The medical profession oversells the benefits of drugs for chronic disease since so few patients would apparently take them if doctors divulged the truth.
The Actual Benefit of Diet vs. Drugs
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One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things, like mammograms and colonoscopies, to prevent deaths from breast and bowel cancer, or the power of drugs, like Fosamax, to prevent hip fractures, or the power of cholesterol-lowering drugs to prevent fatal heart attacks. Patients believe statin drugs, like Lipitor, are about a hundred times more effective than they actually are in preventing heart attacks. Most people wouldn’t take multiple blood pressure medications if they knew the truth, which raises a dilemma for doctors. Most patients want to be told the truth. They want to be told what the chances are that the drugs will actually benefit them, but there is this tension between the patient’s right to know and the likely reduction in patients’ willingness to take the drug if they were so informed. If taking a cholesterol-lowering drug would reduce your risk of getting a heart attack over the next five years by 100%, then, of course, everyone would take it. Even if there were a 50% chance of benefiting, most would still want to take the drugs. But if the chance of benefit is just a few percent, hardly anyone would be willing to take the drugs every day for the rest of their lives. And that’s the actual benefit.
For most people the chance of benefit is normally less than 5% over five years for cholesterol, blood pressure, and blood-thinning drugs. It’s no wonder that doctors seldom share these figures with patients. So, even high risk patients have less than a 5% chance of benefit; whereas, patients don’t want to take drugs unless they have at least a 1 in 5 chance—even those who just had a heart attack. The study therefore suggests that informing patients of the percentage chance of benefit from preventive drug strategies will substantially reduce the uptake of such drugs. They recognize that for the individual, this is unlikely to be detrimental; after all there’s a 95% chance it won’t do anything for them, but for the population at large, it would make a difference; so, doctors and drug companies tend to oversell the benefits by conveniently not mentioning how tiny they actually are, knowing that most patients wouldn’t take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.
The best cholesterol-lowering statin drugs can do here is an absolute risk reduction of 3.1% over six years. A whole foods plant-based diet has been shown to work twenty times better–an absolute risk reduction of 60% after less than four years. Overall, 99.4% of patients who stuck with the diet avoided major cardiac events, such as death from heart attack.
So, when we have to decide whether we want to go diet versus drugs, it’s not a choice between eating healthy to prevent a heart attack, or taking a pill to prevent a heart attack, because in 97% of cases the pills don’t do anything —we’re risking side effects for nothing, whereas if we treat the underlying root cause of the disease, by eating this healthy cholesterol-free diet, we may even reverse the progression of the disease. Stop eating an artery-clogging diet and our bodies can start dissolving that plaque away, opening up arteries, in some cases, without drugs and without surgery. This wasn’t an Ornish study; so, no exercise requirement, no meditation, no stress management, no yoga; just a healthy whole food plant-based diet may work twenty times better than drugs to combat our #1 killer. Now, that’s something doctors may want to tell their patients.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- B Hudson, A Zarifeh, L Young, J E Wells. Patients' expectations of screening and preventive treatments. Ann Fam Med. 2012 Nov-Dec;10(6):495-502.
- P Lytsy, R Westerling. Patient expectations on lipid-lowering drugs. Patient Educ Couns. 2007 Jul;67(1-2):143-50.
- P N Trewby, A V Reddy, C S Trewby, V J Ashton, G Brennan, J Inglis. Are preventive drugs preventive enough? A study of patients' expectatio n of benefit from preventive drugs. Clin Med. 2002 Nov-Dec;2(6):527-33.
- H Leaman, P R Jackson. What benefit do patients expect from adding second and third antihypertensive drugs? Br J Clin Pharmacol. 2002 Jan;53(1):93-9.
- C B Jr Esselstyn, G Gendy, J Doyle, M Golubic, M F Roizen. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.
Images thanks to Derek Gavey via Flickr.
One of the reasons people may undervalue diet and lifestyle changes is an overconfidence in the ability of pills and procedures to prevent disease. For example, people tend to wildly overestimate the power of things, like mammograms and colonoscopies, to prevent deaths from breast and bowel cancer, or the power of drugs, like Fosamax, to prevent hip fractures, or the power of cholesterol-lowering drugs to prevent fatal heart attacks. Patients believe statin drugs, like Lipitor, are about a hundred times more effective than they actually are in preventing heart attacks. Most people wouldn’t take multiple blood pressure medications if they knew the truth, which raises a dilemma for doctors. Most patients want to be told the truth. They want to be told what the chances are that the drugs will actually benefit them, but there is this tension between the patient’s right to know and the likely reduction in patients’ willingness to take the drug if they were so informed. If taking a cholesterol-lowering drug would reduce your risk of getting a heart attack over the next five years by 100%, then, of course, everyone would take it. Even if there were a 50% chance of benefiting, most would still want to take the drugs. But if the chance of benefit is just a few percent, hardly anyone would be willing to take the drugs every day for the rest of their lives. And that’s the actual benefit.
For most people the chance of benefit is normally less than 5% over five years for cholesterol, blood pressure, and blood-thinning drugs. It’s no wonder that doctors seldom share these figures with patients. So, even high risk patients have less than a 5% chance of benefit; whereas, patients don’t want to take drugs unless they have at least a 1 in 5 chance—even those who just had a heart attack. The study therefore suggests that informing patients of the percentage chance of benefit from preventive drug strategies will substantially reduce the uptake of such drugs. They recognize that for the individual, this is unlikely to be detrimental; after all there’s a 95% chance it won’t do anything for them, but for the population at large, it would make a difference; so, doctors and drug companies tend to oversell the benefits by conveniently not mentioning how tiny they actually are, knowing that most patients wouldn’t take them if doctors divulged the truth. To practice non-lifestyle medicine is to practice deceptive medicine.
The best cholesterol-lowering statin drugs can do here is an absolute risk reduction of 3.1% over six years. A whole foods plant-based diet has been shown to work twenty times better–an absolute risk reduction of 60% after less than four years. Overall, 99.4% of patients who stuck with the diet avoided major cardiac events, such as death from heart attack.
So, when we have to decide whether we want to go diet versus drugs, it’s not a choice between eating healthy to prevent a heart attack, or taking a pill to prevent a heart attack, because in 97% of cases the pills don’t do anything —we’re risking side effects for nothing, whereas if we treat the underlying root cause of the disease, by eating this healthy cholesterol-free diet, we may even reverse the progression of the disease. Stop eating an artery-clogging diet and our bodies can start dissolving that plaque away, opening up arteries, in some cases, without drugs and without surgery. This wasn’t an Ornish study; so, no exercise requirement, no meditation, no stress management, no yoga; just a healthy whole food plant-based diet may work twenty times better than drugs to combat our #1 killer. Now, that’s something doctors may want to tell their patients.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.
- B Hudson, A Zarifeh, L Young, J E Wells. Patients' expectations of screening and preventive treatments. Ann Fam Med. 2012 Nov-Dec;10(6):495-502.
- P Lytsy, R Westerling. Patient expectations on lipid-lowering drugs. Patient Educ Couns. 2007 Jul;67(1-2):143-50.
- P N Trewby, A V Reddy, C S Trewby, V J Ashton, G Brennan, J Inglis. Are preventive drugs preventive enough? A study of patients' expectatio n of benefit from preventive drugs. Clin Med. 2002 Nov-Dec;2(6):527-33.
- H Leaman, P R Jackson. What benefit do patients expect from adding second and third antihypertensive drugs? Br J Clin Pharmacol. 2002 Jan;53(1):93-9.
- C B Jr Esselstyn, G Gendy, J Doyle, M Golubic, M F Roizen. A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.
Images thanks to Derek Gavey via Flickr.
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The Actual Benefit of Diet vs. Drugs
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Content URLDoctor's Note
Yes, an ounce of prevention is worth a pound of cure, but a pound isn’t that heavy—why change our diet and lifestyle when we can just wait and let modern medicine fix us up? Turns out we overestimate the efficacy of treatment as well, the subject of my next video: Why Prevention is Worth a Ton of Cure.
Sometimes preventive medicine procedures can even be harmful. See Cancer Risk From CT Scan Radiation and Do Dental X-Rays Cause Brain Tumors?
I’ve previously noted how an honest physician-patient interaction might go in Fully Consensual Heart Disease Treatment. What should we be saying? See: What Diet Should Physician’s Recommend?
So why don’t more doctors do it? See Barriers to Heart Disease Prevention.
More on Dr. Esselstyn’s heart disease reversal study in: Evidence-Based Medicine or Evidence-Biased?
Of course, then there’s just the brute force method: Kempner Rice Diet: Whipping Us Into Shape.
In 2018, I published a series that starts with What Is the Optimal Diet? Check it out!
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