant reimbursement mechanism, fee for service, rewards the provision of medical services – not maximization of the health of a defined population. As a result, we pay a very dear price.

From Sick-care System to a Positive Health System:

It is possible to shift from a sick-care system that doles out interventions to manage the burden of chronic illness to a positive health system, focused on wellness/well-being system, that minimizes unnecessary utilization by focusing on population health. However, it would require tremendous will on the part of numerous constituents to achieve such a powerful transformation. 

Far short of transformational change, there are nonetheless small seeds of hope in the form of new, evolving reimbursement and delivery models, such as ACOs and medical homes that stress population health management. Unfortunately,  the pace of adoption is glacial. For providers who have been burned in the past by assuming risk for a defined population, there’s little enthusiasm for doing so again.

Our Role in Changing the System:

More than three decades ago, Jim Fries gave us one of the keys to healing American health care…a silver bullet. The question is whether we have the fortitude to change the health care paradigm, as well as accept the personal, stewardship responsibility for our health that is essential to success. If so, there’s a role for each of us to play:

Consumers/patients:  We need to understand what it means to be prudent stewards of our health, and the health of our families. It is essential that we understand the role lifestyle choices make in determining our health, and how we might combat risk-factors that imperil our future. For many of us, we will need to have access to resources that will aid in this journey – particularly if we are socio-economically challenged, and thus find lifestyle change all the more difficult. As has been well-demonstrated, the social determinants of health play a profound role in wellness and well-being.

Providers: Health care executives need to take the moral high-ground and do the right things for the communities they serve. One place to begin is with the development of a strategic wellness plan illustrating how wellness initiatives can be integrated into the very fabric of your hospital or health system’s care model. Once developed and implemented, you can then reasonably assert that you do everything possible to minimize unnecessary consumption of health care resources while maximizing the health and well-being of your patients.  

Insurers/Payers: There needs to be an unremitting pressure to partner more fully with providers on the assumption of risk for the health and well-being of a defined population…thus accelerating the demise of fee-for-service medicine, and its replacement with a reimbursement mechanism that rewards wellness.

Employers:  There needs to be broader adoption and implementation of wellness programs that incorporate proven mechanisms for elevating the health and well-being of an employed population. Such programs will likely involve potent incentives for lifestyle modification by those employees at risk. Expect the providers within your network to make two promises: 1) They will do everything in their power to help keep your employees healthy and out of their health system; 2) when medical care is needed, they will provide the highest value care as measured by agreed upon standards of quality, safety, and costs.

Government:  There needs to be dramatically increased spending on proven prevention programs that can be administered at a local, state, or federal level. Furthermore, there need to be greater rewards under governmental reimbursement programs for those providers who embrace risk and demonstrate their ability to reduce the morbidity of a defined population.

Out on a Limb:

Panacea, silver bullet, and transformational change – these are powerful, almost Pollyanna-ish words to use in a serious article about health system change. Yet I’m convinced that this change represents our path to salvation, if we are willing to make the arduous journey.

A blog will never do justice to a proper articulation of the wellness argument, but hopefully it is a start. I welcome your thoughts!